Cervical Disc Herniation: Definition, Diagnosis, and Treatment

The cervical spine is made up of 7 vertebrae stacked and separated by discs, with the exception of the first and second (C1-C2).

In the middle of the spine is the spinal canal, which contains the spinal cord. At each level, a nerve root branches off from the spinal cord, both on the right and left sides. They exit the central canal through openings (the conjugate canal or foraminal canal) located laterally at the level of the intervertebral discs.

The normal intervertebral disc is a flattened, cylindrical structure that connects two vertebrae and acts as a shock absorber. It is composed of a central gelatinous nucleus and a peripheral fibrous ring.

Disc deterioration is characterized by fissures in the annulus fibrosus. The causes are usually dehydration due to aging, microtrauma from mobility problems, and sometimes trauma from cervical sprains. In cases of fissure, the nucleus can migrate into the disc without expanding the annulus, causing acute neck pain such as torticollis or chronic neck pain.

Si la migración es más importante, el núcleo puede atravesar casi la totalidad del anillo y aparecer en la cara posterior del disco formando una hernia. Esta hernia puede, debido a una ruptura completa del anillo, migrar al canal medular o foraminal. Entonces, la hernia puede comprimir estructuras nerviosas contenidas en el canal cervical (raíces periféricas más frecuentemente, y la médula espinal en más raras ocasiones).

More than 80% of herniated discs heal in less than 2 months with medical treatment.

Cervicobrachial neuralgia can often be treated conservatively, which includes rest and anti-inflammatory treatment, sometimes corticosteroids initially. Muscle relaxants and analgesics (sometimes morphine) can also be used temporarily. We can also suggest the use of a soft neck brace, and sometimes physical therapy for spinal pathologies can be very helpful.

In cases that are more resistant to medical treatment, an injection can be performed at the level of the posterior joints. This can be done under radiological supervision by an experienced medical team.