Hernia of the cervical spine: symptoms and treatment

Disc herniation of the cervical spine is an advanced form of degeneration of the cervical intervertebral segments, which is complicated by displacement of the nucleus pulposus of the disc with its extension beyond the anatomical boundaries. The disease is characterized by pronounced neurological and reflex manifestations, including the cerebral type. This is explained by the fact that in this section the ridge connects to the head, and the spinal cord passes into the brain, and a dense neurovascular network is concentrated here. The pathological process is mainly a complication of long-term osteochondrosis, the symptoms of which were ignored by patients for a long time.

MRI of the cervical spine.

Even a hundred years ago, in the field of view of neurologists, pathology with such a serious localization fell into the category of isolated cases, and it was mainly the lot of older people. Today, cervical intervertebral hernia is one of the most common diagnoses among all possible problems with the spine. Now, unfortunately, it too often concerns the working population. The diagnosis of “cervical hernia of the spine” predominates in people 20-55 years old. The incidence rate in men and women is approximately the same: 52% of patients are male patients, 48% are female.

In general, in the structure of all diseases of the human body, cervical hernias occupy 5th place in the number of hospitalizations, 3rd place in the need for surgical treatment. According to data from authoritative sources, at least 20% of people with cervical hernias suffer from severe vertebroneurological disorders, which often lead to disability. In approximately 35%-40%, the pain syndrome becomes chronic, which is why patients live in constant stress and emotional tension.

The risk group includes people suffering from systemic connective tissue diseases, obesity and various metabolic disorders, diabetes mellitus, and orthopedic pathologies. Also, professional athletes, office workers, teachers, machine operators, seamstresses, draftsmen and other people whose cervical region lingers in an immobilized position for a long time or performs monotonous monotonous movements have a high predisposition to displacement of the disc fragment in the cervical region.

What is a herniated cervical spine?

What is the essence of the diagnosis? In local pathological changes in the intervertebral disc, resulting in prolapse of the nucleus pulposus, which occurred due to the impaired integrity of the fibrous ring of the disc. The process of herniation is preceded by advanced degenerative-dystrophic pathogenesis in a specific spinal motion segment. But let's look at how everything happens in reality to make it more clear. Let's gradually get to the main point, starting with a brief excursion into anatomy.

There are only 5 intervertebral discs in the cervical spinal system, and 7 vertebrae. They are located between each successive pair of vertebral bodies, connecting them to each other. Between the 1st and 2nd vertebrae (atlas and axis) the disc is not provided by nature, it does not exist. This means that pathology can occur at levels such as C2-C3, C3-C4, C4-C5, C5-C6, C6-C7. Most often it develops in the C5-C6 and C6-C7 segments.
Each disc element consists of a jelly-like substance (nucleus pulposus), which is enclosed in an annular fibrous rim (annulus fibrosus). The disc performs a shock-absorbing function, absorbing and absorbing shocks and shocks in the spine during human physical activity. It also, together with other structural components, provides the upper part of the spine with the necessary potential for mobility and flexibility.
The main material composition of the disc is represented by water (80%) and collagen fibers (15%) immersed in a matrix of proteoglycans. Collagen provides elasticity to the disc and retains proteoglycans (hyaluronic acid). And proteoglycans are responsible for attraction and control of water balance, creating the necessary intradiscal pressure. A normal ratio of all designated structural substances is possible only with good metabolism at the vertebral levels and complete delivery of nutrients to them.
The structure of the disc is also avascular, or the absence of its own blood supply. Therefore, its supply of nutrition occurs exclusively through the blood vessels of the adjacent vertebrae, which enters through the marginal endplate. At a certain spinal level from C2 to C7, circulatory and metabolic processes may be inhibited. For example, due to constant physical overload or a sedentary lifestyle, possibly due to obesity, autoimmune pathologies or after local trauma. As a result, osteochondrosis develops.
Since in osteochondrosis the blood flow in the vertebral bodies is reduced and the permeability of the marginal plate is impaired (sclerosis), the transport of important metabolites into the disc, as we said, does not occur in the required quantities. This leads to a gradual decrease in the specific fluid content in fibrous and pulpous tissues, that is, the loss of their main component - water. Dehydration serves as a stimulus for thinning, flattening, and disintegration of the intervertebral lining.
Then cracks appear on the inside of the degenerated ring, and the nucleus pulposus changes its normal position. The jelly-like substance sags and moves into the defective part of the ring. As a result, a disc deformation occurs in a certain direction, protruding beyond the boundaries of the vertebrae.
At first, the cervical disc protrudes slightly, but until the ring ruptures, a hernia will not form. This early stage is called protrusion. As soon as a protrusion is diagnosed, this means that all the prerequisites and favorable conditions for the appearance of a hernia have already been created. If the processes of degeneration at the prehernia stage are not stopped in a timely manner, the fibrous ring continues to collapse. The core, in turn, is increasingly dislocated towards the periphery and exerts compression on the weak area of the ring.

