Cervical Disc Injuries
The cervical disc involves circular padded tissue that cushions the space between cervical vertebrae. It actually consists of a shell in which a gel-like material resides.
The cervical disc prevents bone rubbing on bone and provides a bit of height so that the spinal nerves passing on either side of the cervical vertebrae have plenty of room.
Because the cervical spine is relatively unprotected, it is subject to injury from many different sources, including falls, sports injuries, motor vehicle injuries, motorcycle injuries and diving injuries. The bones may become fractured or the disc can herniate or become disrupted, putting pressure on the spinal cord or spinal nerves.
What is a Cervical Disc Injury?
A blow to the side of the head or a forced flexion/extension injury can happen in any of the situations as described above. Certainly a fracture or other bony injury can occur; however, many patients suffer no bony injury but instead develop damage to the cushion between the vertebrae—the discs. Common names for a disc injury include:
- Herniated disc
- Pinched nerve
- Bulging disc
- Torn disc
- Ruptured disc
- Collapsed disc
- Slipped disc
- Disc protrusion
- Disc disease
- Black disc
A herniated disc happens when the connective tissue that binds the disc to the confines of the space between the vertebrae ruptures, spilling out some gelatinous material that then pushes and irritates either the spinal cord or a specific cervical spinal nerve. This causes both neck pain and pain that travels along the spinal nerve affected by the disc.
There are two types of pain you find in a herniated cervical disc:
- Axial pain. This is pain experienced in the neck itself caused by the disc irritating the nerves near the vertebrae. The disc space itself is what is
- Radicular pain. This is the pain not caused by the herniated disc itself but from the leaking disc material putting pressure on the spinal nerve,
- yielding pain that radiates from the neck down a specific spinal nerve, usually one innervating an aspect of the arm or hand.
What are the Symptoms of a Cervical Disc Injury?
As mentioned, the symptoms could be directly related to the disc itself and is located in the area of the vertebrae. Symptoms can also be related to pressure or “pinching” of a cervical spinal nerve. Some of the symptoms of a damaged or herniated cervical disc include:
- Arm pain. It can be a steady pain but is most often a sharp, stabbing pain that shoots from the neck down one arm.
- Pain in the shoulder area.
- Numbness or tingling in the area supplied by the affected nerve.
- Weakness. This tends to occur over time and is because the muscles innervated by the nerve become atrophic and are not as strong. You may have trouble lifting things.
- Pain in the neck at rest or with movement. If the disc is degenerated, you might experience pain including a crunching or crackling sound in the area of your injury.
- Some people have a herniated disc and have no symptoms whatsoever. You can have delayed pain which comes on weeks or even months after sustaining the injury when more of the disc contents spills out or there is greater inflammation of the affected nerve.
What are the causes of a Cervical Disc Injury?
Because the neck is not well protected, it doesn’t take a huge injury to cause a herniated disc. In fact, many cases of cervical disc herniation happen as a result of a slow, wear and tear phenomenon known as a degenerated disc. Those who are older are more prone to getting a disc herniation because discs tend to dry out as we age and they are more prone to rupturing or tearing with even a minor injury.
Certainly, motor vehicle accidents and motorcycle accidents can be the cause of cervical disc injury. These happen due to the blunt force traumatic forces that tear the protective capsule of the disc.
Other causes of a cervical disc injury include sports-related injuries such as diving injuries, falls from a great height, and altercations.
Risk Factors for Cervical Disc Injury
Age is certainly a factor in getting a herniated disc. Because of day to day wear and tear on the neck and because the disc tends to dry out over time, older people are more likely to have these fragile discs herniate with little provocation.
People who engage in high risk behaviors such as driving too fast and reckless driving are at higher risk of getting a cervical spine injury, including a herniated disc. People who don’t wear seat belts are also at higher risk.
People who play rough sports like hockey and football, or those who do high diving can do damage to their cervical discs as part of their sport. People at risk for falls can easily herniate a disc in the act of falling.
Diagnosing a Cervical Disc Injury
Diagnosing a cervical disc injury can be difficult as the bones that show up on x-ray tend to look normal. Discs are a part of the soft tissue of the cervical spine and don’t show up on routine x-rays. The following are the main tests use to assess the degree of injury in a suspected herniated cervical disc:
- CT scan (computerized tomography). The CT scan uses x-ray imagery from many directions in order to create multiple cross-sectional pictures of the
- cervical spine. In many cases, a bulging disc can be detected without contrast dye. In some cases, contrast dye can be used to highlight the disc further.
- MRI. (Magnetic resonance imaging). This uses a strong magnetic field and radio waves that make cross-sectional images of the cervical spine. It is
- perhaps the best test in that it shows discs in great detail and doesn’t require any type of contrast dye.
