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cervical_disc_prolapse

cervical disc prolapse

Introduction

  • cervical disc prolapse occcurs in 0.5-2% of the population and is thus a relatively common cause of neck or radicular pain radiating to one or both arms
  • it is usually due to degeneration of the disc but may be caused by an acute traumatic injury such as direct impact
  • it is most common at C5/6 disc where it tends to cause symptoms due to impingement of the C6 nerve root and pain and/or numbness and/or weakness on the C6 dermatome or myotome (C6 dermatome is outer aspect of upper limb extending down to thumb)
  • a C4-5 disc prolapse affecting the C5 nerve root may cause pain/numbness on outer aspect of shoulder and weakness of the deltoid
  • a C6-7 disc prolapse affecting the C7 nerve root may cause pain/numbness in hand and middle finger or triceps and finger extensor weakness
  • a C7-T1 disc prolapse affecting the C8 nerve root may cause pain/numbness on outer aspect of forearm and 5th finger or weakness of the hand flexors
  • compression into the spinal cord is a neurosurgical emergency and is suggested by either:
    • pain, tingling, numbness, and/or weakness in both arms and/or both legs
    • coordination or walking difficulty
    • bladder and/or bowel control issues such as incontinence or urinary retention
  • most occur in 30-50yr olds
  • it may only last a few days or may last months although most tend to become pain free by 4-6 months

Investigation

  • MRI scan cervical spine is the usual diagnostic modality

Management

  • analgesia - those with severe radicular pain may benefit from neuropathic pain modulators rather than opiates
  • soft cervical collar may provide acute symptomatic relief
  • ice / heat packs
  • initial rest
  • phyical therapy to strengthen and stretch the neck
  • chin tuck exercises
  • strengthen neck muscles to gain a posture with ears directly above shoulders rather than protruding forwards as this will reduce the stress on the discs
  • consider short course of oral corticosteroids
  • avoid exacerbating factors:
    • carrying heavy objects / backpacks / etc
    • strenuous activities, such as physical labor or playing sports
    • specific movements that worsen pain, such as turning head to one side
    • sleeping on the side may exacerbate it so patients may need to sleep more on their backs and modify their pillows
  • consider referral to neurosurgeon for:
    • possible nerve root steroud/anaesthetic injection or epidural steroid injection
    • possible surgical intervention if:
cervical_disc_prolapse.txt · Last modified: 2021/01/23 10:03 by wh