Cervical hernia is a disease that occurs when the cartilage between the neck vertebrae shifts towards the spinal canal and puts pressure on the nerves and spinal cord that come out of the spinal cord and come out of the arm.

There may be a hernia in the neck as well as in the waist. The discs separating the vertebrae are considered semi-joints. It consists of a gel-like substance in the middle of the disc and its surrounding cushions. The outer ones of these pads are stronger and harder than the inner ones. These pads begin to wear out in cases of aging and exposure to trauma. The outer layer gradually gets thinner and is torn after a sudden reverse movement.

The gel-like substance inside slides out of these tears, goes out of the spinal cord and goes to our arm and presses on our nerve, which gives the order for movement to those regions or allows you to perceive the sensation of those regions. Thus, we feel neck, arm pain and numbness, tingling, and sometimes weakness in that arm.

Reasons

Although there is no obvious cause, traffic accidents, traumas, extreme maneuvers, impacts, degenerative changes due to aging, long-term computer and typewriter users, and similar occupations that affect the neck very much have been accused.

Neck hernias are often caused by myofascial pain, fibromyalgia, frozen shoulder, etc. It is confused with diseases affecting the neck and shoulder calculus and arm.

The tensions of daily life, wrong movements and positions of the neck, psychological tension, weakness in the neck muscles, exposure to cold, fatigue, housework, sewing and embroidery, cleaning, hanging curtains, wiping are the factors that increase neck pain. Therefore, the incidence of neck pain in women is higher.

Especially stress causes contraction of neck muscles and neck pain and tension headache occur. In this way, in addition to muscle relaxants, dry needling, relaxation exercises, physical therapy and antidepressant medication are applied to the area.

Stress is the most important reason that increases neck pain and makes it chronic. Our economic, social and psychological problems increase neck pain. Constant tension and painful spots can be detected on the neck. Laughter, regular work, social pursuits and commitment to life are the most important weapons against neck pain.

The neck muscles also attach to the back of the head. Excessive use of these can cause tense posture, heavy working conditions, accumulation of stress, severe neck and headaches. Therefore, headaches may originate from the neck.

Symptoms

The most prominent complaint is pain in the neck, which can be unilateral or bilateral, radiating to the shoulders and arms. The pain sometimes spreads between the two shoulder blades and towards the back, together with a headache.  Pain increases with drooping arm, decreases when it is raised above the head, and the intensity of pain may increase at night. There may be numbness, numbness or hypersensitivity in the arms and/or hands, decreased muscle strength in the arms and/or hands (frequent dropping things from the hand, difficulty in grasping), muscle spasm, limitation of neck movements. If the spinal cord is affected in advanced stages, complaints such as weakness in the legs, numbness, gait disturbance, incontinence or inability to urinate may be seen.

Rarely, it may be accompanied by complaints such as dizziness, tinnitus, flying flies in the eyes, nausea, and poor concentration.

Diagnosis

For diagnosis, first of all, the patient's complaints should be carefully evaluated and a detailed examination should be made to exclude possible diseases. Then, direct radiographs are taken and narrowing of the disc distances, the condition of the cervical axis and degenerative changes are revealed. If any, a mechanical defect is detected. The definitive diagnosis of S-neck hernia is made by Magnetic Resonance Imaging (MRI). It makes a definitive diagnosis by showing the soft tissue. There is no exposure to radiation. If there is degeneration and ossification in the radiographs, computed tomography should also be taken to evaluate their compression on the nerves.

Treatment

Treatment is based on the patient's neurological status. Radiological neck hernia does not require surgery if there are no complaints or findings. However, patients with neurological findings and complaints should be evaluated for surgery. The sooner the diagnosis is made and the surgery is performed, the sooner and more successful the recovery of the neurological deterioration will be. Conservative treatment methods are used in patients who are not considered for surgery, suggestions are made about posture and movements and exercise is given to the patient.

Conservative Treatment

• Drug Treatment: Muscle relaxants, antirheumatic drugs, antirheumatic creams are given to the patients, which are approved as a result of their examinations. Painkillers are added to the treatment of patients with a lot of pain. Patients are given a short collar and rest.

• Manual therapy, called manipulative therapy, is very different from classical massage. It has been used for a long time in many countries such as Europe, Canada, the United States and Far East countries. During this treatment, different manual treatment techniques such as stretching, pressing, turning are applied to the diseased area. This treatment can also give successful results in lumbar and neck hernias, muscle spasms, contractures, neck headaches, spinal locking. In cases with high blood pressure, heart-lung or diabetes  it is an important advantage that these diseases do not interfere with manipulative treatment.

• Massage: Neck massage is performed by professional masseurs. The purpose of this; relaxation of the contracted neck muscles and widening of the superficial blood vessels. Thus, the muscle contractions that cause pain to the patient are eliminated, and the patient is also prepared for the neck pulling process.

• Physical therapy and traction: Physical therapy is extremely beneficial for those with neck pain, especially for chronic pain. Massage, hydrotherapy (water therapy), ultrasound, electrical nerve waves (TENS) are other treatment methods and must be applied by experts. Traction, that is, neck pulling, must be applied with the recommendation of a doctor and under his own control.

• Injection (algological treatment): It is the finding of the place that causes the pain and the administration of drugs that prevent pain perception. It can also be injected into the joints, around the nerve root and spinal cord.

• Strengthening exercises: It is very important in the treatment and prevention of neck pain. It helps in correcting neck curvature.

Surgical treatment
The surgery can be done from the front or back of the neck. If it is made from the anterior part of the neck, almost all of the disc between the vertebrae is removed and a cage is placed between the vertebrae with prosthesis or bone grafts. This is the most commonly preferred method and there is no repetition at the same level.  If surgery is performed on the back, only the overflowed disc is removed and no prosthesis or fixation is performed. There is a risk of recurrence, albeit low, after operations performed from the back.

After the surgery, the patient starts walking after 3-4 hours and can see his own needs. He stays in the hospital for 1 night. After about 7-10 days of rest, he can return to work.