Herniated cervical disc

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Herniated cervical disc

  1. 1. Isnawan Widyayanto
  2. 2. Is a spine condition of the cervical segment that occurs when the gel-like center of a disc (nucleus pulposus) ruptures through a weak area in the tough outer wall (annulus fibrosus).
  3. 3. Spine is made of 24 movable bone called vertebrae. The cervical (neck) section of the spine support the weight of the head and allows head to bend forward and backward, from side to side, and rotate 180 degrees There are 7 cervical vertebrae numbered C1-C7
  4. 4. The vertebral body is a thin ring of dense bone Consisting of the body, pedicles and laminae Vertebral foramen is a whole in vertebral body that spinal cord runs through
  5. 5. Gel like Tissue between each vertebra fibro cartilaginous cushions serve as the spine's shock absorbing system protect the vertebrae, brain, and other structures The discs allow some vertebral motion extension and flexion.
  6. 6. The disc is made up of 3 structures the (1) Nucleus pulposus, gelatinous center (2) Annulus Fibrosus. Its job is to contain the nucleus (3) Vertebral end plates that attach the disc to the vertebrae
  7. 7. •Herniated disc can occur when there is enough pressure from the vertebrae above and below •This can force some or all of the nucleus pulposus through a weakened or torn part of the annulus fibrosus.
  8. 8.  Disc Degeneration: chemical changes associated with aging causes discs to weaken, but without a herniation.
  9. 9. The form or position of the disc changes with some slight impingement into the spinal canal. Also called a bulge or protrusion.
  10. 10. The gel-like nucleus pulposus breaks through the tirelike wall (annulus fibrosus) but remains within the disc.
  11. 11. The nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal (HNP).
  12. 12.     Injury Improper lifting Aging Spontaneous
  13. 13. Symptoms of a herniated disc can vary depending on the location of the herniation and the types of soft tissue that become involved. They can range from little or no pain if the disc is the only tissue injured, to severe and unrelenting neck that will radiate into the regions served by affected nerve roots that are irritated or impinged by the herniated material
  14. 14. •The two most common levels in the cervical spine to herniate are the C5 - C6 level (cervical 5 and cervical 6) and the C6 -C7 level. The next most common is the C4 - C5 level, and rarely the C7 - T1 level may herniate. •Rarely, the herniated disc may put pressure on the spinal cord,causing problems in the leg.
  15. 15.   Include dull or sharp pain in the neck or between the shoulder, pain that radiates down the arm to the hand or fingers, or numbness or tingling in the shoulder or arm. Certain positions or movements of the neck can intensify the pain. Weakness in the arm muscles may accompany the dull pain in some cases
  16. 16. C4 - C5 (C5 nerve root) - Can cause weakness in the deltoid muscle in the upper arm. Does not usually cause numbness or tingling. Can cause shoulder pain.  C5 - C6 (C6 nerve root) - Can cause weakness in the biceps (muscles in the front of the upper arms) and wrist extensor muscles. Numbness and tingling along with pain can radiate to the thumb side of the hand. This is one of the most common levels for a cervical disc herniation to occur.  C6 - C7 (C7 nerve root) - Can cause weakness in the triceps (muscles in the back of the upper arm and extending to the forearm) and the finger extensor muscles. Numbness and tingling along with pain can radiate down the triceps and into the middle finger. This is also one of the most common levels for a cervical disc herniation  C7 - T1 (C8 nerve root) - Can cause weakness with handgrip. Numbness and tingling and pain can radiate down the arm to the little finger side of hand. 
  17. 17.     C4 - C5 (C5 nerve root) - Can cause weakness in the deltoid muscle in the upper arm. Does not usually cause numbness or tingling. Can cause shoulder pain. C5 - C6 (C6 nerve root) - Can cause weakness in the biceps (muscles in the front of the upper arms) and wrist extensor muscles. Numbness and tingling along with pain can radiate to the thumb side of the hand. This is one of the most common levels for a cervical disc herniation to occur. C6 - C7 (C7 nerve root) - Can cause weakness in the triceps (muscles in the back of the upper arm and extending to the forearm) and the finger extensor muscles. Numbness and tingling along with pain can radiate down the triceps and into the middle finger. This is also one of the most common levels for a cervical disc herniation C7 - T1 (C8 nerve root) - Can cause weakness with handgrip. Numbness and tingling and pain can radiate down the arm to the little finger side of hand.
  18. 18.     X-ray CT Scan MRI Electromyography (EMG) &Nerve Conduction Velocity (NCV)
  19. 19. Plain cervical spine radiographs evaluate chronic degenerative changes, metastatic disease,infection, spinal deformity, and stability. But can’t show herniation.
