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Complications of these procedures include death, heart attack, stroke seizure, infection, non union, metal failure, spinal fluid leak, spinal cord damage and root damage.
In addition to all the usual risks and complications there may also be injury to the esophagus and many vascular structures in the neck as well as the trachea and voicebox. These are rare but real possibilities.
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Cervical Disc Herniation on MRI with Cord Impingement |
We have discussed a more advanced form of cervical disease but what about the simple herniated disc. As with discs in the lumbar spine, under pressure of age, lifting, activity and abrupt acceleration and decelerations the disc wall may become slightly incompetent. A fragment of the disc may herniate or rupture into the spinal canal pressing on the nerve roots or cord itself. This may begin as neck pain which then progresses into radiating arm pain, weakness, paresthesias (numbness or tingling) or loss of coordination. Rarely does a single herniated disc cause a myelopathic condition which involves the lower extremities or bowel and bladder function.
Initial evaluation is usually a simple X-ray and then a MRI scan to evaluate the cord and level of root impingement. Sometimes CT myelogram or EMG or NCV (nerve conduction velocity) tests are done looking for other causes of the symptoms such as carpal tunnel syndrome.
Depending on the size of the disc as well as the severity of symptoms surgery might be recommended immediately. This is rare. Usually conservative treatment will get most people through without surgery. Principle treatment involves rest, neck brace in the acute phase, anti-inflammatory drugs, muscle relaxers, physical therapy including heat, massage, traction and gentle manipulation. Sometimes chiropractic manipulation can help but generally high speed manipulations can be dangerous causing stroke and paraplegia. A root block or cervical epidural can sometimes help the pain and inflammation.
In some instances in acute settings, a steroid dose pack will be given orally to calm down cord and root irritation. Generally most persons recover from simple cervical disc herniations but obviously future episodes are possible and activity may be modified.
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