What is Cervical Disc Prolapse?
Injury to a disc in the neck in which the soft jelly-like nucleus pushes out through a tear or weakness in the annulus, often pressing on a nearby nerve root or, less commonly, on the spinal cord itself. Patterns range from a bulge through to a sequestrated free fragment.
Causes
Age-related disc change, poor lifting technique and repetitive lifting, being overweight, a sedentary lifestyle and prolonged sitting with poor posture, long periods looking down at phones, tablets and laptops (“text neck”), smoking, previous neck injury, and genetic predisposition.
Symptoms
Cervical radiculopathy — sharp, burning or shooting pain travelling from the neck into the shoulder, arm or hand, with pins and needles or numbness in a specific area and weakness in a particular muscle group. Symptoms often worsen with extending or rotating the neck towards the affected side. Mechanical neck pain — dull ache, often radiating into the shoulder blades, worse with prolonged sitting and screen work. If the cord is compressed, features of cervical myelopathy may develop.
Diagnosis
History of pattern, triggers and neurological features. Examination of neck range, neurological assessment of the arms (strength, sensation, reflexes), and provocative tests such as Spurling’s manoeuvre.
Imaging
MRI is the investigation of choice — it shows the disc, the nerves and the spinal cord in detail. CT when MRI is not possible or bony anatomy needs definition. X-ray for alignment, instability and degenerative change. EMG is occasionally used to confirm which nerve is affected when the picture is unclear.
Treatment
Most cervical herniations settle on their own — the body reabsorbs the material over weeks to months and the majority of patients improve substantially within 6–12 weeks of conservative care. Non-surgical management: short period of relative rest (a soft cervical collar can be useful briefly), structured physiotherapy (neck range, postural retraining, scapular and deep-neck-flexor strengthening, nerve mobilisation), medications, and CT-guided transforaminal nerve-root steroid injections. Surgery (ACDF, cervical disc replacement, or posterior foraminotomy) is considered for severe persistent arm pain, significant or progressive weakness, or symptomatic myelopathy.