Neck pain is a common complaint since the neck vertebrae have a very mobile structure. Studies have shown that half of the adults in the adult age group have had an attack of neck pain at least once in their lifetime. Not all neck pain is related to neck hernia. Neck pain is mainly caused by mechanical causes and spinal diseases.
In fact, the most common type of neck pain is mechanical neck pain. It is mostly caused by minor traumas affecting the neck or minor injuries affecting the neck muscles and connective tissue. Poor posture is the most important cause of this type of pain. Although it is a common complaint, especially in people who work in a forward-bent position at the desk all day, the real cause and location of the pain cannot be found.
Mechanical neck pain may radiate to the head, shoulders and arms. This pain gradually decreases within 2-3 days and disappears within 1-2 weeks. Sometimes the pain may become chronic in the long term and may intensify in acute attacks from time to time. The spread of pain to the arm and hand or the presence of numbness may be a sign of nerve root compression, that is, neck hernia.
The aim of the treatment of mechanical neck pain is to normalize the neck movements as soon as possible. Since neck movements are painful in the beginning, the person wants to keep his neck still. However, in order to prevent the formation of stiffness due to contraction of the neck muscles, it is necessary to perform natural movements by constantly increasing the degree of pain, as long as the pain allows. During this time, we recommend pain relievers and muscle relaxants to reduce the severity of the pain. Returning the neck movements to normal as soon as possible will prevent the pain from becoming chronic.
Neck pain due to spinal diseases is less common than mechanical neck pain. The main reasons we encounter in patients with this type of pain are as follows:
* Neck hernia
* Degeneration / wear on the neck vertebrae
* Spinal cord involvement due to narrowing in the neck spinal canal
For a better understanding It is necessary to briefly explain the anatomy of the neck region and what a neck hernia is.
Our neck has the ability and structure to carry the weight of the head and enable us to turn our head in all directions. It provides these movements through the discs and joints between the vertebrae (vertebrae). The spinal cord passes through the neck vertebrae. From the holes between the vertebrae, the nerves that provide the movement of the arm muscles and the sense of the arms come out.
There are 7 vertebrae in the neck region. Starting at the level of the second and third vertebrae, there is a cartilage tissue called a disc between all vertebrae. The disc material between the two vertebrae consists of a relatively hard sheath on the outside and a gel-like soft tissue on the inside. With the weakening or tearing of the outer sheath, the inner part slides outward and begins to put pressure on the nerves. While weakening or tearing of the outer layer causes more neck pain; Neck hernia, which can also be defined as the displacement of the inner layer outward, causes pain especially on the shoulder and arm, as it puts pressure on the nerve root. Arm pain is often more severe than neck pain, as there is pressure on the nerve roots. Depending on the severity of the pressure on the nerve roots, weakness and/or numbness may occur in the arm and hand muscles.
As I mentioned before, severe pain in the arm due to the pressure on the nerve root is the most important symptom of neck hernia. The pain, which is severe in the first week, decreases and disappears within 2-3 weeks. During this period, pain relievers and muscle relaxants are recommended to reduce the severity of the pain. Some patients may also benefit from Physiotherapy. The neck brace can be used with the doctor’s recommendation.
In a group of patients, pain may persist despite everything. Surgery may be considered for chronic long-term pain or for severe pain that is unbearable despite the use of painkillers.
In some patients, loss of strength develops due to pressure on the nerve root. The development of loss of strength requires the removal of pressure on the nerve, that is, surgery.
Spontaneous relief of pain does not mean that the disease has disappeared. In order for the patient not to have the same pain attack again, it is necessary to do the exercises that we recommend to protect the neck and strengthen the neck muscles.
To summarize, we apply 3 types of treatment in patients with Neck Hernia; medication, physical therapy, and surgery. With medication and physical therapy, approximately 85% of patients are relieved, their symptoms improve and surgery is not required. Patients whose pain does not go away despite medication and physical therapy, especially those who have weakness in the arm, should definitely undergo surgery. Because the losses that will develop later on may become impossible to recover.
Today, very promising results are obtained in neck hernia surgeries, by experienced hands, with the help of developing new techniques and microscope.
The aim of surgical treatment is to relieve pressure on the spinal cord and nerve tissue. The surgery applied for this purpose is “Cervical Microdiscectomy”. A skin incision of approximately 2-2.5 cm is made from the front of the neck and the cartilage tissue causing the pressure between the vertebrae is removed. Thus, the patient’s pain disappears, complaints such as numbness and weakness disappear immediately.
When the patient wakes up after this operation, which takes about 30-40 minutes, he realizes that his arm pain has disappeared dramatically. He or she can start walking within a few hours and be discharged the same evening or the next morning. After about 1 week, he can return to work.
With removable cervical disc prostheses, which we have placed in place of the disc material removed in young patients in recent years, new hernia formation at adjacent levels and limitation of neck movements are prevented in the following years.
