In order to understand the mechanism of neck hernia, first of all, it is necessary to take a look at the structure of the neck bones. It consists of 7 vertebrae from the skull base. In the middle of each vertebral body is the spinal cord, which is the continuation of the brain. The senses that return to the brain from various parts of the body or the orders that are distributed from the brain to the body travel within the spinal cord. In the neck region, the nerves coming out of the level of each vertebral body spread to the arm and back, providing the sensation and movement of these regions.
The disc tissue, which we call the intervertebral cushion, has the outer part (anulus fibrosus) and inner part (nucleus pulposus). Neck hernia occurs as a result of the gelatinous inner part tearing the outer part, which consists of a stronger connective tissue, and compressing the spinal cord and nerves. The main difference from lumbar hernia is that there is partial or complete weakness in the whole body as a result of pressure not only on the nerves but also on the spinal cord itself. Since the spinal cord terminates at the level of the first lumbar vertebra, there are only nerves going to the foot in the lower lumbar vertebrae.
The increase in pain with the movement of the head and the localization of the pain in the neck or around the spine make us think of pathologies related to the neck region. Neck hernia is one of the most common pathologies of this region.
The complaints of the patient with neck hernia may include severe pain, pain radiating to the arm, headache, stiffness in the neck, numbness, imbalance, decreased ability, numbness, tingling, tinnitus, dizziness or weakness.
The most common symptom is PAIN. It is felt in the area stimulated by the pinched nerve. Neck movements, especially the back movement of the head, can increase the pain. It may respond or be resistant to painkillers. Pain is also severe in neck hernias that start suddenly. Other than that, it starts insidiously and increases over time.
Other conditions that can be confused with neck hernia include Multiple sclerosis (MS), Spinal stenosis, tumors, vitamin B12 deficiency, Spinal infections, Cardiac causes.
If we look at risky occupational groups and increasing causes for neck hernia;
-Traffic accidents, traumas, sudden braking, maneuvers and bumps
-The tensions of daily life,
-Wrong movements and wrong positions of the neck,
-Emotional tensions, weakness in the neck muscles,
-Degenerative changes in bone structure due to aging, calcifications
-Some common inflammatory rheumatic diseases (Ankylosing Spondylitis, Rheumatoid arthritis)
-Fibromyalgia
-Wrong posture and position disorder, stress, exposure to cold, fatigue
-For those who use computers and typewriters for a long time, it can be considered as a profession that affects the neck a lot, such as housework, secretarial, teacher, driver.
As a result of all these, it causes wear on the vertebrae, disc, joint and connective tissue.
Listening to the patient’s complaints and a careful neurological examination are the most important elements in the diagnosis. In addition to Direct Neck X-ray, Magnetic Resonance (MR) and Computerized Tomography (CT), if necessary, EMG-Nerve test is performed for the diagnosis of neck hernia. MRI is known as EMAR among the people and it is a very sensitive and outstanding method for neck hernia. It gives accurate results for 85-90% neck hernia. Most of the time, it alone is sufficient for the diagnosis of neck hernia. Shows soft tissues and nerve.
Today, there is more than one treatment method in the treatment of lumbar and neck hernia in the world. This causes problems from time to time, even among patients and even physicians.
90-95% of neck hernias heal without the need for surgical treatment.
To take a look at the treatment options;
-Manuplative (manual) treatment,
-Orthopedic bed rest + drug therapy (pain reliever, muscle relaxant, anti-inflammatory)
– In addition to drug therapy, primarily rest, Then, physical therapy, traction methods, and if it is not enough, the methods of giving drugs by entering the area with thin probes called needle (epidural steroid injection) or catheter (epidural lysis) can be applied with the techniques that have been developed recently.
Very few patients require surgical treatment. Conditions that require surgery in neck hernias;
Although severe pain in the neck and arms is at the forefront among the conditions that require surgery, the disappearance of pain does not mean that the threat of the spinal cord disappears. Therefore, in addition to numbness in the arms, weakness and limitation of movement, instability of the whole body, walking sideways, staggering and walking, which is called rap rap walking, shows that the neck hernia is quite advanced.
Patients whose complaints do not go away despite treatment and those whose neurological status worsens during treatment are candidates for surgical treatment. It is essential to relax the nerve in surgical treatment. Currently, the standard method is anterior (with anterior approach) microdiscectomy. The surgery is performed under general anesthesia. The patient is discharged within 1 day after the operation. This surgery, in which the herniated disc material is magnified up to 20 times under the microscope, and the spinal cord and nerves are relieved, is successfully performed in almost all hospitals today.
In patients with neck hernia, fusion is performed with prostheses or cages to prevent narrowing or angulation between the vertebrae that may develop after surgery.
Microdiscectomy with microsurgical technique is very successful in well-selected cases, especially in patients with persistent pain. The success rate is 97-98%.
To prevent neck hernia; Correcting posture and position, using the neck upright and properly rather than bending, bending and lifting the neck, systematically arranging the desk and working conditions. In computer use, it is absolutely necessary to correct the desk, computer screen, keyboard and working posture. It is not possible to treat neck pain with painkillers, nor to treat any mechanical pain. Strengthening exercises and Aerobics are very important in the treatment and prevention of neck pain. It helps in correcting neck curvature.
