Cervical Hernia (Cervical Disc Hernia)
What is a cervical disc herniation (neck hernia)?
A cervical disc herniation occurs when the annular fibers surrounding the nucleus pulposus of an intervertebral disc tear, causing the inner part of the disc to protrude outward. This condition typically leads to the following symptoms:
● Neck stiffness and cramping pain in the early stages,
● Pain in the neck, arm, hand, back, lower back, or shoulder (the pain varies depending on the location of the herniation),
● Neck pain, muscle spasms, limited range of motion in the neck,
● Numbness or tingling in the arms and/or hands,
● In larger or advanced disc herniations, weakness and reduced strength in the arm muscles,
● In cases of spinal cord compression, weakness in both arms and legs due to spinal cord damage, which may progress to paralysis.
What is an advanced cervical disc herniation?
In advanced cervical disc herniation, numbness in the arms and hands becomes more prominent. Sensory and strength loss in the arm is a key indicator of an advanced condition.
Is there a difference between a regular and advanced cervical disc herniation?
Most cervical disc herniations improve significantly with symptomatic treatment and rarely require surgical intervention. Medical therapy focused on pain relief and limiting neck movement generally yields successful results. In patients experiencing only tolerable pain, a 3-week course of medication is usually appropriate. However, in cases of severe, intolerable pain or advanced disc herniation, early surgical intervention can provide a definitive solution.
What are the causes of cervical disc herniation?
There are two main causes:
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Sedentary work
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Physically demanding jobs
Sitting for long hours in a fixed position, especially in desk jobs, can lead to cervical disc herniation.
In individuals with weak neck muscles, constantly tilting the head forward can become habitual and increase the risk.
Maintaining a fixed neck position for extended periods, prolonged computer or television use, exposure to cold air (e.g., air conditioning), and lack of exercise are significant contributing factors.
People with a long, thin, and weak neck structure are more prone to cervical disc herniation compared to those with shorter necks. These individuals are more affected by lifestyle and environmental factors due to their weaker muscular support. Improper neck use increases their risk of herniation. On the other hand, those with a straight neck and head structure are less likely to develop this condition.
What are the symptoms of cervical disc herniation?
● Sudden onset of arm pain,
● Neck pain,
● Numbness and pain radiating to the fingers,
● Weakness in the arm and fingers in later stages,
● Feeling of instability or lightness in the legs while walking.
How is cervical disc herniation diagnosed?
Diagnosis begins with a clinical examination and is confirmed through a cervical MRI scan. X-rays and CT scans may also be requested if needed. Electromyography (EMG) is performed to differentiate from other similar conditions.
What are the treatment options for cervical disc herniation?
Most cervical disc herniations respond well to symptomatic treatment and do not require surgery. Reducing pain through medication and limiting neck movements is often sufficient. Patients with only tolerable pain should follow a 3-week medication plan before considering other options. However, in cases of unbearable pain or advanced herniation, early surgical intervention provides a permanent solution.
Definitive indications for surgery:
● Severe arm pain that does not improve despite all treatments,
● Arm muscle weakness,
● Progressive or worsening strength loss,
● Weakness in both arms and legs and impaired walking due to spinal cord damage.
After confirming the diagnosis and ruling out other conditions, surgery is performed using the microdiscectomy technique. A small (1.5–2 cm) incision is made in the front of the neck, and the entire disc is removed under a microscope. A cage implant is then inserted to stabilize the narrowed area.
In some cases, endoscopic total disc surgery is used, offering greater patient comfort and faster recovery.
How long does recovery take after cervical disc herniation surgery?
Patients can usually get up with a neck brace about 3 hours after surgery. If general anesthesia was used, staying in the hospital for one night is recommended. Most patients are discharged the next day. Return to work depends on job conditions and usually occurs within 3 to 10 days. For swimming and similar sports, a rest period of about 2 months is advised.
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