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Cervical Disc Prolapse

Zoomed image of the spinal cord region.
Published by Dr. Umesh Srikantha on April 15, 2020

The normal intervertebral disc consists of a jelly-like substance (nucleus pulposus) at the center, surrounded by a thick band like fibrous ring known as annulus fibrosis.

Cervical disc herniation is a condition in which the inner gelatinous substance of the disc escapes through a tear in the outer, fibrous ring causing a compression of the spinal cord or the surrounding nerves, resulting in neck or arm pain.

It is called by different terms slip disc, bulging disc, herniated disc, protruding disc, ruptured disc

The word “slipped” means that a disc has lost its integrity and that a portion of the disc has passed beyond the normal anatomical boundaries. A herniated disc is the same thing as a ‘slipped disc’. When a disc fragment bulges beyond its normal position nerve irritation may occur which is often call a “pinched nerve”. Varying degrees of disc herniation may occur ranging from “bulge” (which is usually not serious) to “large herniation” or “extrusion”.

Image showing zoomed part of the herniated disc.

Disc prolapse may occur anywhere in the spine and only about 8% of herniated discs occur in the neck region.

Unlike elsewhere in the spine, disc prolapse occurring in the neck can cause serious complications due to compression of spinal cord leading to weakness of hands and legs.

Causes and Risk factors:

  • Aging – continuous wear and tear process that occurs at the joints
  • Improper ergonomics – prolonged strain on the cervical disc due to continued usage without any rest – such as prolonged mobile phone or computer usage in poor posture
  • Activities involving repetitive stress – physically demanding professions involving heavy weight lifting, athletes etc.
  • Smoking – accelerates degeneration process within the disc leading to easy damage
  • Sudden violent trauma – whiplash injuries, motor-vehicle accidents
  • Sedentary life style
  • Hereditary and Genetic factors may also play a role

Symptoms:

Cervical disc prolapse may present variedly depending on the location and extent of herniation:

The image highlights the pain radiated area in the human body in case of a herniated disc in the neck.

  • Pain that radiates down your arm and possibly into your hand. Active Family Chiropractic - Chiropractor in Willow Street, PA US ...
  • Pain on or near your shoulder blade,
  • Continuous or intermittent pain in the neck, especially while turning your head or bending your neck
  • Muscle spasms (meaning the muscles tighten uncontrollably).
  • Sometimes the pain is accompanied by numbness and tingling in your arm.
  • Muscle weakness in your biceps, triceps, and handgrip.
  • Sometimes, pain may have been first noticed pain in the morning after waking up, without any traumatic event that might have caused injury.

The image highlights the pain radiated depending on which cervical disc is herniated.

  • Some patients find relief by holding their arm in an elevated position behind their head because this position relieves pressure on the nerve.
  • Rarely, weakness of legs may occur, with problems in gait and balance,
  • Bowel and bladder disturbance (urgency, loss on control, straining- eek immediate medical attention)

Diagnosis:

Usually suspected during a doctor-visit by physical examination and confirmed by MRI scan

Treatment options:

Initial conservative management maybe attempted depending on nature of disc prolapse – most cases will get better within a couple days and completely resolve in 4 to 6 weeks.

  • Self-care – Restricting the activity, ice/heat therapy, cervical collar may help in restricting movement
  • Period of short bed rest – may help in relieving pain and inflammation – prolonged periods may lead to weak muscles and are counter productive
  • Over-the-counter drugs – Nonsteroidal anti-inflammatory medications, Analgesic (painkiller), muscle relaxants such as Aspirin, Paracetamol, Diclofenac
  • Physiotherapy – Strengthening exercises following percutaneous electrical nerve simulation (PENS) and transcutaneous electrical nerve simulation (TENS) to reduce muscle spasm
  • No role of traction

Indications for surgery include

  • Non-improvement of symptoms after a period of conservative therapy

Zoomed image of the spinal cord region.

  • Recurrent episodes of pain
  • Severe spinal cord compression with signal changes
  • Weakness or numbness of arms or legs and/or bowel and bladder disturbance

Types of surgery:

  • Anterior cervical discectomy & fusion (ACDF)
  • Artificial disc replacement
  • Minimally invasive posterior cervical Laminoforaminotomy and discectomy

Goal of surgery: to relieve the compression on the nerve or spinal cord by removing the herniated disc. Sometimes additional stabilisation may be required.

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