Anatomy
The neck is made up of box-shaped vertebrae that are held in place partly by the shape of the bones and partly by ligaments and muscles. Interspersed between the vertebrae are cartilage discs (disci) that act as shock absorbers. The discs are close to the spinal canal, from which nerves run to the arms.
The back from the side:
A. Vertebra prominens
B. Vertebra coccygea I
C. Promontorium
D. L I
E. Th I
F. Axis
Cause
Herniated discs in the neck can occur after a single trauma, but are most often the result of long-term, gradually developing wear and tear changes in the disc. When the disc is damaged, the liquid contents in the centre of the disc (nucleus pulposus) can squeeze out and press on a nerve root. Herniated discs in the neck account for only 5% of all herniated discs.
Symptoms
Pain and stiffness in the neck radiating to one of the arms. Reduced mobility in the neck. There may be sensory disturbances, loss of strength and paralysis in the arm. Often aggravated by coughing.
Examination
If the injury occurs acutely after a direct trauma, the strategy is to prevent movement in the neck until the injured person has been medically examined (possibly in hospital). This is to avoid aggravating the injury if the cervical vertebrae are fractured.
If you suspect a herniated disc, you should contact your doctor, who will be able to determine the diagnosis and what treatment should be initiated through special examinations (extent of sensory disturbance, muscle weakness, reflexes, foramen compression test). Usually supplement with an MRI scan if treatment is not progressing as planned.
Treatment
If the doctor finds signs of a herniated disc without alarming symptoms (significant
muscle weakness/paralysis), treatment will primarily consist of a few days of relief and then rehabilitation to restore mobility and strengthen the neck and neck muscles. The patient should also be informed about prognosis, pain mechanisms and appropriate behaviour and pain management (including ergonomic guidance).
The vast majority of patients with herniated discs improve after rehabilitation. If the above treatment fails to improve, an MRI scan and possibly surgery will be considered. Surgery is only considered if rehabilitation is unsuccessful. In case of alarming symptoms (significant muscle weakness/paralysis), emergency hospitalisation is advised to assess the indication for emergency surgery. Long-term results after conservative and surgical treatment of herniated discs are largely similar with a duration of 2-3 months.
Especially
Training should be ‘lifelong’ to reduce the risk of relapse after successful rehabilitation. Tobacco smoking increases the risk of back pain by reducing the blood supply to the cartilage discs (disci) so that everyday injuries do not heal as well. Smoking cessation is therefore an important part of treatment
