CERVICAL DISC PROLAPSE

A prolapsed or herniated disc is also known as slipped disc. In this condition tears develop in the outer fibrous covering of the disc called annulus, allowing the inner soft gelatinous nucleus pulposis to escape into the spinal canal and compress the cervical nerve roots or the cervical spinal cord.

This may happen insidiously with wear and tear, through aging, normal daily activities or may be precipitated by acute trauma (such as lifting heavy weights or following a whiplash injury to the neck).

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SYMPTOMS

Primary sysmtoms are:

1. Cervical disc prolapse causes neck pain radiating down the arm and occasionally to the fingers of the hand on the side of the herniation.

2. A large central cervical disc prolapse may cause weakness and numbness in the limbs together with bowel and bladder dysfunction.

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INVESTIGATIONS

1. MRI of the cervical spine shows the spinal cord, the nerve roots arising from it, the vertebra and the discs. MRI shows the degree of degeneration of the disc, the extent of disc herniation and the degree of nerve root compression. Though several discs may show abnormality on MRI the surgeon decides which of the discs is causing the problem and treats accordingly.

2. X-Ray of the cervcial spine shows the vertebra and there alignment. Most commonly this is done in flexion and extension to check for any instability (listhesis).

3. CT scan of the spine is done in certain cases where, after MRI and X-ray, some more information is required by the surgeon. This is particularly relevant in traumatic disc prolapse to look at associated injuries and the size of the pedicles. 

4. Electromyography (EMG) / Nerve conduction test (NCV) is an electro-physiological test of the limbs that is done in certain cases where the diagnosis is in doubt, to rule out conditions like neuropathy that may be from diabetes, hypothyroidism or certain vitamin deficiencies. EMG can also give an indication of which nerve root may be involved by compression from a disc or bony spur called osteophyte, resulting in acute or chronic changes on EMG.

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TREATMENT OPTIONS

1. Treatment can be conservative: i.e. medicine and physiotherapy. If this fails to relive symptoms or neurological signs like weakness or numbness develops then surgery is opted for.

2. Surgery options are

   • Anterior cervical microdiscectomy and fusion (ACDF)

   • Anterior cervical microdisectomy and artificial cervical disc replacement.