Our spine is formed with bones called vertebrae connecting to each other. These bones are linked with a “disc” and two “facet joints”. Discs have important roles such as spine movements, spine flexibility, distribution of the load regularly on the vertebrae and spine and shock absorption and distribution as well as connecting the vertebrae. The main aim of all these structures is to protect biomechanics of the spine and the spine passing through spine channel. Discs consist of two layers. Exterior parts have a rigid and thick structure. This part is called “annulus fibrosus”. The inner part has soft and water-based cartilage (similar to jelly) structure and is called “nucleus pulposus”. The exterior layer surrounds this part as a capsule. Structure of exterior rigid layer deforms due to various reasons. As a result, exterior layer ruptures and the soft part (nucleus pulposus) protrudes and may compress the spine and/or nerve roots spreading to the body from the spine. Sometimes, the exterior rigid layer does not rupture by loses its rigid structure. In this case, the inner soft layer pushes the exterior layer and compresses the spine and/or nerve roots. These two conditions are called “herniated cervical disc”. “Protruded herniated cervical disc” known by the public is the type that occurs with the rupture of exterior part. However, in that case, the important part is the compression exposed by the spine and both types can be called “herniated cervical disc”.

WHAT ARE THE RISK FACTORS OF HERNIATED CERVICAL DISC?

As the discs get wear by age, the risk of herniated cervical risk increases. Because the fluid in the discs between the vertebrae reduces by age and the structures deform. During a sneeze, the pressure increases in the abdomen and head, and it reveals the problems existing in the body previously. A herniated disc, herniated cervical disc cases that may occur by lifting heavy load or dıe to any trauma, may also occur due to sneeze or cough. Staying in the same position for a long time, continues use of computer and wrong standing stimulate herniated cervical disc. Those who work with the computer for a long time may experience herniated cervical disc as they look at a single point. Instant movement is a very important factor for the herniated cervical disc. During a traffic accident, when the neck moves back and forward, permanent and significant problems may occur. Except for traffic accidents, any kind of hitting to the neck is an important factor. For women, works such as needlecraft, cleaning, hanging curtains, wiping windows may cause neck pain to increase. In particular, housewives lift a heavy load, push, pull and work by stretching out. As a result of these movements, firstly neck pain, then herniation occurs. Sports such as basketball, volleyball, and pike may cause herniated cervical disc. Due to some reasons such as dropping asleep on the couch, herniated cervical disc may occur as the neck falls to one side in an uncontrolled way. An unsuitable bed and pillow may cause a herniated cervical disc. Smoking causes vein narrowing and leads to low blood. This condition leads to nutrition deformation in the tissues and causes herniated a cervical disc. A life lack of exercise and sports causes the muscles to weaken, and to load the weight which should be carried by the muscles on the spine and discs, and this condition leads to herniated cervical disc. In addition, the herniated cervical disc may be seen in those who do not have the above-mentioned factors.

IS EVERY NECK PAIN, HERNIATED CERVICAL DISC? WHAT ARE THE SYMPTOMS OF HERNIATED CERVICAL DISC?

Most of the people having Neck pain firstly suspect of herniated CERVİCAL disc. However, as in low back pain, neck pain also has many reasons rather than a herniated cervical disc. The most common reasons for neck pain include wrong movement, unsuitable sleep position, working in a stable condition for a long time, exposure of back and neck areas to the cold. In addition, loss of cervical lordosis causes neck and back pain. Also, there are many diseases that may cause neck pain. Cardiac diseases, tumors located in the upper part of the lungs may cause similar complaints. The herniated cervical disc has specific symptoms. As the nerves spreading to the arms are compressed, pain radiating to one or both shoulders/arm/hand, numbness in arms/hands, neck movement restriction, pain radiating from nape to occiput, chest and back, power loss in hand or arm muscles, inability in hand skills (button-up, writing), grasping difficulties (falling the objects from hand), weakening in hand/arm muscles. If the herniated cervical disc gets severe, it may spread to the legs. Symptoms such as numbness in the legs, imbalance, stiffness in the legs, bladder problems, inability in walking may be seen. While a reason of neck pain may be a simple muscle spasm, it may have a more significant reason. Even though the most common reason of neck pain arises from muscle-joint and and it can be treated with non-surgical methods, if you have neck pain (chronic neck pain) complaint for at least 3 months, you should be examined by a physician.

