The neck and the lower back are both susceptible to the disc (soft structure between the vertebral bodies) coming out and pressing on the spinal cord or the nerve roots. The disc is a normal structure between 2 adjacent vertebral bodies which is meant to allow easier movement between them and also acts as a cushion for any loading activities. Some amount of protrusion of the disc is very common and is noted in a large percentage of the people who have had MRI scan done. Some people however will have significant problems coming from this. The nerves and spinal cord lie just behind the vertebral body so any displacement of the disc can potentially lead to their compression. The nerves because of the pinching between the bone and the disc can stop working.
nerve has two functions:
Both of this can be affected from the compression of the nurse. The compression might be very temporary and cause only shooting or radiating pain in the arms or it might be progressive and eventually cause numbness or even weakness of the muscles supplied by the nerve.
The clinical presentation normally is sharp pain which arises from the neck and is worse in certain positions of the head. The pain travels in a linear pattern along the upper limb. Based on the site of the pain the diagnosis can often be made about the site of compression of the nerve. Detailed evaluation Is hence very essential to make a diagnosis. The pain can be varying from being a very mild discomfort to severe pain which even stops the patient from functioning from day to day functioning to severe disabling pain enough to make a patient cry and be awake through the night.
Detailed examination should include evaluation of sensations in different parts of the upper limb followed by motor evaluation for the muscle function and strength followed by eliciting the jerks around the upper limb to establish a diagnosis.
Other causes, occasionally lesions or problems of the brachial plexus or a nerve getting pinched somewhere else like as in a Thoracic outlet or in the Elbow or the Wrist area can give rise to very similar pain
Investigations would involve an x ray followed by MRI scan of the neck as might be required
Treatment plan normally initially is in the form of medications to settle the inflamed nerve. These neuropathy drugs however can cause some amount of sedation as well however usage of these drugs for a limited duration has been proven to be of significant benefit.
Some surgeons recommend the use of steroids in this condition along with the use of anti-inflammatory and even other analgesic tablets.
In severe cases the use of neck braces and physiotherapy has also been proven to be of use
In some cases, surgery is indicated. The main indication for surgery is significant weakness in the limbs which might be as in sensations or motor power or even unremittent severe pain not responding to medication. Patients would need to follow up with an orthopedic surgeon or a neurologist to monitor the situation and take a call based on the clinical presentation made by a thorough evaluation of the situation. The surgical options include an anterior cervical decompression and Fusion which involves of approaching the disc from the front of the neck taking out the disk and any small osteophytes impinging on the nerve. The disk can be replaced with a small cervical cage or bone and a plate applied in front with screws to stabilize the neck. The procedure itself is a fairly safe procedure and normally does not take more than 90 minutes to complete with the patient going back home within one or two days. Symptoms normally do settle down quite early and most patients do quite well if the surgical procedure is done at the right time.
Cervical Myelopathy
In some patients however the changes are very advanced or at multiple levels. These would then require multiple level surgeries which can be done from the front or the back. In these cases patients can develop Cervical Myelopathy which is a condition caused by prolonged compression of the spinal cord. Do the spinal cord weather damage do too bed vascularity of the nerve tissue in the neck. the prognosis for full recovery remains slightly doubtful in these cases but it is still very worthwhile decompressing the cord and releasing the pressure.
The presentation in these patients is different with many of them reporting altered bladder function and wide and awkward gait. They also complain of clumsiness in standing walking and frequent falling. Some of them might lose sensations in their feet totally and notice slippers or shoes falling out while they are walking. Neurological problems are not as clear as in isolated disc protrusion. Normally these people are slightly older in age.
