There are 23 discs in the spinal column, and six of them are in the cervical spine. Each cervical disc rests between the cervical vertebrae. The intervertebral disks are involved in cervical spine motion, stability, and weight-bearing. The disks are thicker anteriorly and therefore contribute to normal cervical lordosis.
These disks are composed of 4 parts: the nucleus pulposus in the middle, the annulus fibrosis surrounding the nucleus, and 2 end plates that are attached to the adjacent vertebral bodies.
Outer layer-This tough exterior, called the annulus fibrosus, is comprised of collagen fibers that surround the inner core and distribute the forces placed on the structure.
Inner core-This soft jelly interior, called the nucleus pulposus, is a loose, fibrous network suspended in mucoprotein gel that is sealed by the annulus fibrosus.
The middle and outer one-third of the annulus is innervated by nociceptors. Phospholipase A2 has been found in the disc and may be an inflammatory mediator.
The discs need to be well-hydrated in order to maintain their strength and softness to serve as the body’s major carrier of axial load. The cervical section of the spine supports the weight of your head (approximately 10 pounds) and allows you to bend your head forward and backward, from side to side, and rotate 180 degrees.
With age, the cervical discs lose water, thicken and enhance less flexible in adapting to compression. Such degenerative modifications may result in a herniated cervical disc, which is when the disc’s inner core extrudes through its outer core and comes in contact with the spinal nerve root.
In other situations, the cervical disc may degenerate as a result of direct trauma or gradual alterations. With no blood supply and precious few nerve endings, a cervical disc cannot repair itself.
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Herniated Cervical Disc
A herniated disc happens when the gel-like center of the disc ruptures out through a tear in the disc wall (annulus). The gel material is irritating to the spinal nerves, causing chemical irritation. The pain is a result of spinal nerve inflammation and swelling induced by the pressure of the herniated disc. Over time, the herniation tends to shrink and you may undergo partial or complete pain relief. In most cases, if the neck and/or arm pain is going to resolve it will do so in about 6 weeks.
A bulging disc (protrusion) occurs when the disc annulus remains intact but forms an outpouching that can press against the nerves. A true herniated disc occurs when the disc annulus ruptures, subtracting the gel-filled center to squeeze out. Sometimes the herniation is so severe that a free fragment occurs, meaning a piece has broken completely free from the disc and is in the spinal canal.
Stages of Disc Herniation
There are four stages of disc herniation:
(a) Disc protrusion
(b) Prolapsed disc
(c) Disc extrusion
(d) Sequestered disc.
- Disc Degeneration: chemical changes linked with aging causes discs to lose, but without a herniation.
- Prolapse: the disc changes with small impingement into the spinal canal. This stage is also known as a bulge or protrusion.
- Extrusion: the nucleus pulposus ruptures through the tire-like wall (annulus fibrosus) but remains inside the disc.
- Sequestration: the nucleus pulposus bursts through the annulus fibrosus and endures outside the disc in the spinal canal.
Stages 1 and 2 are attributed to as incomplete, where 3 and 4 are the complete herniations. Pain occurring from herniation may be linked with radiculopathy, which involves the neurological deficit. The deficit may comprise sensory variances (i.e. numbness, tingling ) and/or motor changes (i.e. reflex loss, weakness ). These variations are generated by nerve compression produced by pressure from interior disc material.
