The spine, also called the back bone, is designed to give us stability, smooth movement, as well as providing a corridor of protection for the delicate spinal cord. It is made up of bony segments called vertebrae and fibrous tissue called intervertebral discs. Disc protrusion, also called herniated disc, is a condition caused by a tear in an intervertebral disc allowing the disc contents to bulge out.
Disc protrusions in the cervical or neck area place pressure on nerve roots (nerve root compression) or the spinal cord causing radiculopathy. Radiculopathy is a medical term used to describe the neurological deficits that can occur from pressure on the nerves and spinal cord, such as arm or finger weakness, numbness or pain.
Cervical radiculopathy refers to a dysfunction of a nerve root caused by injury or compression of a spinal nerve root in the neck. On the other hand, cervical myelopathy refers to compression of the spinal cord within the neck.
Conditions that can cause radiculopathy/myelopathy include:
- Degenerative Disc Disease: A condition caused by wear and tear on the discs between the vertebrae causing them to lose their cushioning ability.
- Spinal Stenosis: Narrowing of the spinal canal as we age, most commonly due to degenerative arthritis.
- Degenerative Spondylolisthesis: This condition is degeneration (wear and tear) of the vertebral components, usually occurring after age 50, causing slippage of a vertebra onto another, leading to spinal stenosis, a narrowing of the spinal canal.
Cervical radiculopathy can result in pain, numbness, or weakness in the shoulder, arm, wrist or hand. Patients with myelopathy present with weakness, problems manipulating small objects, and difficulty with normal gait.
Your doctor will perform a physical examination to diagnose cervical myelopathy. Magnetic resonance imaging (MRI) scan of your spine may be ordered to confirm the diagnosis and to rule out the other conditions causing similar symptoms.
In addition to a complete history and physical examination, your doctor can use several diagnostic tests such as spine X-ray, spine MRI or spine CT scans and Electromyography and nerve conduction studies to diagnose cervical radiculopathy and myelopathy.
When conservative treatment measures such as rest, medication, physical therapy, and pain blocking injections are ineffective, your surgeon may recommend spine surgery.
The most common spine surgery to relieve symptoms of nerve root compression involves removing the disc and fusing the two vertebrae above and below it with a bone graft. A newer treatment option is now available to replace the herniated disc with an artificial disc. Artificial discs are used in place of a bone fusion to preserve neck movement and flexibility.
A decompressive laminectomy and fusion is a common surgery for treating patients with cervical myelopathy. It is a surgical procedure in which portion of the bone or lamina, causing pressure on the nerves, is removed. In spinal fusion, a piece of bone, taken from elsewhere in the body is transplanted between the adjacent spinal bones (vertebrae). As the healing occurs, the bone fuses with the spine.