Treatment of herniated intervertebral disc C5-C6. Radiculopathy C6.

December 27, 2019

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Hernias in the cervical spine are the second most common. It is formed by 7 vertebrae, the most mobile of which is the area between the 5th and 6th vertebrae. Therefore, it is in this spinal motion segment that the formation of a protrusion of the intervertebral disc is observed, which is called a C5–C6 disc herniation. Their development is facilitated by previous injuries, osteochondrosis, long-term preservation of a forced position with a bowed head, for example, when working with a smartphone, tablet, etc. This, combined with the weakness of the muscular-ligamentous apparatus, creates all the prerequisites for stretching of the fibrous ring, the formation of protrusion, and then C5–C6 neck hernias.

The main danger of the disease is spinal cord stenosis. And since its upper parts are located at the level of the cervical vertebrae, their compression can lead to severe neurological complications.

Types of hernias of the cervical spine

The annulus fibrosus can become thin and deformed anywhere. Therefore, a distinction is made between anterior and posterior (dorsal) hernias of C5–C6. The first ones occur quite rarely and do not pose a serious danger to life and health. But dorsal hernias protrude into the spinal canal, the average width of which is only 1.5–2 cm. Therefore, their formation threatens spinal cord stenosis and compression of nerve endings, which causes severe neurological disorders.

Depending on which part of the spinal canal the intervertebral disc located between the 5th and 6th vertebrae protrudes into, the following types of hernias are distinguished:

• median – located in the center of the disc, which can cause discomfort on one or both sides of the body;
• paramedian - formed on the left or right side of the back of the intervertebral disc, so sensitivity and pain disturbances are present only in one hand;
• foraminal - the protrusion is formed in one of the narrowest anatomical structures of the spine, the foraminal openings, where the sensitive nerve roots pass, which complicates the diagnosis, symptoms and treatment of a C5–C6 hernia;
• diffuse - the entire surface of the disc is affected, which provokes bilateral disorders.

Due to its location, a C5–C6 disc herniation in the cervical spine can compress the blood vessels responsible for supplying blood to the brain. This can lead to a stroke. And when sequestration is separated from it, an urgent operation is required.

Reasons for education

The main cause of deformation of the C5–C6 intervertebral disc is increased pressure on it. This can happen when:

• injury, for example, from a fall, hitting your head when entering a room with a low doorway or ceiling, or when diving in a shallow body of water;
• constant stooping, wearing incorrectly selected shoes, as a result of which concussions occurring when walking or running act like a “whip” on the cervical spine;
• maintaining a forced posture for a long time, for example, when working at a computer, which provokes tonic tension in the deep muscles of the back and neck and their spasms;
• age-related changes leading to the gradual destruction of intervertebral discs.

Symptoms:

The first signs of the formation of a hernia of the cervical spine C5–C6 are:

• acute pain in the neck when turning the head;
• limited neck mobility;
• irradiation of pain to the shoulder, arm and head (migraine-like pain is often present);
• dizziness;
• weakness and numbness of the biceps, wrist extensors;
• tingling or crawling sensation radiating to the hand and thumb;
• increased blood pressure;
• noise in ears;
• voice change.

Since the symptoms of a herniated disc of the cervical spine C5–C6 are very similar to the manifestations of other diseases, without instrumental diagnostic methods it is not always possible to detect it in the early stages of development. Therefore, treatment that is inappropriate to the situation is carried out. As a result, the pathology progresses and spinal cord stenosis may develop, which further aggravates the patient’s condition and causes:

• severe weakness of one or both arms;
• Difficulty in grasping objects and performing small movements;
• severe pain.

In such cases, patients require emergency medical care.

Prevention

To eliminate the possibility of the formation of a cervical hernia or slow down the progression of this pathology, the following requirements should be met:

• Adhere to proper physical activity. When leading a sedentary lifestyle, you should decide on the appropriate form of physical activity. You can do dancing, swimming or yoga. You must attend classes at least twice a week. People whose work involves lifting heavy objects should avoid excessive stress on the spinal column and use a support bandage.
• If your posture is poor, you should not ignore the symptoms; you need to start treatment.
• It is necessary to normalize body weight, since extra pounds lead to increased stress on the musculoskeletal system.
• Go for a massage periodically.
• Normalize your diet by adding foods containing large amounts of calcium and protein.

When a cervical hernia is detected, most often the problem can be dealt with without resorting to surgery. You can return to your normal lifestyle in a short period of time. However, symptoms may reappear in the future. Therefore, it is recommended to use long-term methods to control pathology and perform a set of exercises to prevent possible problems with intervertebral discs.

Diagnostics

If you experience neck pain radiating to the shoulder girdle, head and arms, you should consult a neurologist or vertebrologist. The doctor will conduct an examination and, if there is a suspicion of a hernia of the neck of the 5th and 6th vertebrae, prescribe instrumental diagnostic methods:

• CT;
• MRI;
• X-ray;
• electromyography.

The most complete information about the condition of the cartilaginous bodies of the spine is provided by MRI. The method allows you to obtain layer-by-layer images of tissue and accurately assess the location of the protrusion and its size.

