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Cervical Disk Injuries

Definition

Cervical disk syndrome is an abnormal condition characterized by compression or irritation of the cervical nerve roots in or near the intervertebral foramina, before the roots divide into the anterior and posterior rami.

Cervical disk syndrome may be caused by ruptured intervertebral disks, degenerative cervical disk disease, or cervical injuries. The form caused by ruptured intervertebral disks or by degenerative disease may produce varying degrees of malalignment, causing nerve root compression.

Description

If the cervical intervertebral disk ruptures and extrudes through the annulus and posterior longitudinal ligament, adjacent neural structures may be compressed. Compression of the spinal cord may result in paraplegia or quadriplegia, depending on the segment involved, whereas compression of a spinal root may cause weakness and sensory loss in structures of the upper extremity innervated by it.

The severity of the clinical syndrome depends on the site and severity of compression by the displaced disk fragment.

Often, intrinsic disruption of the disk occurs but the adjacent ligaments hold, preventing complete extrusion of the fragmented disk. The annulus may separate from its attachment to the vertebral body margin or tear sufficiently to allow the disk to bulge into the spinal canal or foramina. Thus, neural structures also may be compressed by protrusion of an injured or degenerated disk.

Causes and Risk Factors

Most cervical disk syndromes are caused by injuries that involve hyperextension, which results in compression of the anatomic structures.

Flexion injuries in the cervical area do not result in nerve compression.

Symptoms

The onset of symptoms and signs of an extruded disk fragment may be acute or insidious. Acute symptoms may follow trauma or be unrelated to injury. Neck and radicular pain radiating down the arm occur simultaneously, but spinal cord symptoms are rare. There is usually limitation of neck motion, tenderness over the brachial nerves, and straightening of the normal cervical lordosis.

The signs and symptoms of cervical spondylosis are those of progressive cervical radiculopathy and, in advanced cases, spastic paraparesis, with mild to moderate sensory deficit in the lower extremities as well as a certain dermatome pattern. Neck and arm pain may or may not be present along with some limitation of cervical spine movement.

Treatment

Initially, cervical disk disease should be treated medically unless there is evidence of spinal cord compression or radicular motor loss in an extremity from severe neural compression.

Medical therapy for patients suffering from radiculitis includes immobilization of the neck and application of mild contraction with the cervical spine in a neutral position. This is best achieved with continuous or interrupted (2 hours) halter cervical traction.

Analgesics, tranquilizers, muscle relaxants, and local heat are frequently used in combination with traction.

There are two methods of treating cervical disk problems surgically. These are posterior decompression of the nerve roots, spinal cord, or both; and anterior decompression of nerve roots, spinal cord, or both, with or without fusion.

The choice is based on consideration of a particular patient's anatomic lesions as demonstrated with MRI, CT, or myelography. It may be necessary to use both an anterior and a posterior approach in separate stages if satisfactory recovery is not observed within 3 to 6 months after the initial operation.

Questions to Ask Your Doctor

What is the anatomical problem that is causing the pain?

Is it caused by an injury or degeneration, or both?

Is there nerve root compression?

How can this be remedied?

What is the medical treatment for the condition?

What are the surgical options?

What are the benefits and risks of surgery?