Posted on: May 23, 2017
Suddenly, with no warning, you feel terrible pain shooting from the base of your neck, through your shoulder, down your arm and into your fingers. You’re not aware of doing anything to set it off. What’s happening? By Dr. John M. Abrahams, FAANS, Chief of Neurosurgery and Co-Director of the Spine Surgery Section of the Orthopedic and Spine Institute, Northern Westchester Hospital.
You are probably experiencing the standard symptoms of a compressed – also called pinched – nerve in your cervical spine, the first seven bones of your spinal column, located in your neck. The pain might also radiate into your chest. Typically, you only have pain in one arm.
From that moment on, you feel pain, weakness or numbness, or a combination of all. The pain is chronic and can be excruciating to the point where you have difficulty with the ordinary activities of life – driving, working, sleeping.
What’s causing your intense pain? Most likely, it results from a herniated disc in your cervical spine. The disc is the cushion between the vertebrae of your spine, and herniation means that part of the disc is outside its normal place. If that material compresses a nearby nerve, you feel a searing pain. Picture a tree with a branch. The tree is the spinal cord. The branch is the nerve. The disc hits the nerve where the branch comes off the tree.
Let’s go back to you – in pain. Like most people, you try to figure out what you did to bring it on. Usually there’s no answer; most disc herniations are not caused by an accident or incident. A person moves a certain way – perhaps simply turning their head — and it happens.
In less-common cases, you may already have disc degeneration from aging and an accident exacerbates it. In 25 percent of cases, the cause of the herniation is degeneration of the spine caused by evolving arthritis.
The protocol is to first try to reduce your pain with Motrin. If your pain continues, your primary physician will order an MRI of your cervical spine. Most probably, this will show disc herniation, letting your doctor make a definitive diagnosis.
Now that you’ve been diagnosed with a pinched nerve in your cervical spine, the priority remains to get you out of pain. Your primary physician’s next step is to put you on a seven-day tapering dose of oral steroids, the dosage decreasing from high to low. If all goes well, the steroids will reduce the inflammation of the nerve that has been “punched” by disc material. The nerve is now swollen – that’s why it’s so painful. Typically, as the pain diminishes, the disc reabsorbs the herniated material, which relieves the pressure on the nerve.
But what if you are among the approximately 30 percent of patients who don’t respond to systemic steroids? Your doctor will then inject steroids around the surface of the compressed nerve. If you respond to either systemic or injected steroids, you could be pain-free within weeks and back to normal in six to eight weeks. The risks of steroid therapy are minimal. In the majority of cases, the disc herniation resorbs during conservative care and symptoms improve.
You’re still in pain? Then your primary physician will refer you to a surgeon. Surgical treatment involves making a one-inch-long incision in the neck and removing the entire herniated disc. That immediately decompresses the nerve. We then insert a spacer where the disc was and secure this plastic piece with two small metal plates to the upper and lower vertebrae. The body heals by fusing the upper and lower vertebrae. You’ll have a minimal loss of mobility of the neck– five degrees of lateral rotation – which you won’t even notice.
A recent alternative to the spacer is a disc replacement made of titanium. No fusion is involved. I use the disc replacement in select cases. The choice depends on a patient’s condition. Either way, surgery takes less than an hour and most patients leave the hospital the same day. You’ll probably be back to work in a week.
After surgery, physical therapy helps strengthen your core and expand your neck’s range of motion. And your prognosis will be excellent. More than 95 percent of patients undergoing surgery enjoy a complete resolution of their symptoms. Once you fix the disc, they do great – with no recurrence.
In one in ten patients who have surgery, a disc above or below the one that herniated also breaks down. Because surgery changes the dynamic of the area, there does exist a small risk that the levels below or above the removed disc will herniate. In that case, we do the same treatment.
At Northern Westchester Hospital (NWH), we perform more than 1,000 spine surgeries a year and have developed great expertise in surgical treatment and post-surgical care. If you stay here overnight, the physical therapist comes to your room to start your recovery. NWH also has a comprehensive outpatient physical therapy facility.
This is a rewarding surgery for us, because the patient comes in so debilitated and leaves so happy. After being in such pain, they are thrilled to get their life back so quickly.