Why and how do intervertebral hernias form?

Intervertebral discs are fibrocartilaginous formations that are located between the bodies of adjacent vertebrae. Each disc consists of a central part, the nucleus pulposus, and a surrounding annulus fibrosus. The main function of the discs is a spring one: they spring during walking, changing body position, when jumping, and absorb any impacts, the force of which is directed along the spinal column.

The main causes of intervertebral hernias:

• spinal column injuries;
• long-term intense physical activity;
• sedentary lifestyle, constant work in a monotonous uncomfortable position;
• osteochondrosis;
• sports injuries, sudden strong movements;
• excess body weight (in this case, the spinal column experiences constant stress).

Changes that occur in the disc during intervertebral hernia:

• Stage I. Prolapse is a protrusion no larger than 2-3 mm. The disc still protrudes slightly beyond the vertebral body. But swelling forms in the area of ​​damage, and the first symptoms of the disease may appear.
• Stage II. A protrusion is formed - a protrusion larger than 5 mm in size. Symptoms are more pronounced.
• Stage III. Extrusion is the prolapse of the core of the intervertebral disc outside the vertebra (dangling in the form of a drop). As a result of the inflammatory process, osteophytes—bone protrusions—begin to grow on the vertebrae. The nerve roots are compressed and blood circulation is disrupted.
• Stage IV. Due to inflammation, poor circulation and compression of nerve roots, atrophy processes begin in the tissues. The intervertebral disc also atrophies, shrinks, ceases to perform its functions, two adjacent vertebrae practically grow together.

The spine includes seven cervical vertebrae, which are designated by the letter C with the vertebra number - C1-C7, respectively, twelve thoracic - Th1-Th12 and five lumbar - L1-L5. Below are the five sacral vertebrae, which in an adult fuse into one bone, the sacrum. Most often, hernias form in the most mobile parts of the spine: the cervical and lumbar. In the thoracic region they are much less common, since the pectorals take part in the formation of the chest and are more rigidly fixed.

The hernial protrusion can be located in front, behind or to the side of the vertebral body. The symptoms of the disease depend on this.

Conservative treatment methods

When the presence of a hernia of the cervical spine C5–C6 is confirmed and its size is determined, in the absence of severe neurological disorders, treatment begins with the prescription of conservative therapy. Its use is advisable for disc herniation of C5–C6 up to 0.3 cm, maximum 0.5 cm.

Therapy includes:

• drug treatment;
• spinal traction;
• exercise therapy;
• physiotherapy.

It is also recommended to wear a Chance collar during treatment. It will help reduce the load on the affected spinal motion segment, which will create favorable conditions for its recovery. It is important to maintain the correct rest and work schedule and not to overload your neck.

How to treat a hernia of the cervical spine C5–C6 is decided by the doctor individually in each case. This depends not only on its size, but also on the existing clinical picture.

Drug treatment

Initially, all patients are prescribed a complex of medications, the combination of which can reduce inflammation and pain, improve nerve conduction and create good preconditions for the regeneration of cartilage tissue. This:

• NSAIDs – have analgesic and anti-inflammatory properties;
• muscle relaxants – eliminate muscle spasms, which reduces pain and improves tissue trophism;
• B vitamins – have a positive effect on the quality of nerve impulses;
• chondroprotectors – help improve the condition of cartilage.

Spinal traction

Since the formation of a hernia is usually caused by increased pressure of the vertebrae on the disc, increasing the distance between them should lead to an improvement in the patient's condition. For this purpose, spinal traction or traction therapy is used. A course of sessions allows you to reduce the load on the intervertebral disc and thereby reduce the intensity of pain.

Exercise therapy

Therapeutic exercises help strengthen the neck muscles and create support for the spine. The set of exercises is selected individually. To be effective, it must be performed daily, but if pain occurs during any exercise, you should immediately consult a doctor.

Physiotherapy

To improve metabolic processes and accelerate tissue restoration, a course of sessions of electrophoresis, magnetic therapy, and ultrasound therapy is prescribed.

Treatment of median hernia

Treatment of a median hernia in the CELT clinic is always effective, prompt and successful. The process uses modern equipment and drugs that allow you to achieve the desired results. Surgical intervention is practiced only if there are indications for it or conservative treatment has not brought the desired effect.

This treatment method, epidural blockade, has proven itself well. It allows you to achieve pain relief, which occurs immediately after the procedure, lasts up to six months and has a therapeutic effect. Thanks to this manipulation, you can significantly delay, and often even refuse, the operation.

When prescribing treatment, our specialists are primarily guided by the interests of our patients; treatment is always built on trust and interaction, which also brings excellent results!

Surgery for disc herniation at the C5–C6 level

Today, whenever possible, they try to avoid surgical interventions in the cervical spine. But sometimes there is no other choice. Spine surgeons recommend surgery for:

• lack of effect from conservative treatment after 1–3 months of continuous treatment and persistence of acute pain;
• increase in neurological disorders;
• significant reduction in quality of life.

