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Cervical Disc Prolapse

Introduction

A cervical disc prolapse is a prolapse of the soft material within the middle of an intervertebral disc of the neck (nucleus pulposus) that breaks through the outer ring of the disc known as the annulus fibrosis.

The prolapse may press on one of the nerves supplying the arm giving rise to pain, numbness and weakness in the arm and then collectively as brachialgia.

Patient History

Patients who develop symptoms of a prolapsed intervertebral disc within the neck often complain of pain and tingling in a specific distribution of the upper limb depending upon which disc is prolapsed.

The most common discs that prolapse are those between the fifth and sixth cervical vertebra (C5-6) and the sixth and seventh cervical vertebra (C6-7).

Pain goes into specific regions that indicate the level of the prolapse and there is sometimes weakness associated with a particular movement.

From the history it is often possible to diagnose, which of the most common discs have prolapsed.

Examination

When patients are examined they often demonstrate reduced sensation in the area of pain and weakness of particular movements. In addition, particular reflexes in the upper limb are lost that can be demonstrated by the examining doctor.

This information gives further evidence of the level of disc prolapse.

Special Investigations:

The most common special investigation used for a prolapsed intervertebral disc within the neck is an MRI scan. The MRI scan confirms the level of the disc prolapse, the size of the prolapse and the extent of the nerve compression.

Plain x-rays may be used but these are less helpful as they only show the bones and do not show the discs themselves.

If there is any doubt about the nerves that are compressed the treating doctor may request nerve conduction studies or CT scans.

Natural History of a Cervical Prolapsed Intervertebral Disc:

Provided there is no progression in weakness and the pain can be controlled with simple analgesics the majority of cervical disc prolapses improve over a period of up to two months.

Treatments are described below, which help to alleviate the symptoms.

Majority of patients with a prolapsed cervical disc will not require surgery however those that do may require either an anterior cervical discectomy and fusion or posterior decompression. These treatments are dealt with in separate information packs.

Non-Surgical Treatments

Oral Analgesia

As pain is the most predominant feature painkillers are the mainstay of the majority of patients.

There is a separate leaflet on the All About Spines website that describes the use of various painkillers.

Painkillers including over-the-counter medication such as paracetamol and ibuprofen can be used. It is important to recognise medications that contain paracetamol such as cough and cold medication so that the total dose of paracetamol within any one day does not exceed the stated maximum.

Patients who are on other medications or who are susceptible to gastric side effects from non-steroidal medications such as ibuprofen or who are on blood thinning tablets such as warfarin should use non-steroidal medication with care and if there is any doubt consult their treating practitioner.

Other medication that is available over-the-counter includes codeine type medication and low dose diclofenac.

If these medications do not reduce the level of pain stronger painkillers can be obtained from your local family doctor and again these are dealt with in the article on pain medication.

Physical Therapy

Patients often find that physical therapy is of assistance. Physiotherapy, chiropractic treatment and osteopathy may all be of benefit. Traction devices may be utilised by various therapists.

Alternative treatments and Eastern medicine may utilise acupuncture and acupressure, homeopathic medicines may be of use.

The simple application of either heat or cold may reduce the pain.

The use of a collar is generally regarded as something that should be avoided although medical practitioners may sometimes recommend its use for severe pain.

Injection Therapy

If the pain continues in spite of simple measures, your practitioner may recommend injection of steroids into the facet joints and around the nerves to try to diminish your symptoms and avoid surgery.

Surgery

Surgery aims to remove the disc material that is pressing on the nerve.

Surgery may be performed from the front of the neck allowing complete removal of the disc and replacement of the disc itself with a cage of either plastic or metal that is filled with artificial bone or bone graft from the patient. This allows decompression of the nerve, fusion of the segment that has caused the problems and prevention of further difficulties.

There are debates about whether a single level fusion will cause accelerated wear and tear above and below the fusion, however this is a matter of debate and is by no means an absolute consequence of a fusion.

Alternatively, your surgeon may approach the disc from the back of the neck by gently mobilising the nerve root, removing the disc material and leaving the remainder of the disc in place.

The approach depends upon the surgeon's preference and experience and will be discussed with you at the time of your consultation.

Overall

Overall, cervical disc prolapses give rise to arm pain known as brachialgia. The majority of patients improve without surgical treatment but may require painkillers and physical therapy.

Patients who suffer a prolapsed intervertebral disc often complain of some residual symptoms even after the pain has diminished that include episodes of pain that can often be managed with short courses of painkillers and gentle mobilisation.

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