Herniated Disc Cervical/ACDF – Slipped Disc in the Neck

The spine is divided into several regions, each defined by its curvature and function. The cervical spine, located in the neck, supports the head and connects it to the trunk. This section of the spine bears less weight than others and boasts the highest degree of mobility and flexibility, allowing for movements such as tilting, bending, and rotation.

The cervical spine consists of seven vertebrae, which are the small bones that create the spine. The back of each vertebra arches to form the lamina, a structure that provides a protective covering over the spinal canal. Within this canal travel the spinal cord, nerves to the arms and hands, and arteries supplying blood. The upper section of the cervical canal is particularly spacious, which helps prevent pressure on the spinal cord during neck movements.

Intervertebral discs, made of robust connective tissue, are located between the cervical vertebrae. Each disc features a tough outer layer known as the annulus fibrosus and a gel-like center called the nucleus pulposus. These discs, along with two small spinal facet joints, enable movement and provide stability, while also serving as shock absorbers.

As individuals age, their discs gradually lose water content, becoming shorter, less flexible, and less effective as cushioning between the vertebrae. This degeneration can lead to tears in the outer layer of the disc. A herniated disc occurs when this outer layer ruptures, allowing the nucleus pulposus to leak out.

When the inner material of a herniated disc presses into the spinal canal, it can irritate the spinal nerves, leading to swelling and pain. Herniated discs are most common among middle-aged individuals, especially older adults, who are at a higher risk due to decreased water content in their discs. Additional risk factors include obesity, smoking, and poor posture during physical activities.

Herniated discs can also occur due to sudden pressure from trauma, such as in motor vehicle accidents or sports injuries.

A primary symptom of a herniated cervical disc is neck pain, which may radiate as shooting pain into the arms. Patients may experience burning sensations in the shoulders, neck, and arms, along with weakness, numbness, or tingling in the arms. Headaches can also occur. In rare cases, severe symptoms like loss of bowel and bladder control combined with significant arm and leg weakness signal a serious issue that requires immediate medical attention.

To diagnose a herniated disc, your physician will conduct a physical examination and review medical imaging. This may involve discussing your symptoms and medical history, as well as performing simple movements to assess muscle strength and joint stability. A neurological examination may be conducted to evaluate nerve function, as some nerves from the cervical spine extend to the arms.

X-rays can reveal the condition of the cervical vertebrae. In some cases, a myelogram, which involves injecting dye into the spinal column to enhance X-ray images, may be utilized to detect pressure on the spinal cord or nerves caused by herniated discs, bone spurs, or tumors.

Additional imaging techniques, such as CT scans and MRI scans, may be ordered for a more detailed view of the spinal structures. CT scans offer layered images of the spinal canal, while MRI scans provide the most precise visuals of the discs, ligaments, spinal cord, nerve roots, and tumors.

Nerve conduction studies may also be performed to assess the function of cervical spinal nerves and identify areas of compression. A common test is the Nerve Conduction Velocity (NCV) test, which measures how quickly nerve impulses travel. The NCV test may be uncomfortable but is generally brief.

An Electromyography (EMG) test is often conducted alongside the NCV test, measuring muscle impulses to identify nerve issues. The doctor will insert fine needles into the muscles controlled by the spinal nerve to assess the nerve impulse activity, which may cause temporary discomfort.

Many patients with herniated discs can find relief through non-surgical treatments. This may involve over-the-counter or prescription medications to alleviate pain, including steroids or nonsteroidal anti-inflammatory drugs (NSAIDs).

Your doctor may recommend rest for a few days and possibly the use of a soft neck collar for support. Physical or occupational therapists can help reduce pain and muscle spasms while teaching exercises to strengthen neck muscles.

After surgery, your activity level and body positioning will be initially restricted. You will need to avoid lifting and strenuous activities until your doctor gives the go-ahead. Wearing a neck brace during the recovery period will provide necessary support. Over time, your activity level will gradually increase, and physical therapy will focus on flexibility and strengthening exercises, as well as teaching proper body mechanics and posture.

Surgery is typically recommended when non-surgical treatments fail to alleviate symptoms, particularly if a herniated disc is pressing on a nerve or the spinal cord, causing functional loss. The most common surgical procedure for a herniated cervical disc is the anterior cervical discectomy and fusion.

This procedure involves removing part or all of the herniated disc and fusing two or more vertebrae to prevent movement and relieve pain. The surgeon makes a small incision at the front of the neck to access the vertebrae, carefully moving muscles and arteries aside.

After removing the disc material, a bone graft or interbody fusion cage is placed in the empty space to promote fusion between the vertebrae. Bone grafts can be taken from the patient's own body or sourced from a donor. Surgical hardware is then used to secure the vertebrae and facilitate healing.

Following surgery, the incision is closed with stitches, and patients receive pain management immediately after the procedure. A neck brace may be required to support the healing process.

Patients should anticipate an overnight hospital stay and may require assistance at home during the initial recovery period. Your doctor will outline activity restrictions and advise against lifting, household chores, and yard work until cleared to resume normal activities. Wearing a neck brace will aid in recovery, and physical therapy will introduce exercises to improve strength and promote proper posture during daily activities.

Recovery varies for each individual based on surgery type and the severity of the condition. Your surgeon will provide specific guidance on what to expect. Generally, recovery from an anterior cervical discectomy and fusion may take several weeks. While arm pain often resolves quickly, weakness and numbness may take longer to improve.