by Jeffrey R. Carlson, MD
Patients often ask me for a recommendation of the best treatment options for their herniated disc in the neck. In this article, I will discuss how I arrive at these recommendations, based on neck anatomy, specific criteria and the conditions unique to each patient.
The cervical spine (neck) has 6 discs made of cartilage that provide the cushion and mobility for the bones in the neck. Being soft (somewhat like a jelly doughnut), sometimes these discs can rupture and pinch the nerves which exit from the spinal column. The nerves in the neck are those that give function, sensation and pain responses in the arms. Patients will often have severe pain in the neck or arm with even small amounts of disc rupture.
The difference in the neck and the lower back discs is how closely they sit next to the nerves. In the cervical spine, there is not a lot of room between the discs and the nerves because of the size of the spinal canal and the presence of the spinal cord. In the lumbar (lower back) spine, there is more space between the discs and the nerves and there are fewer nerves in the spinal canal which can be compressed. Those nerves in the very lowest part of the spinal canal spread out like a fan when the spinal cord ends, which allow them to move away from the discs if they rupture, as they have some mobility.
In general, there are 3 options for treatment of cervical spine disc herniations. These include: 1) medications (either pills, creams or steroid injections); 2) manipulation (physical therapy or chiropractic care); or 3) surgery to remove the disc and relieve the pressure on the nerves.
Usually, surgery is thought of as a last resort; however, a new (July 2017) study from Rush University Medical Center in New York, suggests that surgery on cervical disc herniations will lead to significant reductions in neck and arm pain very quickly after surgery. This study was done in patients that had one or two levels of disc rupture in their neck who needed surgery. The pain reduction makes sense, in that the pressure is relieved when the disc is removed and the nerve can then stop hurting and return to normal.
An easy analogy to understand is this: think of it as having a splinter in your finger or foot. Yes you can live with it, you can cover up the pain and irritation with Advil and Alleve, you can wait for the next several weeks for the body to heal around the splinter or wait for it to become infected and get much worse. Most of us would choose to remove the splinter right away, because we don’t want to be bothered with it later. In the same way, our bodies will heal most injuries, including disc herniations, but the fastest way to feel better and return to normal is to fix the problem surgically.
Cervical spine fusions are now routinely done as outpatient procedures, meaning patients go home a few hours after the surgery. With improved minimally-invasive techniques in fusion surgery, the procedure is much less traumatic and decreases the need to keep the patient in the hospital. Great strides have been made in the area of Anesthesia, providing effective pain management and nausea control to help patients with the side-effects of the medications used in surgery.
The Hospital for Special Surgery has recently agreed (Spine, July 2017) that one and two level cervical fusions can be done safely as outpatient procedures. Over 4,000 patients, included in their study, did not have any higher risk or complication rates than patients that had in-patient surgery.
Surgery on the neck is never taken lightly and all options should be discussed thoroughly with your fellowship-trained spine surgeon, prior to making your decision. Together, you can plan for a successful surgery and recovery.