Modern technologies make it possible to extremely reduce intraoperative risks and avoid the development of complications. Therefore, surgical treatment of a C5–C6 disc herniation in the cervical spine is carried out through:

• nucleoplasty;
• endoscopic surgery;
• microdiscectomy.

Often the pathology requires complete removal of the affected intervertebral disc. In such cases, to maintain a normal range of motion, disc replacement using M6-C implants is recommended. They are very similar to a natural intervertebral disc both externally and functionally, withstand tens of thousands of cycles of movement and do not limit the mobility of the spinal motion segment. If it is not possible to install an endoprosthesis, neurosurgeons use transpedicular fixation tactics or achieve spinal fusion of the remaining vertebrae.

Nucleoplasty

This is the least traumatic operation, with virtually no likelihood of complications. It is performed through a pinpoint puncture of soft tissue and immersion of a cannula or a special instrument into the center of the C5–C6 disc. Through the action of a laser, cold plasma, radio waves or liquid pressure (hydroplasty), part of the nucleus pulposus is destroyed. As a result, the protruding part of it is slightly retracted, which removes pressure from the nerve endings and instantly leads to the elimination of pain.

Today, hydroplasty is more often performed, since its technology eliminates the risk of strong heating of tissues and allows you to accurately control how much of the nucleus pulposus will be removed. In this way, it is possible to treat several hernias in one session, for example C5–C6, C6–C7.

After the operation, only a pinpoint puncture remains, which does not require sutures. A postoperative scar does not form.

Endoscopic surgery

This is a gentle method for removing a C5–C6 hernia, which also involves a puncture, but with a slightly larger diameter than with nucleoplasty. Special endoscopic equipment equipped with a camera is inserted through it. Therefore, control over manipulations is carried out through the monitor.

Microdiscectomy

If it is impossible to remove the herniated disc of the 5th and 6th vertebra using gentle methods, microdiscectomy is performed with total replacement of the disc. The operation is performed under general anesthesia. To gain access to the spine, an incision is made on the front surface of the neck, but its size usually does not exceed 1.5–2 cm. Despite the apparent traumatic nature, the surgical intervention does not involve serious blood loss and takes no more than 1–1.5 hours.

Anatomical features

The spine consists of 24 vertebrae connected by intervertebral discs that perform a shock-absorbing function. The discs are surrounded by a hard shell called the annulus fibrosus. Inside they are filled with gel-like contents - the nucleus pulposus.

Vertebrae consist of bodies and arches. The arches form the spinal canal, a vertical cavity that houses the spinal cord. Spinal nerves depart from it, which transmit impulses to all organs, regulating their activity.

Rehabilitation

How the rehabilitation will proceed and what restrictions will be imposed depends on the type of surgery performed. After hydroplasty, the patient can leave the clinic on the same day, completely free of pain and return to their usual lifestyle. Endoscopic removal of a C5–C6 disc herniation involves a hospital stay of several days.

After microdiscectomy, the patient is usually discharged from the hospital on days 5–7, but full recovery requires several months. During this period, patients are prohibited only from serious physical activity; no other restrictions are imposed.

To speed up the recovery process, the following are prescribed:

• drug therapy - analgesics or NSAIDs are usually recommended to eliminate postoperative pain and inflammation;
• physiotherapy – magnetic therapy and electrophoresis procedures accelerate tissue regeneration processes;
• Exercise therapy – special exercises help strengthen muscles and create reliable support for the spine;
• wearing an orthopedic collar helps reduce the load on the cervical spine.

It is gymnastics for a hernia of the cervical spine C5–C6 that helps prevent relapse and avoid the formation of protrusion in another spinal motion segment. And to improve results, patients are recommended to visit the pool regularly.

Thus, the treatment tactics for C5–C6 hernia are well established. But in order for the treatment to be effective and less traumatic, you should contact only vertebrologists who are well versed in the intricacies of diagnosing and treating spinal diseases. It is this specialist who will be able to tell whether surgery is needed in a particular case or not.

FAQ

Do treatment methods depend on the location of the hernia?

Effective treatment of a hernia depends mainly on the stage of the pathology, as well as the consequences or complications. Any type of hernial protrusion: hernia of the lower back, cervical or thoracic region, requires conservative treatment or surgical intervention. Hernial formation of any part of the spine responds positively to traditional drug therapy, gymnastics, and massages.

What are drug blockades?

Spinal block is a method that allows you to quickly and effectively relieve pain at its localization. The effect lasts about a month and accelerates the healing process. Allows you to return to your normal lifestyle and comfortably engage in therapeutic exercises.

The blockade consists of local administration of multicomponent painkillers. It is not a treatment, but serves only to relieve acute pain during conservative therapy. The procedure is carried out by a specialist - a neurologist or surgeon in a medical facility.

What is spinal traction?

Traction is an effective manipulation indicated for hernial lesions accompanied by compression of the nerve roots. It is carried out in medical clinics using special equipment and is accompanied by pain relief in the acute period. The patient is placed on a flat, hard surface, and then the spine is slowly and safely stretched, eliminating possible pinched nerve endings.