The cervical disc acts as a shock absorber between the bones in the neck. The disc degenerates, typically around age 30- 40 years and older. The normal gel-like shock absorbing center of the disc dehydrates gradually, and as this happens the space between the vertebral bodies collapses. This causes the disc space to narrow, and as a result added stress is applied to the facet joints of the spine. This causes neck pain as a result of further wear and tear. With time this leads to cervical arthritis, and degenerative disease. In addition to the ongoing degenerative process the cervical disc can also protrude and put pressure on the spinal cord or nerve roots when the rim of the disc weakens. This is known as a herniated cervical disc/disc bulge.
Discs are soft, rubbery cushions found between the hard bones (vertebrae) that make up the spinal column. The discs in the cervical spine (neck) are composed of a thick outer ring of cartilage (Annulus fibrosus) and an inner gel-like cushion (Nucleus). These function as shock absorbers for the cervical vertebrae, and also allow for movement. The spinal canal is a hollow space in the middle of the spinal column that contains the spinal cord and other nerve roots.
As the disc degenerates it may herniate or rupture when part of the nucleus pushes through the outer edge of the disc and migrates toward the spinal canal and nerves. The spinal nerves are very sensitive to even slight amounts of pressure, which can result in pain, numbness, or weakness in one or both arms.
In children and young adults, discs have high water content. As people age, the water content in the discs decreases and the discs collapse and become less flexible. As the discs begin to shrink the spaces between the vertebrae get narrower. Scientific research has shown certain conditions that can further weaken the disc, these include:
- Improper lifting
- Excessive body weight which can place added stress on the discs
- Sudden pressures (Accidents, Injuries)
- Repetitive strenuous activities (Lifting, Twisting, Rotation, Work related injuries)
As with pain in the lower back, neck pain is also common. When pressure is placed on a nerve in the neck, it causes pain in the muscles between your neck and shoulder (Trapezius muscles). The pain may shoot down the arm. The pain may also cause headaches in the back of the head. Other symptoms include:
- Weakness in one or both arms (If you also have significant weakness in both arms or legs, you could have a serious problem and should seek immediate attention.)
- Tingling (a "pins-and-needles" sensation) or numbness in one or both arms
- Loss of bladder or bowel control
- Burning pain in the shoulders, neck, or arm
- Difficulty with your grip strength
- Difficulty with your handwriting
- Difficulty with your balance
- Difficulty opening jars
During your consultation, Dr. Pablo Pazmino will take a complete medical history to rule out other conditions that can cause symptoms similar to cervical herniations. Dr. Pablo Pazmino will also perform a complete and thorough physical examination. Radiography (X-rays) and other diagnostic imaging tests (MRI) will then be reviewed so that Dr. Pablo Pazmino can evaluate your bony quality, any instabilities, herniations causing any neural compression, bony spurs or other abnormalities to reveal the extent of damage to your cervical spine.
At Santa Monica Spine we pride ourselves in our duty to educate our patients. Dr. Pablo Pazmino uses his background as a teacher to ensure that you understand your pathology, imaging and treatment options completely during each visit. Our patients often comment on their amazement at the amount of time and effort we take to review their studies, often in a manner which they have never seen before. We want our patients to be involved in every step of the process and we feel that education is the first step towards achieving that goal together.
At Santa Monica Spine / Beverly Spine we are very thorough. Dr. Pablo Pazmino will rely on you to provide us with a complete history of any and all medical illnesses, hospitalizations, surgeries, or chronic conditions which you may have had in the past, or for which you have seen other physicians in the past.
More specifically we will require a history of your neck and arm pain itself. What is the exact location of the neck pain? Arm pain? When did the problem begin? What does the pain feel like? Has your neck been injured before? Have you previously been treated for neck pain?
Nonsurgical treatment is effective in treating the symptoms of neck pain. Symptoms of neck pain may last for days, several months, or become chronic. If symptoms are mild, Dr. Pablo Pazmino may recommend a variety of nonsurgical treatments.
- Rest. A soft cervical collar or neck brace may be used to limit neck motion and relieve irritation.
