14 March 2019 In the early stages, cervical pain should be treated by use of medical and preventive measures. However, treatment of degenerative disc disease should correspond to the stage of the disease diagnosed by imaging and the type of symptoms being experienced by the patient. Cervical pain: medical and preventive measures Cervical pain should be treated with the following measures: Change in habits: take care when undertaking physical exertion, avoid incorrect posture and do physical exercise; Physiotherapy: massage, ultrasound and specific exercise programmes; Weight control; Medication: muscle relaxants and anti-inflammatory agents. In cervical pain involving pain and numbness of the limbs, medical treatment or surgical treatment may be indicated. What can you do when you are suffering from cervical pain? In the event of cervical pain involving pain and numbness of the upper limbs, initial treatment should be medical , such as: Rest; Medication: anti-inflammatory agents, muscle relaxants and analgesics; Physiotherapy: treatment programmes created in response to the specific characteristics of each case, which could include massage, ultrasound or specific exercise programmes. When should surgical treatment of a herniated cervical disc be considered? Surgical treatment may also be indicated when: A herniated disc is diagnosed and there is a strong correlation between the images and the patient's complaints; Conservative treatment carried out for 4 to 8 weeks has failed, depending on the patient’s degree of incapacity; The patient is suffering with very severe pain that is resistant to the most powerful analgesic treatment available; A motor deficit of the upper limbs is diagnosed, in which case surgical treatment needs to be performed as soon as possible in order to maximise the chances of neurological recovery. What are the surgical procedures? Spinal herniation is one of the areas dealt with by neurosurgery and orthopaedics. There are 2 types of surgical approach to the treatment of herniated cervical disc: Anterior approach to the cervical spine; Posterior approach to the cervical spine. Anterior approach to the cervical spine Surgical intervention is carried out under general anaesthetic , and with an anterior approach to the cervical spine. After a small incision is made in the skin of the anterior cervical region , the planes are dissected via the inner face of the sternocleidomastoid muscle between the trachea, the oesophagus and the neurovascular bundle (carotid artery, jugular vein and vagus nerve) in order to reach the anterior face of the vertebral bodies. Once the space requiring intervention has been found, the entire intervertebral disc and disc fragments that have extruded into the spinal canal and which are responsible for the neurological affectation are removed. Wherever necessary, bone spurs on the posterior part of the vertebral endplates (osteophytes), when considered relevant to the clinical condition, may also be removed . Finally, a spacer can be placed in the intervertebral space, using a bone graft, in order to maintain disc height and foraminal diameter and to promote fusion between the vertebral bodies. The other alternative is the placement of a disc prosthesis that will make it possible to preserve movement between the vertebrae. The advantages of the disc prosthesis are: Promotion of a faster recovery; Reduced likelihood of degenerative wear from the adjoining intervertebral spaces. Posterior approach to the cervical spine In the case of highly lateralised or foraminal disc hernias , a posterior approach may be taken. In this approach, a skin incision is made in the posterior cervical region , followed by dissection of the muscle planes so that the posterior part of the spine can be reached and part of the bone and yellow ligament that make up the posterior wall of the spinal canal is removed. Once the spinal canal and the intervertebral foramen have been exposed, the displaced intervertebral disc fragments are removed and the decompression of the affected nerve root is confirmed. This can be done with minimally invasive techniques involving small incisions of the skin and muscle, which allows for: Faster, less painful recovery; A quick return to a normal, active life. This article was written with the support of physicians and other clinical professionals from the Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
