The incidence of cervical hernia is close to that of lumbar hernia. Cervical hernia has some important differences from lumbar hernia. The most important of these differences is that where the cervical disc herniation occurs, there is the spinal cord itself and the nerves going to the arm. However, at the level of the herniated disc, there are only nerves going to the legs, not the spinal cord. Therefore, in a herniated disc, only the nerves going to the legs and the tissue surrounding these nerves, which we call dura, are under pressure, whereas in a cervical herniation, the spinal cord itself and the nerves going to the arm are under pressure. In both cases, there may be central pain (waist-neck) and extremity pain (pain radiating to the arms and legs).
When there is only spinal cord compression in a cervical disc herniation, sometimes there may be no pain. Although the exact reason for this is unknown, it is not a very rare condition. In this case, spinal cord pressure can progress silently and cause serious and permanent neurological damage, even walking difficulties and paralysis. When pressure permanently damages the spinal cord, a serious condition we call myelopathy occurs. Initially, the symptoms are vague and patients often do not understand anything. There may be subtle pulling, contraction, and very slight disruption in walking, especially in the legs. This can make diagnosis very difficult in painless cases. Sometimes, since these cases may be young, it may be overlooked that the complaints may be due to height, and time may be wasted by investigating other diseases. At this stage, if diagnosed at an early stage, myelopathy can return with treatment. Otherwise, permanent loss of strength, difficulty in walking, or even serious paralysis may occur. To give an example, in the last year, I sent three patients for surgery due to cervical disc herniation and myelopathy, without any complaints of pain. These cases had no pain. One of them was a 50-year-old patient who had not been diagnosed for almost a year. He only had a slight difficulty in walking. The diagnosis could not be made because there was no neck or arm pain and the patient was relatively young for myelopathy. The other was a 43-year-old patient whom we followed due to cervical disc herniation and significant compression on the spinal cord. We detected myelopathy in follow-up MRIs, even though he had no complaints. The other, unfortunately, was an elderly patient in a wheelchair. Severe myelopathy developed without any neck complaints and was placed in wheelchair.
If a patient has a detected hernia or serious spinal cord compression due to calcification or canal stenosis, the patient should be monitored with serial MRIs (usually once a year) even after the treatment is completed and the pain has completely disappeared. In critically ill patients, SEP examinations, which check the spinal cord sensory pathways, and MEP examinations, which monitor the movement pathways, should also be performed annually. These electrophysiological tests can detect deterioration in spinal cord functions even before the MRI image changes. Thus, it may be possible to make an early diagnosis. In myelopathies, which progress without any symptoms before, there is not much that patients and doctors can do except be more careful.
With conservative, that is, non-surgical treatments (physical therapy, traction, ozone and cortisone injection in the neck, etc.) part heals. Myelopathy occurs in a very small number of cervical hernias (less than 1%). Whether the cause is calcification or hernia, myelopathies are usually treated surgically. However, not all myelopathy requires surgery. A myelopathy that does not show clinical signs in a very old patient can be monitored with conservative treatment methods. Here, the patient's possible risk-benefit ratio should be considered when making a surgical decision. As in almost every disease, early diagnosis of myelopathies due to canal stenosis in the neck is extremely important to prevent permanent damage. Patients who have complaints such as weakness and difficulty walking as sequelae after the surgery can only regain their former health with a physical therapy and rehabilitation program.
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