Disc Problems (Prolapse)
A cervical disc prolapse, is a condition that appears to be
most prevalent in the 30-50 age group and is rare outside
this group. The prolapse of a disc is less common in the cervical
spine than in the lumbar spine. The pathology is similar to
the lumbar spine prolapse, where the soft nucleus centre of
the disc leaks out of the disc and puts pressure on the nerves
which emerge from the cervical spine. A chemical radiculitis
will ensue due to proteoglycan/phospholipase released from
the nucleus polposus causing an inflammatory reaction.
Symptoms and Diagnosis of Disc Prolapse
Patients with a cervical disc prolapse will experience severe
pain, which can be present in the neck, shoulder and down
the arm. This pain will be exacerbated by neck movements and
even by coughing or sneezing. The pain is often so severe
it will stop the person from sleeping. Classic patterns of
pain are often observed with a cervical disc prolapse; sometimes
there is no neck pain and the symptoms are felt in the arm,
or the opposite may be true, with neck pain only. In addition
to pain, there may be muscle weakness in the upper limb, paraesthetic
bouts or total anaesthesia. C6-C7 disc herniates most frequently
Once the patient history of severe neck pain with associated
arm pain has been established, diagnosis is relatively straightforward.
In these circumstances, neck movements will produce pain down
the arm in what is called a dermatomal pattern. This is because
the nerve roots at each level of the cervical spine supply
the skin sensation to known areas of the arm.
In some cases the diagnosis may not be so straightforward
and other tests may be necessary. An MRI scan may be helpful
in the diagnosis of cervical disc prolapse, although the findings
of these scans are not 100% reliable.
Treatment of Disc Prolapse
When the symptoms appear, the patient should rest and take
pain-relieving medication. There is some controversy as to
whether a neck collar (a soft collar which supports the neck
and prevents movement) is helpful in the early stages of this
injury. The success of a soft collar in these circumstances
is dependent upon the individual. One thing which is universally
agreed is that the collar should not be worn for much longer
than 48 hours, and as long as pain allows it should then be
discarded. Once the pain resolves, a gradual return to normal
activity should be encouraged, as should exercises to restore
the normal range of neck movement. If the symptoms persist
it may be necessary to see an orthopaedic consultant and surgery
should be considered.
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