Hernia and coracoid osteophytes.

Ultimately, the ring-shaped structure ruptures with a fragment of jelly-like cartilage falling out through the formed hole. Open prolapse of part of the nucleus pulposus into the intervertebral space through a peripheral through breakthrough of the disc is a herniation of the cervical spine.

Charging for the neck

For a herniated disc in the cervicothoracic region, it is recommended to do therapeutic exercises under the supervision of a specialist. The process usually uses special devices, for example, a gymnastic stick. The ideal exercise for fighting a hernia is:

You should start any workout with a short warm-up. To do this, you need to take a stick in your hands and stretch them in front of you. Then make 12 circular movements in each direction.
Extend your arms with the stick in front of you so that they are at shoulder level. Gradually tighten your fingers, squeeze them with force. Stay in this position for a few seconds. Lower your arms and repeat the approach several times.
Take the gymnastic stick almost by the edges, as far as your arms reach. Slowly turn the machine one way, then the other. Perform 12 turns.
Clasp your hands, place them on the back of your head, spread your arms to the sides. With your head, slowly press on your palms, creating slight resistance, and thereby activating the work of your neck muscles.
Place your hands behind your head, clasp them, bring your elbows together, keep your back straight. Try to lower your head to your chest with your hands, and at the same time, through the work of your muscles, keep it in one position.

For a herniated spine, regardless of its location, various therapeutic exercise techniques are used. They were developed by doctors with extensive experience and have a minimum number of contraindications. The exercise therapy complexes of Bubnovsky, Shishonin, and Dikul have proven themselves well. They are suitable for patients with various musculoskeletal disorders.

Types and stages of intervertebral hernias in the neck

We told you that discs can be pre-herniated and truly herniated. At the stage of protrusion in the cervical region, the cartilaginous layer is considered small up to 0.2 cm and corresponds to stage 1 of the pathology. Protrusions exceeding 0.2 cm are classified as medium and large sizes (2, 3, 4 degrees). So, let's give a more precise description of each stage.

Stage 1 – the integrity of the disc is preserved, the size of the bulge is up to 2 mm inclusive.
Stage 2 – moderate severity, the integrity of the fibrous ring is compromised, the protrusion is increased from 2 mm to 4 mm.
Stage 3 – severe, the ring is torn, the disc displacement is strong, equal to 4-6 mm.
Stage 4 (extrusion or sequestration) – a critically severe degree of deformation, which can end in sequestration at any time. The size of the hernia at this stage is > 6 mm, and can reach up to 8 mm or more.

Sequestration is the most dangerous form of the disease, when a sagging cartilage fragment is completely torn off from the disc with a piece of dead cartilage entering the spinal space. Such pathogenesis can, in a short period of time, cause serious irreversible damage to the nerve, including its death, which leads to paralysis.

In general, all disc prolapses at the level of the neck, which are greater than 4-6 mm in volume, are considered clinically extremely unfavorable, since they seriously impair cerebral circulation, depress and disrupt the unity of the two main parts of the central nervous system - the brain and spinal cord.

Unacceptably large sizes (> 4 mm) in this section are associated with the highest risks of partial/complete immobilization of the arms and legs, as well as paralysis of the torso from the affected area and below. In addition to paresis and paralysis, severe dysfunction of the genitourinary and reproductive organs develops with high frequency.

CT slice.