HOW IS HERNIATED CERVICAL DISC DIAGNOSED?

The most reliable diagnosis of herniated cervical disc is made with an examination carried out by a physician. In that case, complaints of the patient and examination findings are the most important diagnosis criteria. The examinations for final diagnosis are MRI (the most common one) 7 computed tomography, x-ray and EMG (electromyography). If the physician gets suspect of herniated cervical disc due to patient’s complaints and examination findings, s/he may request these examinations, if s/he thinks that findings do not require surgical intervention, s/he may not request examination, s/he may follow the process or may direct the patient to another branch. Each neck pain case or herniated cervical disc suspect does not require advanced examination.

HOW ARE THE HERNIATED CERVICAL DISC CASES NAMED?

Discs and accordingly herniated cervical disc are named according to their vertebrae. There are 7 cervical vertebrae in our body. These are named as C1, C2, C3, C4, C5, C6, C7 from top the the bottom (C=Cervical Undermost cervical vertebra (C7) is followed by thoracic vertebra (T1). Discs are named according to the vertebrae between which they locate (for example C5-6 disc). Herniated cervical disc cases are named according to the disc in which they occur (e.g. C5-6 herniated cervical disc or C5-6 disc herniation).

WHAT ARE NON-SURGICAL TREATMENT METHODS FOR HERNIATED CERVICAL DISC?

Early Stage: Treatment of herniated cervical disc is depending on the severity of compression of herniation on the nerves. If there is just neck and/or back and/or arm pain and there is not any insensibility, significant power loss, leg findings, bladder problem, it means that herniated cervical disc is at early stage. In that case, the patient is recommended pain killer, edema healer and myorelaxant medication on nerve root, use of neck collar for a short time, bed rest and avoiding movement forcing the neck, use of suitable bed and pillow, when the pain decreases, slight neck exercises. If the herniated cervical disc gets severe: If the complaints lasts despite the above-mentioned recommendations, physical treatment can be applied. Physical treatment should be supervised by a specialist. During physical treatment, the pain may increase in the first a few days, but the patient should continue the treatment. Despite the all treatment, if the pain of the patient does not stop, spinal injection treatment or “nucleoplasty” may be applied. Nucleoplasty is based on heating the disc, destroying the nerves in the disc and collapsing the herniation by opening the space in the disc with radiofrequency waves by entering with a needle to the herniated cervical disc under x-ray in severe herniated disc cases. Nucleoplasty is carried out in one session under local anesthesia without anesthetizing the patient completely under hospital conditions and it does not require hospitalization. It has very low risk, however it does not guarantee to treat the herniation completely and success rate is not very high. In addition, it may not be applied for every type of herniated cervical disc. Also, traction, manual treatment, laser treatment for the skin and ozone therapy, which are not proved to be superior to rest, medication and physical treatment can be applied. In the event that these treatments are carried out in an unconscious and uncontrolled way or if the time is lost with these treatments while the patient is required to be operated immediately, unrecoverable problems may occur.

WHEN IS THE OPERATION CARRIED OUT FOR HERNIATED CERVICAL DISC?

SHOULD THE OPERATION BE CARRIED OUT IMMEDIATELY?

If the patient still has complaints despite the above-mentioned treatment of which effect is medically proved, if this pain restricts social life of the patient, if there is significant sensation loss in arm and/or legs, significant power loss, myloysis, bladder problem, difficulty in walking, the compression on the nerves should be removed with operation. If the patient experiences urinary incontinence, power loss in hand, arm or legs, imbalance, inability in walking, starting instantly and gets severe within days or even hours, immediate surgery is required. These findings show that compressed nerve cells are about to die (or even dead). In that case, even hours are essential for the intervention. Otherwise, the patient may remain paralyzed for life long.

WHAT MAY OCCUR IF I DO NOT UNDERGO OPERATION?

