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Inter vertebral disc prolapse - Coggle Diagram
Inter vertebral disc prolapse
The cervical region consists of 7 cervical vertebrae with their intervening disks
The disk is made-up of
central nucleus pulposus and
annulus fibrosus at the periphery.
The disk functions as an
effective shock absorber and
gives the cervical spine more mobility.
If the disk material herniates because of trauma or
old age, it gives rise to the cervical disk syndrome.
More than 90% of the disk lesions in the cervical spine occur at the C5 and C6 levels
as these are the most mobile segments.
About 70 % of the people are affected with these changes by the age of 70 years
types
Soft disk lesions
Hard disk lesions:
This is more common than the first,
seen in older age group,
gradual in onset and
is usually due to cervical spondylosis.
Rarely large posterior osteophytes may cause pressure on the anterior portion of the SC and produce mixed symptoms of the
upper limb nerve root pain &
lower extremity weakness
(cervical spondylosis with myelopathy)
common in young adults and
is usually following trauma.
In this, there is only a nuclear herniation through the wide annulus fibrosus of the disk.
Clinical Features
Symptoms
The patient complains of
pain in the neck, gradual or acute in onset.
There is history of morning stiffness.
Extension of the neck increases the pain
may also complain of radiating pain along
the neck, shoulder, upper arm, forearm and hand
if the nerve root is compressed
Tingling and numbness develop ,
but it does not follow the dermatomal pattern.
signs
Movements of the neck are decreased due to pain.
Pain increases on hyperextension.
There is localized tenderness over the spinous process.
Trigger point tenderness at the scapular region is present.
Pressure against the top of the head increases pain
if the nerve root is compressed
sensory, motor and reflex changes occur and
follow the dermatomal pattern
Rarely symptoms referable to the lower limbs develop due to pressure of posterior osteophytes on the anterior portion of the cervical cord.
This symptom complex appears as a
combination of cervical roots and cord symptoms
[LMN upper limbs + UMN lower limbs].
dermatomal & myotomal pattern table
Investigations
X-ray
Normal in soft lesions
but in hard lesions it shows,
narrowing of disk space,
anterior and posterior osteophyte formation, and
narrowing of IV foramen
Myelography
It helps in localizing the lesion but is invasive.
MRI
This is useful, as it is non-invasive,
and helps localize the lesion,
but its high cost is prohibitive
CT Scan
It is more useful in evaluating traumatic conditions of the neck than degenerative conditions.
EMG, diskography, thermography is occasionally used
Treatment
Conservative Treatment
Rest
Cervical traction: Continuous or intermittent
Physiotherapy: Modalities, Isometric neck exercises
NSAIDS
Neck exercises
Cervical collar
Surgical treatment
Less than 5 % of the cases of cervical spondylosis require surgery
& is usually indicated in cases of chronic pain,
.
failed conservative treatment and neurological deficits due to root or cord compressions
The surgical procedure usually consists of removal of the cervical disk through an anterior approach and
.
cervical interbody fusion by placing an autologous iliac bone graft.
.
Excision of large osteophytes can also be
done through this route.
Excision of one or two cervical
bodies(corpectomy) may be justified inmultiple
level disk pathology.
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Preventive Measures
This can be done by
good postural habits and
using proper sized pillows of 7.5-10 cm thickness and should be placed under the neck rather than the head