The species diversity of such disc lesions in the cervical region is similar to lumbar and thoracic hernial protrusions. The pathological focus is classified according to its location (direction) relative to the spinal canal and vertebral bodies. According to this criterion, the following types of hernias are distinguished:

lateral, or lateral – located strictly on the sides of the vertebral bodies;
anterior, or ventral - grow anteriorly, that is, oriented in the opposite direction from the spinal canal (less dangerous view);
posterior, or median – the protruding component faces clearly towards the center of the spinal canal (the most dangerous form);
posterolateral, or paramedian - the deformed element is tilted several degrees away from the median axis leading directly into the spinal canal.

The share of lateral and posterolateral localizations is approximately 85%, median and ventral – 15%. Unfortunately, the relatively favorable location of the neck hernia - anterior - is the least common (5%) among patients.

Restoring normal blood circulation in the lower extremities

Bend your back, lifting your head up. Arch your back, point your head down. The pace is moderate, 5-10 repetitions are recommended.

Patients should remember the need to take into account the rules of caution when performing therapeutic exercises.

The basic rule is that loads should not provoke pain. If noticeable discomfort appears during the exercise, the load should be stopped and the back should be relaxed, resting for a few minutes on a hard surface. You should not start with high loads; it is important to monitor your own well-being. Under normal load conditions, the spine will return to its original shape and restore its previous flexibility.

Symptoms and pain with a cervical hernia

A pathological focus within the cervical spine is usually accompanied by local pain in everyone, which can radiate to certain parts of the body innervated by the cervical-vertebral nerves. The pain, depending on how advanced the hernia is, can be unbearable or moderately tolerable. In addition, it can be either shooting, burning or aching. The symptomatic spectrum is quite diverse, patients mainly complain of:

acute painful syndrome in the neck and collar area, aggravated by turning and tilting the head;
stiffness of movement, crunching in the neck, tension in the neck muscles;
frequent dizziness and intense headaches, mostly one-sided in the back of the head;
pain and paresthesia in the form of crawling goosebumps, tingling, numbness, other unnatural signs in the hands (mostly in the wrists, fingers, forearm);
weakness, paresis of one of the upper limbs, difficulty raising the arm up;
pain in the shoulder, in the area of the shoulder blades, diaphragm, and occasionally in the leg;
pain, numbness in one half of the face;
discomfort and noise in the ears;
hoarseness, feeling of soreness and foreign body in the throat;
spots before the eyes, decreased visual acuity and blurred vision, other visual disorders;
vestibular disorders, for example, unsteadiness, unsteadiness of gait;
poor memory ability, absent-mindedness, increased fatigue;
irritability, depressed mood, depression;
light sleep or insomnia;
surges in blood pressure, more often blood pressure tends to increase in severe pathogenesis with compression of the cervical artery that supplies the brain.

The pathology in most people provokes excruciating pain, which in dominant cases appears in the upper back, arms and head.

Complex for acute and subacute periods

Acute and subacute periods of the disease are characterized by intense pain. Therefore, it is necessary to carry out exercise therapy in a gentle manner. You can't move your head. The best option for performing gymnastics would be exercises in fixing collars. You need to do exercise therapy while sitting or lying down:

sitting with relaxed hands on your hips, rotate the shoulder joint successively: first forward, then backward
sitting with your arms down, perform the following movements: spread your arms to the sides, raise them, bringing your palms together, lower them to shoulder level, return to the starting position
swing up and forward from the starting position, quickly clench and unclench your fingers

Diagnosis of the cervical spine

When a patient comes to the clinic, the neurologist first collects and analyzes the patient’s medical history. This is followed by testing of the spinal cord using special non-hardware tactics for examining the spine. Non-hardware diagnostics are based on neurological tests, which involve checking the problem area of the back using motor and palpation techniques, thereby establishing:

presence and degree of neurological deficit;
dependence and nature of the pain syndrome when performing certain movements of the neck, limbs, etc.;
the consistency of the reflex response and the volume of amplitude of movements of the cervical level in various physiological directions;
impaired sensitivity in areas of the body associated with SHO (hands, facial area, etc.).