Some cells in our body cannot rejuvenate themselves after they died. Nerve cells are this kind of cells. Therefore, paralyze or spine injuries may cause permanent damages. The actual problem of herniated cervical disc is the compression of and damage to the spine or nerves spreading from the spine to the body. In case that the patient does not undergo operation in time, power loss, sensation loss, urinary incontinence, burn-tingling in the arm-legs, and difficulty in walking may be permanent. Unfortunately, there are some misbeliefs such as “if I undergo operation, I become permanently disabled, I cannot get up for a long time, I have to use neck collar or my herniation reoccur and I have to repoperated” in the public. With new operation techniques and devices, these concerns are not true any more. In cases requiring operation, if the patient does not undergo operation, the problems may be bigger.

HOW IS HERNIATED CERVICAL DISC OPERATION CARRIED OUT?

Herniated cervical disc surgery is divided into two as anterior and posterior interventions. Anterior or posterior type is determined by the neurosurgeon after your examination, radiological examinations (MRI). In this decision, location of the hernia and experience of the surgeon are very important factors. For anterior interventions, right side of the neck is used generally. After a 4-5 cm incision is made, subcutaneous tissue and following superficial muscles are passed and it is advanced through neck muscles until carotid artery is seen.

To reach the spine, carotid artery is pushed outside and esophagus and trachea are pushed inside, and cervical spine is reached with special ecartors. To determine the location of the vertebrae to be operated, x-ray is taken during operation and operative site is confirmed. Afterwards, ecartors are placed. After this stage, the procedure carried out under microscope is microdiscectomy.After this approach, prosthesis or bone is placed to fix the both vertebrae instead of removed disc.

Afterwards, operation distance is controlled with x-ray once and after bleeding control, incision is sutured to that sutures are not required to be removed and the operation is terminated. Posterior method is carried out in limited number. If the hernia is not at mid line and the nerve root arising from spine is at the opening of the foramin, posterior method is recommended.

AFTER HERNIATED CERVICAL DISC SURGERY

• Depending on the surgeon’s opinion, the patient can be rise 2-3 hours after the operation, 8 hours after the operation or next morning.
• Generally, the patient is discharged within the first 24 hours.
• You can go home sitting in a vehicle
• You can do daily simple activities at home.
• After the operation, wear clothes which can be opened from front side.
• For the first week (sometimes longer), the patient may feel difficulty while swallowing, jamming sensation in the throat.
• The problem is the edema in the esophagus.
• For this reason, consume soft foods for the first 3-4 days.
• Hoarseness is generally temporary, but sometimes it may last for 3 months.
• Permanent hoarseness is very rare.
• For the first a few days, you may complain of pain, burning feeling and stinging in the incision area in the neck.
• By time, first the pain stops.
• It may take a while to get rid of complaints such as numbness, tingling.
• Neck collar may be recommended depending on surgeon’s opinion.
• While discharging, unless otherwise stated, should not continue to use medicine when your medication finishes.
• Pay attention that your bed and pillow is suitable for neck health.
• For sleep, use your bed.
• After the operation, go for control examination as stated.
• There is no need to remove the sutures.
• Sometimes, it may be required to make sutures outside, in that case sutures are removed on 7th day.
• If you have redness, swelling, discharge on the incision, call your physician.
• If you are recommended to use neck collar, stop using it after first 15 days.
• However, for the first 3 months, use the collar during travel and pay attention that seat squab is at the same level of your head.
• When you are discharged after the operation, you can get out.
• If you have an office job, you can start to work after 3 weeks – 1 month.
• But, those working in heavy works should rest for 6 weeks.
• For the first 6 weeks, do not carry load more than 1 kg.
• After 1 year, pay attention to not to carry load more than 7 kg.
• Do not drive for 6 weeks after operation.
• You can take short flights.
• However, do not fly across ocean for the first 3 months.
• For the first 4 months, do not exercise sports requiring contact.
• Just exercise jogging.
• Afterwards, you can start sports activities which do not require contact.
• The most recommended sports activity is swimming.
• Complete healing period is after 4 months.
• In that period, you can do many activities, as it is in your healthy period.
• After you get back to daily life, continue to do recommended exercises and if possible to swim.

DOES HERNIATED CERVICAL DISC REOCCUR?

In anterior interventions, recurrence is not possible as the disc is removed. In posterior interventions, herniation may reoccur as just herniated part is removed. Also, it should be noted that new herniation may occur in other discs.