- Medication. Dr. Pablo Pazmino may prescribe nonsteroidal anti-inflammatory medications (NSAIDs) or other non-narcotic pain relievers to relieve your pain and reduce swelling. Muscle relaxers, analgesics, and anti-inflammatory medications are also helpful.
- Cold compresses or ice can also be applied several times a day for no more than 20 minutes at a time.
- After any spasms settle, gentle heat applications may be used.
- Acupuncture. Dr. Pablo Pazmino works with a team of Acupuncture specialists and may recommend this if indicated for your symptoms.
- Physical therapy. In some instances a specifically guided course of Physical Therapy is all that is required. Dr. Pablo Pazmino works hand in hand with a small group of therapists. Any physical activity should be slow and controlled, especially bending forward and lifting. This can help ensure that symptoms do not return-as can taking short walks and avoiding sitting for long periods. For the neck, exercises or traction may also be helpful. To help avoid future episodes of pain, it is essential that you learn how to properly stand, sit, and lift. A cervical traction device, hot and cold therapy, or active exercise program may help relieve symptoms. Exercises may include neck strengthening, neck and shoulder stretching, and aerobic exercises. Patients may also receive gentle massage and perform activities to improve posture.
- Injections: A series of selective nerve root blocks or epidural injections of a cortisone-like drug may lessen nerve irritation and allow more effective participation in physical therapy. These injections are given on an outpatient basis over a period of weeks. Dr. Pablo Pazmino only works with a small group of physicians who he trusts to perform these injections. Click here to see some of the recommendations Dr. Pablo Pazmino makes in regards to injections and pain management physicians.
Surgery may be necessary for patients with progressive neurologic symptoms or severe pain which do not improve with other treatments. Surgery may be required if a disc fragment lodges in the spinal canal and presses on a nearby nerve, causing significant loss of function. Surgical options in the neck are varied and depend entirely on the patient, the symptoms, exam findings, and the pathology. For some patients, a smaller surgery may be performed on the back of the neck that does not require fusing the bones together. These posterior approach options can include a microdiscectomy or posterior procedure like a minimally invasive microscopic Cervical Posterior Foraminotomy (click graphic below), depending on the size and position of the disc herniation.
In the neck, an anterior approach may be required. Anterior approaches can either be in the form of an Anterior cervical discectomy and fusion (ACDF) or a Cervical arthroplasty(ADR: Artificial Disc Replacement). This involves removing the entire disc to take the pressure off the spinal cord and nerve roots. The procedure for both an arthroplasty and a fusion are similar up to this point.
A fusion, (ACDF, an Anterior Cervical Discectomy and Fusion), is the current gold standard for treatment of the degenerated or herniated disc. With this procedure after the discectomy is performed, a spacer is placed inside the disc space, to restore the former height and curvature the collapsed disc was intended to assume, and a metal plate may be used for stabilization. The bone between the vertebral bodies will then grow through the center of the spacer and weld (or fuse) the vertebral bodies together. Once fused this completely eliminates painful motion from the involved area through a cervical fusion. Once the fusion mass is consolidated Dr. Pazmino will allow a progression of activities ranging from driving, work and sports. Final fusion occurs at 12-16 months. Patients are not required to wear a soft collar, unless needed for comfort while driving.
There are new minimally invasive methods for achieving an Anterior Discectomy and Fusion. For more information on these new techniques ask Dr. Pablo Pazmino to elaborate on the different options for your fusion.
A Cervical artificial disc replacement is another treatment option for a degenerated or herniated disc. Dr. Pablo Pazmino gained special training in different models of cervical disc replacements during his training abroad in Brazil, where these discs were available prior to their use here in the United States. With this procedure after the discectomy (Complete removal of the degenerated or herniated disc) is performed, Dr. Pablo Pazmino completely mobilizes the collapsed disc space. Next Dr. Pablo Pazmino custom sizes each patient for height, weight, depth and angulation for their artificial disc replacement. Fluroscopy is used throughout the entire procedure to ensure accurate placement. Next an artificial disc replacement is placed in the disc space and either spikes or a keels are used to stabilize the implant within the spine. This arthroplasty eliminates painful motion from the degenerated disc and eliminates several co-morbidities associated with a fusion. Complete range of motion is achieved within 6-12 weeks. Patients are not required to wear a soft collar, unless needed for comfort while driving. All incisions are placed within the skin folds, or wrinkles of the neck and a plastic surgical closure with dermabond is performed afterwards.