Based on complaints and neurological tests, a specialist can make a preliminary diagnosis, and during the initial examination. But treatment will not be prescribed until suspicions of a hernia are confirmed by the results of hardware imaging. The generally established diagnostic standard for the purpose of detecting pathology and obtaining reliable detailed information about the clinic of hernial protrusion is magnetic resonance imaging (MRI). Using volumetric layer-by-layer MRI images in different projections, as a rule, facts about:

the development and degree of structural changes in the intervertebral discs at any stage;
localization of the damaged fibrocartilaginous lining, and in the case of sequestration - the number and location of sequestration;
the specifics of the growth of the bulge (direction vector);
exact dimensions of the formation down to a millimeter;
the presence and severity of pinching, compression of components of nerve nodes, arteries, spinal canal and spinal cord;
intra- and paravertebral edema, inflammation, atrophy;
condition of muscle tissue, ligaments, tendons, intervertebral joints;
presence/absence of concomitant diseases on the examined part of the spinal column - stenosis, arthrosis, tumors, blood supply problems, etc.

X-ray does not fully reflect the clinical picture, since it visualizes only the outlines and position of the bone elements of the spine, the distance between the vertebrae, and osteophytes. X-rays do not show soft tissues, which include cervical discs, spinal cord, nerve plexuses, vascular and musculo-ligamentous structures. The slice-by-slice computed tomography method, although it involves the use of more advanced radioactive technologies than conventional x-rays, is also not informative enough in terms of the value of the obtained clinical signs in the diagnosis of this disease.

No conclusion is made about a cervical hernia based on X-ray or CT images alone; these are two auxiliary tactics, the advisability of which in each case is determined individually. Only MRI can thoroughly examine the problem area. Magnetic resonance imaging also has a significant advantage - it works on the phenomena of nuclear magnetic resonance and, unlike devices with ionizing radiation, does not have a negative effect on the human body.

Correct body position

The lowest intradiscal pressure is observed in the supine position, the degree of load corresponds to 25 kg. For comparison, when a person just stands, it reaches 100 kg, and when sitting – 140 kg. With physical activity, the initial values increase significantly. In a supine position during exercise therapy, it is possible to achieve isolated strengthening of the necessary muscle elements without harming the problem area. Therefore, the main exercises for patients with lumbosacral hernias are those that will be performed in the following positions:

lying on your back;
lying on your side;
on the stomach;
On knees.

By doing gymnastics in the listed starting positions, the weak section will be unloaded, and physical training will take place in a safe and productive manner, since we will protect the lower level of the back from additional axial load and pressure above the parts of the body located above.

Of value are tasks for natural traction of the spine, performed on an inclined surface, which allow you to expand the interarticular distance and reduce mechanical compression of nerve fibers, as well as relieve swelling and inflammation, normalize blood flow and metabolic processes in the problem area.

The truth about treatment: analysis of the effectiveness of all tactics

Do medications help?

In the acute period, doctors prescribe medications for pain, inflammation and swelling for local and internal use to relieve painful manifestations of the disease. The basis of such drug therapy is NSAIDs:

Indomethacin;
Ibuprofen;
Meloxicam;
Diclofenac.

In addition to non-steroidal anti-inflammatory drugs for pain, specialists prescribe medications from a series of analgesics:

Analgin;
Spasmalgon;
Ketorol.

If the clinical picture is aggravated by muscle hypertonicity, muscle relaxants are recommended to relax the spasmodic muscle structures. Among the most used muscle relaxants are Mydocalm and Siralud.

With constant debilitating pain, which NSAIDs and analgesics cannot cope with, a transition to treatment with strong hormonal or anesthetic drugs is carried out. These include glucocorticosteroids, lidocaine and novocaine. Using powerful hormone-containing and anesthetic agents, only as prescribed by a doctor in specialized conditions, the patient is given a course of spinal blockades. In the very near future, a person with such a critically unsafe diagnosis needs to undergo surgery.

All of the listed drugs act purely symptomatically: there will be no effect in terms of reducing the hernia component. In fact, they only temporarily relieve pain by blocking the transmission of nerve-pain impulses in the problem area. They also have a moderate anti-inflammatory effect. All intervertebral deformations and degenerations still do not disappear.

Note that limiting yourself only to drug therapy, even if it helps to get rid of pain, is the height of recklessness. With this approach, a hernia of the cervical spine will soon remind itself, and next time in a more vivid manifestation. But the worst thing is that, living only on painkillers, intervertebral pathogenesis will actively progress, increasing the risk of disability more and more every day.

Achieving stable remission through a drug regimen in complex combination with other conservative methods, as observations show, is not always achievable. If the initially prescribed complex treatment for 3 months, maximum 6 months, does not lead to tangible and lasting improvements, the patient is recommended to undergo surgery.

