The pain from a cervical herniated disc can usually
be controlled with medication, and conservative (non-surgical) treatments
alone are often enough to resolve the condition.
Treatment is designed to resolve the pain initially, and the weakness,
numbness and tingling will go away over time. Once the pain starts
to improve it doesn't usually return. It may be a little while before
the other symptoms go away, but if the pain is under control there
is no reason to move to a more aggressive (surgical) treatment, as
there is no evidence that surgery helps the nerve root heal any faster.
However, for patients with profound weakness due to a disc herniation,
it may be reasonable to consider surgery earlier to give the nerve
the best healing position (e.g. to relieve the pinching).
Conservative treatments
Generally, treatment will begin very simply with rest and medication.
Anti-inflammatory medications such as ibuprofen (e.g. Advil, Nuprin
or Motrin) or COX-2 inhibitors (e.g. Bextra or Celebrex) can help
reduce the inflammation of the disc material, which will help reduce
the amount of pain. If pain is severe, or continues for more than
two weeks, stronger medication such as oral steroids may be considered.
While the medications diminish the amount of pain, if the condition
doesn't resolve on its own, there are several options that can be
considered:
-
Physical
therapy for exercises to help relieve the pressure on the
nerve root
-
Chiropracticor osteopathic treatments for gentle,
low velocity manual manipulation to help relieve the pressure on
the nerve root. However caution should be used with manipulation
if the patient is experiencing any neurological problems.
-
Manual traction to help open up the cervical foramen where
the nerve root exits the spinal canal. If this therapy helps relieve
the pain, a home traction unit can be prescribed. Traction should
be initiated under a physical therapist's supervision.
-
Epidural injections may be considered if the pain doesn't
get better with medication and physical treatments. Epidural injections
effectively relieve pain approximately 50% of the time, and if
they do work they may be repeated every two weeks up to a total
of three times within one year.
Surgical treatments
Most episodes of pain from cervical disc herniation will be taken
care of with 6 to 12 weeks of conservative treatment. However, if
it doesn't get better in that time or if the pain is very severe,
surgery may be considered. The success rate for using surgery to
relieve arm pain from a cervical disc herniation is about 95 to 98%.
Risk of complication is low with an experienced spine surgeon.
The disc may be removed from the back of the neck (posterior approach)
or from the front (anterior approach). Generally, surgeons prefer
the anterior approach for most cervical disc herniations.
- Anterior approach—This approach may be favored
if there is any disc space collapse, as the approach allows the
surgeon to open up the disc space and place a bone graft to keep
it open. This procedure opens up the foramen, which gives the exiting
nerve root more room.
- Posterior approach—This approach may be favored
for a large soft disc that is lateral (to the side of) the canal.
This approach is technically more difficult than the anterior approach,
and also requires more manipulation to the spinal cord.
Both surgeries can usually be done with an overnight stay in the hospital. |
