Can completely heal the bulging intervertebral disc with an operation

Collared disc herniations do not always have to be operated on

by Maja Langsdorff

Herniated discs in the cervical spine are extremely rare. They are four times more common in the lumbar region, says neurosurgeon Christoph Hamburger from the Großhadern Clinic in Munich. Sciatica and lumbago are the most well-known ailments that can cause spinal disc damage in the lumbar region. Patients with incidents on the neck often search in vain for relevant information. Generally understandable publications mostly deal with incidents in deeper regions that have little in common with those around the neck. Because of the different anatomical conditions, herniated discs in the lumbar region usually threaten one or more nerve roots, but not the spinal cord. Herniated discs on the neck are not operated on more often, but often faster, because of the risk of paralysis.

Often, a slipped disc on the neck is a problem of aging, but not age. "We have patients between 14 and 84, athletic, unsportsmanlike, fat, thin," says Hamburger. The intervertebral discs, bulging with fluid and elastic in adolescents, change with the aging process. And it starts early. Professor Ernst Grote from the Neurosurgical Clinic at the University of Tübingen: "Degeneration begins at the age of 20, and it affects the sedentary civil servant as well as the hard-working bricklayer." He is convinced that everyone who only sits or stands is at increased risk wear - and smokers. With these, namely, the supply of the intervertebral discs with oxygen is hindered.

Herniated discs are not uncommon per se; every fifth person has one. Most have no idea about this because the incident itself does not necessarily cause discomfort. Only when a nerve is pressed does pain arise. But that doesn't mean that an operation is necessary. A cervical disc operation is "only the most extreme means and, on top of that, very complicated," says Walter Oberländer, editorial consultant for the magazine "Medizin heute". When computed tomography appeared in the mid-1980s, and later magnetic resonance imaging, which made it possible to take very precise images of the spine, this led here and there to, to put it cautiously, greater willingness to operate quickly.

However, neither a few weeks of pain nor a tomographically confirmed finding are generally a reason for an operation on the neck. Almost every orthopedist, neurologist and neurosurgeon says the sentence at some point: "We do not operate on the image, but on a person." That means: You don't correct a changed anatomy, but remove a functional disorder that is expressed in pain or paralysis. Surgery usually removes the pain quickly. But it doesn't change the fact that there are signs of wear and tear on the spine, emphasizes Christoph Hamburger: “The operation takes the pressure off the nerve. As a rule, this means that people are 'born again'. "

The operation of a herniated disc may be a routine matter for specialists - the patient should get a second opinion if possible before such a serious procedure. There is often the chance for self-healing - a process that can take months, however. Operations are only called for in three cases: when acute paralysis occurs, when paralysis persists or intensifies despite conservative treatment (see "Surgical Methods"), and when the neck disc bulges towards the spinal cord (medial). That rarely happens, "but then it burns," says Hamburger. In the worst case, there is a risk of paraplegia without rapid surgery.

Most of the time, however, the disc material does not emerge medially, but laterally, so that "only" one nerve root is massively pressed and irritated, inflamed and swollen. As uncomfortable as the pain may be, it is only an accompanying symptom. More alarming are abnormalities that indicate nerve root damage: tingling, numbness, weakness. Since each nerve is responsible for a specific muscle, damage to or death of a nerve also poses a risk to the muscles. Depending on which cervical vertebrae the herniated disc lies between, the arm extensor (triceps), the arm flexor (biceps) can be weakened and paralyzed or individual fingers can become permanently numb.

The operation may be the quicker and sometimes the only way to get rid of the symptoms permanently. For what follows, it is crucial that the patient takes responsibility for his or her body and, as Grote says, "becomes more body-conscious and does less overexploitation". Hamburger criticizes more and more patients with the claim "Doctor, fix it". Strengthening the muscles and thus the connective tissue through regular, light compensatory gymnastics is the only way to prevent further problems. Prevention is also recommended for (still) healthy people: Anyone who often has a sore or stiff neck and sits a lot shouldn't wait until they have "their fist in their neck".