Long-term internal use of pain medications or their injection method is fraught with the development of side effects - stomach ulcers, liver and kidney diseases, hematopoietic and immune systems. External agents - gels, creams, ointments - have less negative reactions. But in terms of the strength of the analgesic effect they provide, they are significantly inferior to oral medications and injections.

It is impossible not to say a few words about popular chondroprotectors, the action of which is aimed at improving metabolism and activating nutrition in osteochondral structures. Remember, their benefits have been clinically confirmed exclusively for osteochondrosis that has not developed into a cervical hernia. It is acceptable to use such drugs for small protusions as a preventive measure for further degeneration of the cervical intervertebral disc. But! When hernia has already occurred, chondroprotectors are ineffective or “don’t work” at all. When a global restructuring of the disk contents into an irreversible (!) non-viable state has already occurred, they do not provide any therapeutic or prophylactic benefit.

The effect of gymnastic exercises

Of course, it will not be possible to get rid of the disease through special gymnastic exercises for the neck. Exercise, even the best, is not able to “retract” the fallen pulpous element back or destroy it without a trace, or “patch” the gap in the fibrous ring. This can only be accomplished during surgical treatment.

However, exercise therapy has been proven to improve well-being and, importantly, prevent the development of atrophy of the muscles of the cervical and cervicothoracic complex and upper extremities. Let us immediately emphasize that the productivity of LH action is significantly reduced in the penultimate and final stages of the hernia. Still, unique physical training makes the greatest contribution to the restoration of musculoskeletal potential after surgical repair of a hernia. In general, the effect of physical therapy both during conservative therapy and at the time of postoperative rehabilitation is due to:

stimulation of blood circulation;
activation of metabolic processes;
increasing the production of nutrients necessary to maintain the functions of the spinal structure;
strengthening and increasing endurance of the neck muscles;
correct, gentle development of motor and support functions of the neck;
increasing the distance between the vertebrae, which helps prevent or reduce radicular/vascular compression.

But in order to really benefit from gymnastics, you need to get a training program from a specialist that is specially designed just for you, taking into account all the characteristics of the clinical picture on MRI. Plus, indicators of age and body weight, level of physical fitness, and associated health problems are taken into account.

It is advisable to take the first course in a physical therapy room under the supervision of a professional instructor in order to thoroughly understand and hone the technique of each individual exercise. When performing training, it is important to follow 5 rules:

Regularity of exercise therapy.
Gradual increase in load.
Smooth and accurate movements of the cervical spine.
Complete abolition of physical exercise if the slightest pain or changes in sensitivity appear in any part of the body.
Based on point No. 5, urgently contact a treating specialist so that he can conduct a high-quality examination and make adjustments to the therapeutic exercise plan.

Taking and applying any physical activity on your own from the Internet, at random, or on the advice of other patients is highly not recommended! In the acute phase, exercise therapy is contraindicated! If you neglect these rules, the likelihood of achieving disastrous results is too high. Consequences of an illiterate campaign - exacerbation of symptoms of hernia SHO

, increased frequency of relapses, progression of disc displacement, even greater reduction of the spinal lumen, compression and death of nerve endings, damage to the spinal cord/brain, compression and narrowing of the cervical arteries, separation of the hernial sequestrum. As a result, the deadline for the operation will not move away, but will noticeably get closer.

Contraindications to physical therapy

There are cases when physical therapy is contraindicated. Among them are:

oncological diseases;
stroke;
pre-infarction condition;
diseases accompanied by elevated body temperature;
exacerbation of intervertebral hernia;
hypertensive crisis;
if a little time has passed since surgery.

Impact of massage

The leading function of massage is to create a trophic effect. This means that massage techniques make it possible to increase blood circulation in the area of interest, ensure better lymph outflow and the supply of necessary metabolites and oxygen to tissue cells. Another goal of massage is to prevent atrophic phenomena in muscle structures and reduce intradiscal compression. However, we note that in no way can special techniques for massaging the cervical-collar area eliminate the hernia and reduce its volume.

This type of treatment is recommended strictly according to indications, since it is not equally useful for all types of hernias. It is prescribed especially with caution for medium and large protrusions, nerve pinching in the projections of the neck. Such manipulations in a neglected, complicated clinic can give a completely opposite effect, since it is easy to turn a large hernial mass in an unfavorable direction using this method of influence. Therefore, before prescribing a massage, the doctor must weigh the pros and cons.

