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https://www.medilaw.tv - medical animations, Shows a lateral and a superior cross-sectional view of a cervical inter-vertebral disc protrusion. The nucleus pulposus degenerates, increasing pressure on the annulus fibrosus. Annulus micro-tears occur and weaken the disc wall, resulting in the nucleus pulposus protruding into the annulus fibrosus. The annulus bulges and irritates the adjacent spinal cord and nerve root.
When you sit, stand up, bend or twist, large compressive forces are applied to your spine. There are several factors that determine the ability of your inter-vertebral discs to handle these forces:
your inherited make-up
disc health -- worsened by smoking, poor nutrition, sedentary lifestyle, weak muscles, and obesity
poor posture -- while sitting, standing and lifting
heavy loads during home, work or sporting activities.
When the forces applied to your back exceed the strength of your discs, minor injuries to the disc can occur. It is important to note these injuries may or may not hurt at the time. As the continuous stresses and repeated injuries accumulate, they cause wear and tear on the spine's discs and joints. The intervertebral discs dry up, becoming thinner and stiffer. The inner nucleus loses it soft gel-like consistency, becoming more like crab meat.
Often the annulus of the posterior inter-vertebral disc is the first area injured. Small tears occur that heal with weaker scar tissue.
As more scar tissue accumulates, the annulus becomes weaker overall. This weakness can suddenly give way and allow a bulge to form, called a disc protrusion. The inflammation from the injury or the pressure of the protrusion against the spinal cord or nerve root, irritates the nerves and surrounding structures and causes pain.
A herniated nucleus can not be pushed back into the disc by exercises nor surgery, and a torn annulus can not be sutured closed by surgery. The natural repair process using scar formation is the only way to heal the annulus tear. The symptoms of most herniations resolve over six to twelve weeks, so wherever possible, your doctor will try to wait for this to occur. The surrounding inflammation decreases, the annulus tear scars over and any extruded material shrinks.
Urgent surgery is used to remove bulging disc material that is compressing nerves and causing severe arm symptoms, before permanent damage is done to the nerves, and the arm symptoms become irreversible. Sometimes it is necessary to remove the entire disc. In this case, sometimes the neck pain does resolve.
If after six to twelve weeks of conservative treatment, there are still uncontrollable arm symptoms, then elective surgery will be considered.
Remember, the pressure relieving, or decompressive, surgery can't cure the neck pain caused by a torn annulus. This must heal by itself. The purpose of surgery is to remove the nerve compression and reduce the arm symptoms.
The safest and most effective treatments for an acute disc herniation are
Physical therapies - correct posture, activity modification (avoiding excess neck movements, physical activities above shoulder level), low impact and flexibility, strength and endurance exercises, hydrotherapy, physical therapy modalities such as heat, ice, massage, and manipulation or mobilization
Medications - early aggressive use of medication to reduce pain, inflammation, muscle spasm and sleep disturbance
Other treatments -- ie acupuncture, ultrasound, laser, short-wave diathermy.
These treatments provide temporary pain relief, and can help the inflammation and bulging that are causing the pain to settle.
A very large herniation into the spinal canal can place severe pressure on the nerves in the spinal cord, and damage them, causing myelopathy. In the cervical spine, this myelopathy can lead to arm and leg weakness and numbness, and sometimes bowel and bladder dysfunction. This may require urgent surgery to avoid permanent damage to the spinal cord and permanent weakness and numbness.