Cervical disc prolapse is a condition wherein the disc in the neck slips causing severe pain the neck and arm.
The cervical vertebrae are the seven vertebrae in the neck. Cervical disc prolapse is less common than lumbar disc prolapse in the lower back. The lower four cervical vertebrae namelyC4, C5, C6 and C7 are more prone to prolapsing, the disc between C6 and C7 being the most frequently affected.
A disc is made up of an inner gel like substance called nucleus surrounded by an outer tough fibrous coat. When due to wear and tear of the disc the cartilage breaks down or thins, the inner nucleus bulges out through it. This is medically known as a disc prolapse.
Causes of cervical disc prolapse
- Wear and tear- In certain occupations like acrobatics, gymnasts and computer users, the neck undergoes repeated strain. This leads to wear and tear of the discs which is a cushion between two vertebrae. Wear and tear also occur naturally in old age.
- Commonly, people affected are in the age group of thirty to fifty years.
- Sometimes trauma to the neck due to a car accident or sports injury (like boxing, wrestling) can lead to a cervical disc prolapsed.
Symptoms and signs of cervical disc prolapse
Pain in the neck which is severe and shooting down the arm is a common complaint. It should be noted that the symptoms vary from person to person, so some patients may have only neck pain and others may have a pain only in the arm.
Tingling and numbness down the arm
Muscle weakness in one or both arms due to nerve compression.
Headaches similar to migraine
Some cases of cervical disc prolapse are asymptomatic and symptoms arise only when the disc bulges backwards or to the sides, putting pressure on nerve roots that come out from the spinal canal. Disc prolapsed without symptoms should be left alone.
Diagnosis of cervical disc prolapse
The diagnosis is quite clear after taking a thorough history and examining the neck. Most patients complain of the pain starting after a jerk or twisting strain to the neck.
Investigations to diagnose cervical disc prolapse
An x ray of the cervical spine and sometimes an MRI is indicated.
Treatment of cervical disc prolapse
A multipronged approach is advised as regards conservative treatment.
- Physiotherapy: Neck exercises to strengthen the neck muscles and reduce pain are taught by a physiotherapist. These should be practised regularly by the patient.
- Drugs: When the pain attacks, anti-inflammatory drugs are prescribed. In severe cases cortisone injections can be given.
- Rest: It is a good idea to rest the neck, so avoid computer work for long durations and take a break from sports. Once the pain subsides, the person must be encouraged to do neck exercises to regain mobility and function.
- Traction: This option generally shows good results in people suffering from cervical disc prolapse. A traction kit can be used at home under medical guidance or traction can be given at the hospital. Traction increases the space between the vertebrae thus allowing the disc to fall back into place.
- Surgery: If all the above options do not give good results after having tried them for weeks or months and the patient’s lifestyle is affected, surgery is the only option.
Principle of surgery – The bulging disc is removed and an artificial implant can be inserted to take over the function of the disc.
Photograph via sxc.hu
Written by Dr Nisreen Nakhoda, General Physician
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