Disc Herniation
Intervertebral discs are rubbery cushions between the segmental bones of the spine (vertebrae) that act as shock absorbers and provide the normal flexibility of the spinal column. Each disc’s normal location is directly adjacent to the spinal nerves. When the discs deteriorate with age or are otherwise affected by injury, they become prone to herniation (bulging/rupture), which can cause a piece of the disc to move out of place and squeeze a spinal nerve.
Although herniation can occur in any section of the spine, lumbar (low back) and cervical (neck) disc herniations are the most common. Symptoms may include low back or neck pain along with pain radiating into the leg (sciatica) or arm, along with weakness and/or numbness.
Cervical radiculopathy refers to a pinching or inflammation of a cervical nerve from its exit point in the spine, called the neural foramen. The symptoms of cervical radiculopathy may include pain, numbness, or weakness in different areas of the arm or hand. Different common conditions associated with cervical radiculopathy include cervical disc herniation and cervical spondylosis.
Non-operative treatment of Radiculopathy
The logic of using non-operative treatment is reinforced by a variety of evidence from scientific studies. Some studies have shown that cervical radiculopathy usually improves with time without the need for surgery. The nature of some of these non-operative treatment modalities are noted below.
Relative rest and collar immobilization
It may be important to refrain from repetitive movements of the neck and forceful or heavy lifting movements during the acute phase. A soft cervical collar is often helpful to limit neck motion and provide splinting or rest in a position of comfort.
Medication
Whenever possible, your physician may prescribe anti-inflammatory medication, particularly at the outset of the problem. Some radiculopathies will respond to non-steroidal anti-inflammatory medication alone, but a short course of oral corticosteroid medication is often prescribed as well.
Physical therapy
The physical therapist can administer intermittent neck traction to help relieve pain. If traction is particularly effective, a patient can purchase a traction unit and self-administer traction at home on a regular basis. When pain is reduced, range of motion and strengthening exercises can help to gradually restore areas in the neck and shoulder that have been weakened by disuse and pain.
Epidural steroid injection treatment
In many cases, the initial therapies for cervical radiculopathy are ineffective. Epidural steroid injection may benefit patients who would otherwise suffer with the kind of lasting pain that would sometimes necessitate surgical treatment. The procedure can be performed in an outpatient setting using fluoroscopy (x-ray guidance).
The membrane covering the spine and nerve roots is called the dura. The space surrounding the dura is the epidural space. An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, reducing pain and hopefully aiding the healing process. It may provide permanent relief or pain relief for several months while the injury/cause is healing.
Improvement may occur immediately or within two weeks. Some patients will respond with one injection, but some may require up to three, interspersed over the course of a recovery period of one to three months. Most patients will benefit from a gradual exercise performed simultaneously with the supervision of a physical therapist.
