CERVICAL DISK SYNDROMES

Cervical Disk Syndromes

Overview

  • The cervical region contains seven cervical vertebrae and intervening disks.

  • Disks consist of:

    • Central nucleus pulposus (inner part)

    • Annulus fibrosus (outer part)

  • Function: Shock absorption, provides mobility to the cervical spine.

  • Herniation of disk material leads to cervical disk syndrome.

  • Most lesions occur at C5 and C6 levels due to mobility.

Types of Cervical Disk Lesions

  1. Soft Disk Lesions

    • Common in young adults.

    • Usually follows trauma.

    • Characterized by nuclear herniation through the annulus fibrosus.

  2. Hard Disk Lesions

    • More prevalent in older adults.

    • Gradual onset often associated with cervical spondylosis.

    • May cause pressure from posterior osteophytes on the spinal cord, resulting in mixed symptoms (pain in upper limb and weakness in lower extremity).

Clinical Features

  • Gradual or acute neck pain.

  • History of morning stiffness.

  • Neck extension exacerbates pain.

  • Tingling and numbness from compressed nerve root.

  • Radiating pain pattern:

    • Along neck, shoulder, upper arm, forearm, hand.

  • Decreased neck movement due to pain.

  • Localized tenderness over spinous processes and scapula.

  • Increased pain upon applying pressure on the head.

Sensory, Motor, and Reflex Changes

  • Depending on nerve root compression:

    • Follow dermatomal patterns.

    • Lower limb symptoms may arise from pressure on the anterior cervical cord (cervical spondylosis with myelopathy).

Distribution of Symptoms

  • Symptoms manifest as lower motor neuron signs in upper limbs and upper motor neuron signs in lower limbs.

Investigations

  1. X-ray

    • Normal in soft lesions.

    • In hard lesions: reveals disk space narrowing, osteophyte formation, intervertebral foramen narrowing.

  2. MRI

    • Non-invasive, useful in lesion localization but costly.

  3. CT Scan

    • More applicable in traumatic neck conditions than degenerative ones.

  4. EMG

    • Assesses electrical activity in muscles.

Rehabilitation / Treatment

  • Conservative Treatment: Rest is crucial for healing and reducing inflammation.

  • NSAIDs: Commonly used for pain relief.

  • Gradual Exercises: After pain reduction, encourage graded isometric neck exercises.

Measures to Reduce Pain and Inflammation

  1. Thermotherapy

    • Superficial: IFT, TENS, infrared rays, hydrocollator packs.

    • Deep: Ultrasound, SWD, microwave therapy.

  2. Cryotherapy

    • Utilizes ice packs and massages.

  3. Massage

    • Friction, kneading, etc., to alleviate pain and induce relaxation.

Strengthening and Mobilizing Exercises

  • Strengthening Exercises: Focus on isometric exercises when movement is contraindicated.

  • Weak Muscle Improvement: Active assisted neck exercises for strengthening.

  • Mobilization Exercises: Relaxed active and passive movements for neck mobility.

  • Combination Exercises: Integrate exercise types using PNF technique.

  • Cervical Traction and Collars: Additional support methods.

Additional Measures

  • Maintain correct neck posture throughout daily activities (chin tucked, neck straight).

  • Use appropriately sized pillows to support proper neck alignment during sleep.