Ask the Expert: Dr. Andrew Sama, Orthopedic Spine Surgeon, Answers Your Questions on Cervical Disc Herniations

by Dr. Andrew Sama
Dr. Andrew Sama, Orthopedic Spine Surgeon

Q1: What are the best non surgical or surgical options for a 41 year old male suffering from a cervical disc herniation? How long is recovery from both options?  

Most non surgical treatment for cervical disc herniation is centered around decreasing inflammation and pain and maintaining or improving range of motion and stability. This usually includes physical therapy, massage, sometimes traction and anti-inflammatory medications or muscle relaxants. If pain persists or if there is any weakness or progressive neurologic issue, then sometimes it is necessary to consider surgery. Surgery is typically done through the front of the neck to decompress the nerves and fuse the spine segment in question. Some newer techniques for stabilizing the spine with a disc replacement that preserves motion can be considered on a case by case basis.

Q2: If an index finger has been numb for many years from the herniation C-5-6, stenosis C-6-7, can epidural or surgery help get the feeling back? I have been told after a few years the nerve can be dead.  

Surgery can sometimes help regain lost function but in some cases permanent nerve damage may have occurred.  A neurologist can perform a test called an EMG to see if there has been permanent nerve damage before considering surgery.

Q3: Are there any exercises that can help prevent cervical disc herniations?  

I am not familiar with specific exercises that can prevent disc herniation but we know that maintaining a general level of fitness, good cervical muscle tone and flexibility is good for overall spine health.

Q4: I’ve heard that stretches and exercise can make a cervical disc herniation worse but I have also heard that remaining inactive is the worst thing you can do. What’s the best thing to do?  

Aggressive stretching or manipulation of the neck can sometime cause herniations to worsen and inactivity can make muscles stiff leading to increased pain. I usually recommend that patients maintain a good level of basic fitness, be mindful to strengthen their core and avoid high impact activities that may predispose one to cervical injuries.

Q5: Is surgery the only way to treat a cervical disc herniation?  

No, in fact, most disc herniations are treated non-surgically with good results. Physical therapy, anti-inflammatory medications and time usually result in improvement and the body can absorb the herniation. It is only if there is progressive neurologic deterioration or persistent or worsening of pain that we recommend surgery.

Q6: What is the most common cause of cervical disc herniation?  

Herniations can occur for a variety of reasons some of which may be related to an accident or direct injury while others are less obvious and may be the result of daily activity.

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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

M Jerome says:

I read your articles about cervical disc herniation, can surgery be perform in the front of the neck instead of the back c3, c4, and c7

Thank You

HSS on the Move says:

Hello, thank you for your question. Dr. Andrew Sama, Orthopedic Spine Surgeon, says: “Depending on the reason for the surgery and the location of the problem being treated, decompression and fusion surgery can often be performed from the front of the neck. Your surgeon should review your condition and imaging studies and can advise you on the safest and most effective approach for your case.” If you are interested in care at HSS, please check with our Physician Referral Service at 877-606-1555.

Dave says:

I recently had C3-C4 and C4-C5 disks removed and had a titanium plate inserted to assist in the bone fusion. No real issue from the surgery, but I went for my 10 day-post op check-up and the titanium plate was not completely vertical (tilted a litted). Doctor said is was normal and not even bothered by it, but I was struggling on how it could happen if the plate was supposed to be secured by six screws …. is this normal?

HSS on the Move says:

Hi Dave, thank you for reaching out. Dr. Andrew Sama, Orthopedic Spine Surgeon, says: “The plate may have been placed in the ‘slightly tilted position’ at the time of surgery. Biomechanical studies have shown that as long as the plate is well fixed to the bone, the fact that it may be somewhat oblique or ‘tilted’ should not matter to the overall success, strength, and integrity of the surgical construct.” It is best for you to consult with your treating physician. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Terri says:

1) How and why do i have all symptoms of c8 radiculopathy that were confirmed by emg though doesent correspond with my C7/t1 that was normal on the MRI??? 2) What else if anything could cause c8 radiculopathy in last 2 digits per my imaging that would explain this medically?? 3)Whats your final assessment and why?
To date: Undergone much PT and recieved facet injections at 2 sites: above and below ACDF. Persistent neck pain into scalpula and upper extremity unilateral hand numbness especially D4, D5. Now with new weakness in opposite hand
History/background/ diagnostics:
Former ACDF at c5/6 labeled degenerative disk in mid/late20”s.. Resulted in great sucess post surgery. several years later- accident occurs: results multiple levels damaged, cervical spondylosis. ***MRI findings: no cord/ vertebral lesion and multi DDD below above acdf.
C4/5 herniation and degeneration and cord encroachment.
C5/C6- bony overgrowth causes cord encroachment.
C6/C7 herniation degeneration but without any encroachment.
C7/T1- unremarkable.. *Myelo gram- showed small extradural lesion at C5/6 with thecal sac compression. A spur projecting from posterior border of C6, small ventral defect..
***EMG- left- UE tested. Neuro exam: weakness ADM, APB, 1st D1. Decreased sensation digits 3,4,5 clawing in 5th digit. DTR 1+. NCV: left ulnar sensory nerve decreased conduction veloc (wrist-5th digit, 42/s) Polyphasic Volition 1st D1 and ADM. No acute radiculopathy, plexopathy, peripheral neuropathy. Final: Abnormal test concluded Chronic C8 radiculopathy…

HSS on the Move says:

Hi Terri, thank you for reaching out. It is best for you to seek an in-person consultation with a treating physician so that they can better determine the best course of treatment. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

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