Cervical Disc Protrusion (Slipped disc in the neck)
Cervical Disc Protrusion (Slipped disc in the neck)
Condition
Herniation of part of the intervertebral disc causes pressure on a nerve or the spinal cord. The cause is usually degenerative (wear and tear) but can also follow trauma.
Symptoms
Patients usually present with signs of radiculopathy (arm or leg pain) or myelopathy (neurological symptoms including clumsiness of the hands). Patients with myelopathy often present later as the early signs may be subtle and not immediately recognized.
Complications
Permanent numbness or weakness of the arm/ hand, neuropathic pain due to nerve damage or paralysis effecting arms and legs in cases of severe myelopathy.
Treatment
Conservative (non-operatively)
Most patients with a slipped disc causing arm symptoms only (radiculopathy) respond to conservative management within ~3 months. This usually composes of regular analgesia and physiotherapy. If the pain does not settle surgery should be considered. In cases of myelopathy an operation should be considered as soon as possible! Damage to the spinal cord is often not reversible. The main aim is to prevent deterioration.
Treatment
Conservative (non-operatively)
Most patients with a slipped disc causing arm symptoms only (radiculopathy) respond to conservative management within ~3 months. This usually composes of regular analgesia and physiotherapy. If the pain does not settle surgery should be considered. In cases of myelopathy an operation should be considered as soon as possible! Damage to the spinal cord is often not reversible. The main aim is to prevent deterioration.
Operation
Anterior cervical discectomy or cervical disc replacement can address radiculopathy and myelopathy. Often it is the surgical treatment of choice for patients who have not responded to conservative treatment. A laminectomy is also indicated for myelopathy and posterior foraminotomy for radiculopathy. In rare cases, a corpectomy might be necessary. There are several factors which will influence the decision which procedure is chosen. The differences are explained in the ’operations‘ section.
Outlook
The vast majority of patients undergoing surgery for radiculopathy are cured or significantly improve after surgery. None of the operations obviously change the nature of the underlying disease (i.e. wear & tear). In cases of myelopathy, the main aim is to prevent deterioration although symptoms often improve to some degree, in particular the stiffness of hand and walking. In some cases of myelopathy, patients continue to deteriorate despite successful surgery due to the damage that has been done. Unfortunately, the recovery of the spinal cord is often slow and unpredictable and might take many months.