- Cervical myelogram. In this test, a contrast dye is injected into the cerebrospinal fluid and plain x-rays are taken. The contrast will be interrupted
- where the disc is herniated so the films can depict the areas of disc damage quite easily.
- Electromyelogram. This can be done along with nerve conduction studies to see areas where the nerve’s impulses are interrupted. Muscles that are affected
- can be detected with an electromyelogram. This is a good test to see which cervical nerve or nerves are affected.
Treatment of a Cervical Disc Injury
The treatment of a cervical disc injury can be conservative or invasive, depending on the wishes of the patient, the skill of the doctor, and the severity of the disease.
If conservative treatment is suggested, the patient must follow a prescribed exercise program to reduce pain and they must avoid putting the neck in painful positions.
They need to take anti-inflammatory medication to ease the pain as much as possible. Studies have shown that the herniated part of the disc will shrink over time.
Common pain medications used in a cervical disc injury include:
- OTC meds. These can be used if the pain is especially mild. They include Tylenol (acetaminophen), which relieves pain directly, Motrin or Advil (ibuprofen), which acts as an anti-inflammatory and pain medication or Aleve (naproxen), which is also an anti-inflammatory pain medication.
- Narcotic pain relievers. These can be used if over the counter medications don’t seem to work. They are stronger pain relievers such as Vicodin, Oxycontin, and Percocet. While they work well, they can be sedating and cannot be used over the long term because they have a potential for addiction.
- Nerve pain relievers. There is a class of medications that act directly to decrease the pain in the nerve. They include Neurontin (gabapentin), Lyrica (pregabalin), Cymbalta (duloxetine), amitriptyline and Ultram (tramadol). They have no addiction potential so they are increasingly becoming popular for the treatment of herniated discs.
- Muscle relaxants. These include Valium (diazepam) or Flexeril (cyclobenzaprine) which help if you have limb spasms as part of your symptomatology. Side effects include dizziness and sedation, which limit its use.
- Cortisone injections. These are used to reduce inflammation in the disc and affected nerve. Spinal imaging is used to locate the proper area and cortisone is injected near the affected area. Results can last for about 3 months.
Physical therapy is used to loosen spasm in the cervical muscles and to reduce the pain of the herniated disc. You can go from having a painful neck to being able to exercise the neck, at least to some degree. In physical therapy, you’ll likely do these therapeutic things:
- Ice, especially early on in the disease process
- Heat, to relax muscles
- Traction, to take the pressure off the spinal nerves
- Ultrasound, to provide heat relief
- Electrical stimulation
- Bracing for the neck for the short term
If conservative therapy is not working or if the doctor recommends more aggressive management, you will be referred to a neurosurgeon or spinal surgeon, who will decide if you will get better with surgery. Because surgery causes pain in and of itself, it sometimes leads you to trading one type of pain with another. You may be able to relieve the nerve root pain but will still have cervical pain. For this reason, invasive surgery is done on just a few patients with a herniated cervical disc. Invasive surgery is done under the following conditions:
- The conservative management does nothing for the symptoms after six weeks
- There is a disc fragment lodged in the spinal canal so that it is both pushing on a nerve and causing progressive weakness of parts of the body.
- You have significant difficulty performing the activities of daily living such as standing up or walking.
In surgery, most surgeons simply remove only the portion of the disc that is actually protruding from the vertebral space. In some cases, the entire disc is damaged and must be removed. In such cases, the vertebrae need to be fused together using metallic hardware so that the spine is stable and the bones don’t rub together with bone on bone. Artificial discs do exist and your surgeon may consider putting one in.
Complications of a Disc Injury
Cervical disc injuries tend not to be temporary problems that go away over a few days or weeks. Even with the best treatment, the complications of cervical disc herniation secondary to trauma include ongoing neck pain, which can interfere with sleep, movement of the neck, or even having the neck stationary, as with writing on a computer with your job. The cervical pain tends to be sharp and associated with spasm of the cervical muscles.
Another complication is opioid drug addiction. If your doctor treats your longstanding pain with opioids, you can become addicted to the drugs and use them even when your pain is not that bad. You can exaggerate your pain in order to get more pain medications. This can cause problems at home and at work.
The cervical nerve root can be chronically painful so that with every movement of the neck you get shooting pains down the arm that interfere with activities of daily living.
This pain can be very severe and can cause most of the complicating factors involved in having a cervical disc herniation.
If you or a loved one has suffered a cervical spine injury caused by another's negligence and would like to discuss your legal options, contact me online or call me at 916.921.6400 to set up a FREE consultation with an experienced Injury Lawyer