see also:

• lumbar disc prolapse

• 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 or on the spinal cord itself (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

• MRI scan cervical spine is the usual diagnostic modality
  • it is important to assess whether there is evidence of spinal cord compression (see below)

• 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
• physical 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 steroid/anaesthetic injection or epidural steroid injection
  • for possible surgical intervention if:
    • not settling
    • there is severe radicular pain
    • there is evidence of spinal cord compression / myelopathy - this warrants urgent MRI and neurosurgical assessment
      • this generally presents with neurologic symptoms such as:
        • clumsiness, dropping objects, loss of fine motor dexterity (difficulty buttoning a shirt or writing)
        • numbness, tingling, or weakness in the arms and hands
        • staggering, unsteadiness, or balance problems when walking
        • hyperactive reflexes, spasticity (stiffness), or positive pathological reflexes (such as Hoffman's or Babinski signs)
        • localized or radiating pain/stiffness in the neck and shoulders