Cervical herniation is a result of the displacement of the cartilage structure called the disc, located between the cervical vertebrae, towards the spinal canal and the nerve roots emerging from the spinal canal; It is a disease caused by pressure on the nerves going to the shoulder, arm, between the shoulder blades and the spinal cord. Cervical vertebrae are the smallest and weakest vertebrae of the spinal system. It is easily affected by acute and chronic traumas, occupational strains, and posture disorders. The muscles most affected by stress-related muscle spasm are in the cervical spine. Although the neck does not carry a heavy load like the waist, it is the most mobile part of the spine. Cervical vertebrae; They can make forward, backward, right, left and sideways and combined movements. The neck is the part of the spine that is most commonly herniated after the waist.
Posture disorders, leaning forward, constantly working in front of the computer, sports performed in uncontrolled and bad positions, excess weight, large breasts, inappropriate bras, microtraumas applied to the neck. Long-term and repetitive lifting, stress, and stress cause more people to suffer from cervical disc herniation and other neck pains today.
Neck Anatomy
Neck, head. It provides the connection between the body and the body. The neck supports the head and keeps it in a balanced position. It allows the head to move easily in many directions. The neck is the carrier and supporter of the vital vessels that feed the brain, the trachea and the esophagus.
There are 7 vertebrae in the neck. The first vertebra is called the atlas, and the 2nd cervical vertebra is called the axis. There is no disc between the atlas and the skull base, or between the atlas and the axis. There are discs between the 2nd vertebra (axis) and the 3rd cervical vertebra and between the other cervical vertebrae. Discs are actually jelly-like cushions that prevent the vertebrae from rubbing against each other. Discs provide the flexibility of the spine and the shape of the spine. The core part of the discs in the cervical spine is slightly anterior. Therefore, the front part of the discs in the cervical spine is higher than the back. This condition contributes to the cervical spine being shaped like an inverted C with the opening facing backwards. The most important function of the discs is to transmit the amount of load on them to the lower levels in a balanced manner.
The cervical vertebrae are held together by discs and strong ligaments. This system gains flexibility and strength with the muscles. The shape of the cervical spine also keeps the cervical spine healthy and strong. If the axis of the neck is disrupted, as is the case with posture disorders, its durability decreases and it becomes prone to injuries.
The spinal cord passes through the canal in the cervical spine. The spinal cord, 2 cm thick, is an extremely important structure that transmits the orders it receives from the brain to the whole body. In a way, it is an extension of the brain. The nerve roots leaving the cervical spine are also very close to the spine.
In the neck; The nerves coming out of the spinal cord provide shoulder, arm and hand movements, feeling and strength.
A healthy neck is a balanced neck. The cervical spine has a natural curve to maintain this balance. Maintaining this slope is very important for a comfortable and pain-free neck. If this slope is disrupted, degeneration and deterioration begins in the cervical spine. The most important cause of neck, shoulder and arm pain is the deterioration of this curvature.
The structure of the intervertebral disc;
The structure we call the intervertebral disc is briefly called the intervertebral cushion. . In addition to being a joint between the vertebrae, it has the function of absorbing the load on the vertebrae.
The disc consists of three parts.
Cartilage tissue (end plate, end plate); It is a cartilage structure that rests entirely on the lower and upper vertebrae and is as wide as the entire spine. It limits the core part between both vertebrae.
Connective tissue (annulus): It is a strong structure that surrounds the core part in the middle. This elastic connective tissue is strongest in the front part of the spine, and weaker in the back part where the spinal cord and nerves are located, and especially on the sides. Therefore, herniations occur towards the back and to the side.
Nucleus: It is a jelly-like structure with a high water content. Together with the elastic connective tissue surrounding it, it absorbs the load on the spine.
How does a cervical hernia occur?
In a cervical hernia; We call it a hernia when the part we call the core bulges or tears the elastic part we call the connective tissue, causing pressure on the spinal canal and nerve roots. In the initial phase, the core of the disc slightly balloons the outer fibers of the disc (annulus fibrosis) towards the nerves. The stage is called bulging, then this ballooning increases (herniation), and in the most advanced stage, the outer fibers of the disc tear and the nucleus bulges outwards. This stage is called extrusion (overflow) or fragmentation (free particles). Patients with cervical disc herniation may also have hernias at different stages. Calcification is a healing process of cervical hernia.