At the beginning of the development of a hernia, massage can serve as an excellent measure to prevent the progression of degenerative-dystrophic pathogenesis in a still slightly changed disc. But we emphasize that massage techniques, if the doctor gives the go-ahead for them, should be carried out by a good massage therapist from the neurology department. And, finally, this is an auxiliary treatment tactic, which makes sense to use purely in conjunction with other basic treatment programs.

Cervical physiotherapy

Physiotherapeutic procedures also do not treat a hernia, but fight its symptom complex according to approximately the same principle as massage and exercise therapy. The goal of standard physiotherapy sessions (magnetic therapy, electrophoresis, laser and ultrasound therapy) is to reduce swelling around the affected intervertebral disc, promote blood flow to the weak area, and relieve muscle strain.

If this goal is fully achieved, the patient feels much better after a course of physical therapy, noting an increase in the range of motion in the neck, a persistent disappearance or reduction in pain and other previously disturbing signs. But, according to clinical studies, the effect of physiotherapy is noted by only 50% of patients with this diagnosis. In some cases (up to 40%, as a rule, with stage 3-4 pathology), on the contrary, after treatment with physiotherapy, a deterioration in well-being is observed.

General recommendations

In order for the classes to be useful, you need to follow certain rules. Otherwise, you should not expect a positive effect from exercise therapy. Tips and tricks:

It is important to exercise regularly. Moreover, the load should increase gradually - from 10-15 minutes in the first classes to 40 minutes in the future;
It is better to perform exercises in the morning on an empty stomach. In the evening you need to take time to stretch;
It is important to monitor your own sensations - if pain occurs, you should immediately stop training. Pain syndrome means that the exercise is performed incorrectly;
each exercise is usually performed 6-8 times;
Exercises that involve sudden movements and twisting should not be included in the program. Do not run, jump or do strength exercises;
a set of exercises can be divided into several parts and performed throughout the day.

If you want to learn in more detail how gymnastics is performed to treat cervical osteochondrosis at home, you can read an article about it on our portal.

It is important to do the exercises correctly

Attention! At a minimum, the first exercise therapy classes should be supervised by an experienced instructor. Then you can perform them at home, having received a preliminary consultation with a neurologist.

Complications and consequences of the disease

The cervical region is the narrowest part of the spinal system, in which the largest arteriovascular highway passes. The department includes the largest arteries - the left, right vertebral and basilar, each of which forms up to 6 groups of vascular branches.

In the back of the neck there is also an important cervical nerve bundle (node), which consists of the hypoglossal, lesser occipital, greater auditory, transverse, and supraclavicular nerves.

Thus, even slight deformations of the disc, displacement of the vertebrae in an overly narrow area, densely penetrated by nerves and blood vessels, can cause a real catastrophe:

clamping of arteries and nerve roots, constant severe pain;
blocking the circulation of blood and cerebrospinal fluid between the spinal cord and brain with severe cerebro-vertebral signs;
neurotic nature of auditory and visual disturbances, frequent loss of consciousness, coordination disorders;
serious dysfunctions of the gastrointestinal tract (nausea, vomiting, fecal incontinence), urinary system (uncontrolled urination) and genital organs (impotence, frigidity, infertility);
muscle weakness of the arms, including complete or partial paralysis;
depression of respiratory functions due to severe damage to the spinal substance and nerve nodes, up to the cessation of breathing;
insufficient blood supply to the brain, which can lead to cerebral ischemia and stroke.

For what diseases is exercise therapy necessary?

Moderate physical activity, which physical therapy provides, has a positive effect not only on a person’s neck, back, and spine, but also on his body as a whole. Thanks to the work of muscles, most physiological processes are stimulated:

the tone of the central nervous system increases;
blood circulation and heart function improves;
the vascular system is strengthened;
Pulmonary ventilation improves, due to which there is an abundant supply of oxygen to all organs and tissues.

This positive effect of exercise therapy on the body is used in the treatment of many diseases:

cardiovascular (stroke, hypertension);
gynecological (prolapse of the uterus, internal genital organs, infertility);
articular (arthritis, arthrosis);
respiratory (pneumonia, bronchitis);
obesity;
and etc.