  20. 20. CT scan delineates cervical spine fracture and is used extensively in trauma cases. Occasionally a CT scan with a myelogram may also be ordered, as it is more sensitive and can diagnose even subtle cases of nerve root pinching.
  21. 21. The single best test to diagnose a herniated disc is aMRI (Magnetic Resonance Imaging) scan. A MRI scan can image any nerve root pinching caused by a herniated cervical disk.
  22. 22. An EMG is an electrical test that is done by stimulating specific nerves and inserting needles into various muscles in the arms or legs that may be affected from a pinched nerve. If the muscles have lost their normal innervation, there will be spontaneous electrical activity. These test can detect nerve damage and muscle weakness
  23. 23.          Brachial Neuritis Cervikal Myofascial Pain Cervikal Spondylosis Cervikal Sprain and Strain Complex Regional Pain Syndromes Fibromyalgia Neoplastic Brachial Plexopathy Osteoarthritis Osteoporosis (Primary         and Secondary) Paget Disease Psoriatic Arthritis Radiation-Induced Brachial Plexopathy Rheumatoid Arthritis Rotator Cuff Disease Scheuermann Disease Thoracic Outlet Syndrome Traumatic Brachial Plexopathy
  24. 24.  Nonsurgical - Self care : Rest and restrict activity - Medication - Physical theraphy and exercise - Bracing - Cervical traction  Surgical
  25. 25. Conservative non surgical treatment is the first step to recovery. Most cases of cervical pain do not require surgery and are treated using non-surgical methods. In most case, the pain from herniated disc will get better within a couple days and completely resolve in 4 to 6 weeks.
  26. 26. NSAID, such as aspirin, naproxen, ibuprofen, etc used to reduce inflammatory and relieve pain. Analgesic, such as Acetaminophen can relieve pain but don’t have the anti-inflammatory effect of NSAIDs. Muscle relaxant such as methocarbamol may be presribed to control muscle spasm. Steroid may be prescribed to reduce swelling and inflammation of the nerves. Taken orally in tapering dosage over a-five day period Steroid injection into the area of your herniated disc may performed if the pain is severe.
  27. 27. NSAID, such as aspirin, naproxen, ibuprofen, etc used to reduce inflammatory and relieve pain. Analgesic, such as Acetaminophen can relieve pain but don’t have the anti-inflammatory effect of NSAIDs. Muscle relaxant such as methocarbamol may be presribed to control muscle spasm. Steroid may be prescribed to reduce swelling and inflammation of the nerves. Taken orally in tapering dosage over a-five day period Steroid injection into the area of your herniated disc may performed if the pain is severe.
  28. 28. NSAID, such as aspirin, naproxen, ibuprofen, etc used to reduce inflammatory and relieve pain. Analgesic, such as Acetaminophen can relieve pain but don’t have the anti-inflammatory effect of NSAIDs. Muscle relaxant such as methocarbamol may be presribed to control muscle spasm. Steroid may be prescribed to reduce swelling and inflammation of the nerves. Taken orally in tapering dosage over a-five day period Steroid injection into the area of your herniated disc may performed if the pain is severe.
  29. 29. NSAID, such as aspirin, naproxen, ibuprofen, etc used to reduce inflammatory and relieve pain. Analgesic, such as Acetaminophen can relieve pain but don’t have the anti-inflammatory effect of NSAIDs. Muscle relaxant such as methocarbamol may be presribed to control muscle spasm. Steroid may be prescribed to reduce swelling and inflammation of the nerves. Taken orally in tapering dosage over a-five day period Steroid injection into the area of your herniated disc may performed if the pain is severe.
  30. 30. NSAID, such as aspirin, naproxen, ibuprofen, etc used to reduce inflammatory and relieve pain. Analgesic, such as Acetaminophen can relieve pain but don’t have the anti-inflammatory effect of NSAIDs. Muscle relaxant such as methocarbamol may be presribed to control muscle spasm. Steroid may be prescribed to reduce swelling and inflammation of the nerves. Taken orally in tapering dosage over a-five day period Steroid injection into the area of your herniated disc may performed if the pain is severe.
  31. 31.  Mckenzie exercises can be used to help reduce the pain in the arm.  In the initial period a physical therapist may also opt to use modalities, such as heat/ice or ultrasound, to help reduce muscle spasm.
  32. 32. A cervical collar or brace may be recommended to help provide some rest for the cervical spine.
  33. 33. For patient whose pain doesn’t improve with the nonsurgical treatment, surgery may be necessary. The goal of surgery is to remove the portion of disc that is pushing on the nerve. Surgical procedure to remove the disc called Discectomy
  34. 34.  Anterior Cervical Discectomy and Fusion (ACDF)  Artificial disc replacement  Minimally invasive microendoscopic discectomy  Posterior Cervical Discectomy
  35. 35. Thank You

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