Cervical spine
Cervical spine pathologies are conditions that appear in the neck area although they can cause pain in the upper back pain area or pain radiating towards the shoulder and hands.
A cervical disc herniation, or herniated disc occurs when the discs and accompanying ligaments in the spine are intact, but a protrusion may form that presses on the spinal nerves. This condition causes pain in the neck, shoulder and arms. Typically, symptoms include a dull or sharp pain in the neck or shoulder. Sometimes, the pain may radiate along the arms to the hands and even to the fingers. In addition, a tingling sensation and numbness may be felt in the fingertips. This condition may develop in people of different age groups, especially in the age group between 30-50 years.
diagnosis
The diagnostic process includes a physical examination, evaluation of symptoms and medical history, and a neurological examination. A computed tomography (CT) scan or magnetic resonance imaging (MRI) scan may then be recommended to evaluate the disc damage.
care
Both surgical treatment approaches and non-surgical (conservative) treatment approaches are accepted for the treatment of cervical disc herniation, depending on the symptoms and findings during the examination.
Conservative treatment methods include drug therapy such as anti-inflammatory drugs (NSAIDs), and muscle relaxants as well as pain relievers. Physical therapy treatments including massage, stretching exercises and neck stretching can be recommended. In most cases, these treatment measures may relieve the pain in about 4-6 weeks.
If the condition does not allow treatment with conservative approaches such as in turtles with significant pressure on the spinal cord, or in case of failure of conservative treatment, surgical treatment may be necessary. A herniated cervical disc can be repaired by discectomy or laminotomy. These spine surgeries can be done using a minimally invasive method that involves smaller incisions and tiny instruments.
Cervical disc herniation
Cervical radiculopathy, also known as "pinched" nerve, is caused by damage to the root of a nerve in the spine. It is characterized by neck pain radiating to the shoulder and arms. As we age, the discs in the column lose height, lose their elastic properties and may form bulges, the vertebrae come closer to each other and the disc collapses and creates bone spurs to stiffen the spine. In this process, the bone spurs, or osteophytes, narrow the holes through which the roots exit the spine and pinch the nerve root.
The pain caused by this condition is sharp and may even be felt like a pin or needle. The pain may worsen with extension movement of the neck or turning the head.
diagnosis
The diagnostic process includes a physical examination, evaluation of symptoms and medical history, and a neurological examination.
Computerized tomography (CT) or magnetic resonance imaging (MRI) and sometimes even an electromyelography (EMG) test are usually performed afterwards.
care
Cervical radiculopathy is often treated with non-surgical (conservative) treatment methods such as physical therapy, pain medications, anti-inflammatory drugs, or steroid injections injected into the spine. If conservative treatments fail or if the condition worsens, surgical treatment may be required. The purpose of the surgery is to create space for the compressed nerves, maintain the stability of the spine and provide a correct position for the spine. The three types of procedures that can usually be done for cervical radiculopathy include:
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ACDF - discectomy and fixation in an anterior approach or cervical disc replacement in an anterior approach
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Laminectomy/laminotomy/forminotomy
Cervical radiculopathy
Cervical myelopathy causes numbness in the hands, clumsiness of the fingers and instability of the legs. Often the swelling is slow, painless and in many cases it cannot be noticed until the symptoms are quite advanced. Usually, there are difficulties in writing, turning a key, holding a knife and fork, unsteadiness in the legs and falls. Sometimes the function of the bladder and intestines may be affected as well.
The most common cause is degenerative changes of the cervical spine with pressure on the spinal cord in the spinal canal. Pain in the arms may accompany cervical myelopathy if the exiting nerve roots are also stressed and inflamed (cervical radiculopathy).
A conservative non-surgical treatment plan is always the default preference. However, if the neurological deterioration is significant, it is recommended to perform decompression surgery without or with fixation, in which the goal is to release the pressure on the spinal cord.