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 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:
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Physical therapy for exercises to
help relieve the pressure on the nerve root
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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.
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