Cervical disc prolapse: what are the symptoms and treatment options?
Cervical spine (neck) is the most mobile region of the spine. It has to carry the weight of the head in different postures and protect the spinal cord and nerve roots in the spinal canal while allowing a wide range of movements. This makes the discs in the cervical spine equally prone to degeneration (wear and tear) as in the lumbar spine. The nerve roots coming out of the spinal cord at each level pass through a narrow canal called neural foramina to exit the spine and run down the arms on each side. A disc bulging into the spinal canal or the neural foramen causes compression of the nerve root and leads to pain felt from the neck and upper back to all the way down the arm.
Just like the disc prolapse in the lumbar spine that causes back pain and pain in the legs, a disc prolapse in the cervical spine (neck) causes neck and upper back pain often radiating down the arm, forearm and may be associated with numbness or weakness in the hand. Acute cervical disc prolapse may cause severe intense neck and arm pain. If the nerve root function is affected, there may be numbness or tingling sensation in the hand and fingers along with weakness of the group of muscles supplied by that particular nerve. Pain may typically aggravate on lying in bed. Most of the times, keeping the painful side arm over the head may relieve the pain as the nerve root is a bit relaxed in that position.
The good news is that in most of the patients, the pain gets better in initial few weeks and the numbness and muscle weakness starts improving gradually. Initial treatment involves rest, anti-inflammatory medications and physiotherapy modalities.
But in a smaller percentage, surgery is required to alleviate the pain and achieve better nerve function recovery. Three usual situations where surgery is advised are:
- Severe intolerable pain not responding to conservative management,
- Pain that persists beyond 6 to 8 weeks.
- Significant numbness and muscle weakness affecting upper limb function.
When is surgical treatment necessary?
Surgical treatment is most commonly a discectomy and fusion done from the front of the neck. The entire disc along with the prolapsed part is removed and the segment is fused with bone graft and a titanium or PEEK cage in the disc space.
Cervical disc replacement is another option in suitable patients, where an artificial disc is placed in the disc space after discectomy. Surgical removal of prolapsed disc fragment can also be done through a minimally invasive approach from the back of the neck. It has the advantage of avoiding a fusion of that segment. Treatment options are discussed by the treating physician and the patient and the most suitable option decided based on individual case scenario.