A Cervical hybrid artificial disc replacement is yet another treatment option for a degenerated or herniated disc in a patient with a prior fusion, or for the patient with multiple level disc herniations. . With this procedure after the discectomy (Complete removal of the degenerated or herniated disc) is performed, Dr. Pablo Pazmino completely mobilizes the collapsed disc space. Next Dr. Pablo Pazmino custom sizes each patient for height, weight, depth and angulation for their artificial disc replacement. Fluroscopy is used throughout the entire procedure to ensure accurate placement. Next an artificial disc replacement is placed in the disc space and either spikes or keels are used to stabilize the implant within the spine. At a prior level there has already been a fusion performed or can be performed during our procedure. This combination of arthroplasty and fusion eliminates painful motion from the involved disc and eliminates the comorbidities associated with a fusion. Complete range of motion is achieved within 6-12 weeks. Patients are not required to wear a soft collar, unless needed for comfort while driving. All incisions are placed within the skin folds, or wrinkles of the neck and a plastic surgical closure with dermabond is performed afterwards.
We have done research on our initial outcomes with cervical arthroplasty and presented these findings at national and international meetings. If you are interested in our outcomes please read our findings in the research section. Dr. Pablo Pazmino specifically analyzed how long patients after surgery took before returning to sports, work, and sexual activities.
Each of these surgical procedures is performed with Dr. Pablo Pazmino’s partner Dr. Carl Lauryssen: Neurological Spine Surgeon. To perform the procedure the patients are under general anesthesia and monitored throughout the case by an Anesthesiologist. This procedure may be performed on an outpatient basis or require an overnight hospital stay. You should be able to return to work in 2 to 6 weeks after surgery.
Newer Cervical artificial disc replacements are on the horizon as a new treatment option for degenerated or herniated disc in select patients. Dr. Pablo Pazmino is the Principal Investigator for the Discover Cervical Arthroplasty from DePuy. This is an ongoing clinical trial and we are currently recruiting patients with cervical pathology for entry into the study. With this procedure after the discectomy (Complete removal of the degenerated or herniated disc) is performed, Dr. Pablo Pazmino completely mobilizes the collapsed disc space. Next Dr. Pablo Pazmino custom sizes each patient for height, weight, depth and angulation for their artificial disc replacement. Fluroscopy is used throughout the entire procedure to ensure accurate placement. Next an artificial disc replacement is placed in the disc space and either spikes or keels are used to stabilize the implant within the spine. The arthroplasty eliminates painful motion from the involved disc and eliminates the co-morbidities associated with a fusion. Complete range of motion is achieved within 2-12 weeks. Patients are not required to wear a soft collar, unless needed for comfort while driving. To find out if you qualify contact us via telephone or email.
When Should You Seek Medical Care?
If severe pain occurs following an injury (motor vehicle accident, diving accident, or fall), a trained professional, such as a paramedic, should immobilize you to avoid the risk of further injury and possible paralysis. Emergent medical care should be sought immediately.
Immediate medical care should also be sought when an injury causes pain in the neck that radiates down the arms and legs.
Radiating pain, or numbness in your arms or legs which causes weakness in the arms or legs without significant neck pain should also be evaluated.
If there has not been an injury, you should seek a Spinal Evaluation with Dr. Pablo Pazmino when pain is:
- Continuous and persistent
- Accompanied by pain that radiates down the arms or legs
- Accompanied by headaches
- Accompanied by numbness, or tingling
- Accompanied by weakness!
Many patients seek care for Degenerated Disc pain by Dr. Pablo Pazmino because as an Orthopaedic surgeon he is specifically trained to diagnose, treat, and help prevent problems involving the muscles, bones, joints, ligaments, and tendons. Although Dr. Pablo Pazmino confines his practices to Spinal pathology he also treats a wide variety of diseases, injuries, and other conditions, including Foraminotomy.