Pain in cervical hernia
Not every cervical hernia causes pain. Sometimes, while there is mild pain in advanced cervical disc herniations, there may be much more severe pain in mild cervical disc herniations. Most patients with cervical disc herniation describe pain that occurs upon getting out of bed, without any recollectable trauma or stress. Neck movements are painful and limited. Moving the neck backwards usually increases the pain. The pain is partially relieved when the arms are raised and the head is taken behind the head. There is a pain in the neck, usually affecting the arms on one side, and the pain may radiate to the head and between the shoulder blades. Not every pain in the neck and shoulder area and radiating to the arms means a cervical disc herniation. However, many diseases that cause neck pain cause similar complaints. Sometimes, even most of the time, patients may experience neck calcification, neck axis disorders, slight neck misalignment, which we call subluxation, and neck canal stenosis. A cervical disc herniation, which normally does not cause pain, may manifest itself as severe pain as a result of stress and abnormal loads. Occupational strains that cause cervical disc herniation can also cause diseases such as tears, tendonitis and impingement in the shoulder girdle muscles, causing both neck and shoulder pain. In this case, it may be difficult to understand whether the pain felt in the shoulder is due to the neck or the shoulder itself.
How to make the diagnosis;
If necessary, in addition to plain x-ray examination, It may be necessary to have an MRI examination of the cervical vertebrae and an EMG of the nerves.
Which diseases can a cervical disc herniation be confused with?
Neck stiffness, muscle spasm; strong> It usually occurs with excessive stretching of the muscles that support the neck. Lifting something heavy, excessive sports, work activity, and improper desk work may cause muscle spasm. Also, don't sleep in the wrong position, don't use a high pillow. and bad travel conditions can also cause neck stiffness. Stress is the most important reason why stiff neck and neck diseases that normally do not cause pain cause neck pain.
Poor posture and misuse of the neck
Suitable for neck health in daily life. every wrong movement and posture; It causes wear and tear in the vertebrae, discs, joints and connective tissue. This situation is especially common in those who sit at a desk, students who are preparing for exams, those who use keyboard devices, and those who do a lot of manual work. The loss of the natural lozdoz (neck hollowness) in the neck is the most important finding of neck abuse. This condition is seen on x-ray as a flattening of the neck axis. This situation paves the way for neck herniations and osteoarthritis (calcification).
Degeneration and calcification in the disc;
As a result of advancing age and misuse of the spine, the bone structure, ligaments and The discs begin to wear out. The gel-like disc hardens, loses its flexibility, and its height decreases. Calcifications develop in the soft tissues around the spine. The newly formed ossicles, hardened ligaments and narrowed disc spaces can put pressure on the nerves and cause neck, arm and general body pain. Muscles that contract due to chronic pain may cause the situation to become more severe. Numbness and weakness may occur in the hands and feet due to spinal cord compression. Its treatment is similar to that of a cervical disc herniation.
Tension, stress, smoking:
The most important reasons that increase and chronicize neck pain. Economic, social and psychological problems increase neck pain. Constant tension in the neck brings the vertebrae closer together, causing pressure on the discs. Laughing, traveling, working regularly, social activities and commitment to life reduce the severity of neck pain. Smoking impairs the nutrition of the discs, and chronic cough due to smoking increases the intra-disc pressure.
Narrowing of the spinal canal (cervical stenosis, cervical spondylitic myelopathy):
Especially advanced Numbness in the hands, weakness and clumsiness, difficulty in walking, and sensory deficits in the hands and feet may be observed at different ages. Pressure on the spinal cord as a result of narrowing of the channels through which the spinal cord and/or nerves pass It depends on. Early detection of the disease and early treatment is necessary. It is due to previous traumas, unsuccessful surgical interventions, advanced hernias and extreme spinal degenerations.
Rheumatic diseases;
Rheumatic diseases such as rheumatoid arthritis and anclosing spondylitis cause permanent neck movements. may cause limitations. Joint stiffness and limitation of movement lasting more than an hour in the morning are common in rheumatic diseases.
Entrapment (compression) of the arm and hand nerves;
Nerves originating from the spinal cord in the neck. As it moves towards the hand, the nerve is compressed by various tissues on its path. As a result of compression here, weakness, numbness and pain may occur in the hands and arms. Numbness seen at night, especially in the first 3 fingers of the hand, is typical for wrist canal nerve compression syndrome. In thoracic outlet syndrome, there may be pain, numbness, tingling and swelling on the little finger side of the hand. Again, jams on the little finger side of the hand may be due to ulnar groove syndrome. There are many other impingement syndromes like these in the upper extremity. Impingement syndromes can also be seen together with neck diseases. EMG should be performed in such cases of pain and numbness.
Other causes;
Cervical spine and spinal cord tumors, tumor metastases and Syringomyelia, which forms cysts in the spinal cord, and multiple sclerosis disease. , ALS, bone infections (tuberculosis, brucellosis) can also cause neck and arm pain.
How should the treatment be?
Nerve root compression due to cervical disc herniation. The majority of patients recover without requiring surgical treatment. Treatments such as resting the cervical spine, paravertebral point injections, physiotherapy, hot and cold applications, IMS, neural therapy, and prolotherapy, alone or in combination, provide improvement in many patients. These treatments can also be used successfully in cases of recurrence or pain that persists after surgical treatment. Surgical treatment can be performed in patients who do not respond to treatment, have progressive neurological deficits, and have large hernias on imaging.
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