(Also called Herniated or Propapsed disc)

The spine consists of a series of vertebra that are stacked on top of another from the neck to the pelvis. These vertebraes are connected and kept in correct position by the discs that are between the vertebra and also the facet joints that are located on the side of the vertebral bodies and these interlock with each other.
There are also supporting ligaments and tendons. The discs between the two adjacent vertebraes are composed of a central, soft, jelly-like substance called the nucleus pulposis and an outer, tougher fibrous part called the annulus fibrosus.

What happens in some people is that the tough annulus fibrosus becomes damaged and tears, leaving a defect in the strong outer layer. A bit of the nucleus pulposis can then push through this tear and end up in the spinal canal and press against the nerves in the spinal canal. This can be because of a traumatic injury but is usually due to an inborn predisposition towards weak discs.

What is it?

As with a lumbar disc prolapse, there is herniation of the nucleus pulposus through the annulus fibrosus. The spinal cord extends from the brainstem to the lower spine and stops just below the level of the thoracic and lumbar spine junction. Therefore a slipped lumbar disc purely compresses nerve roots that are dangling in the spinal canal.

A herniated (slipped) cervical disc compresses the cord or the nerve roots as they leave the spinal cord. Compressing the spinal cord is obviously very dangerous and can lead to paralysis. The earliest signs of paralysis are very brisk reflexes when the surgeon taps your knee or elbow.

What are the symptoms?

When the part of the nucleus that herniated compresses the nerves in the spinal canal, you may experience neck pain and pain in one or both arms. Some people have a feeling of pins and needles in the hands. Pain, discomfort can also be felt in the shoulder, between the shoulder blades and on the front of the chest (thorax).
The later effects are those of weakness in the arms and hands and unsteadiness and weakness of the legs.

How is it diagnosed?

A clinical examination by your doctor or therapist will allow for a reasonable suspicion but the only definite way is by doing a magnetic resonance (MR) scan (see the section on tests).
Sometimes because of technical factors a CT scan is performed (see the section about tests). This is usually when a MR scan cannot be performed due to the unavailability of a MR scanner, when there are contra indications to doing a scan or there are technical factors like the presence of metal fusion apparatus in the spine that make a MR scan unreliable.
See the section on tests for the terminology that you will find on your MR scan report and what it means in plain English.
Other tests that might be used are discograms and nerve blocks. Sometimes EMG’s are also used (see the section on tests).

What is the treatment?

There are always four options:

No treatment - This is acceptable if there is no serious nerve compression - therefore in the absence of spasticity or muscle weakness.

There are always people who choose this option for a variety of personal reasons.

Non-invasive treatment - The initial treatment for a cervical disc herniation is conservative treatment that might include anti inflammatory medication, analgesics, physiotherapy and other manual treatment such as chiropractic manipulation, pressure point therapy, massage therapy, traction and other therapies. In some cases a rhizotomy or a nucleoplasty might be suggested as part of the conservative management.

Semi-invasive - These include procedures like radiofrequency rhizotomies (see the section on rhizotomies) and disc nucleoplasties (see the chapter on nucleoplasties). These treatments are highly effective, have very few side effects or complications and are performed as day procedures. These procedures have a very definite place in the non - surgical management of cervical disc disease.

Currently only some spinal surgeons are trained in these techniques and you should enquire about these directly. If your surgeon is not skilled or trained in these, there is a whole spectrum of treatment modalities that you are being excluded from. Try and consult someone that has training in these, and performs these on a regular basis to see whether you qualify for these treatments and whether they are suitable for your condition.

If conservative management is unsuccessful, then surgery is usually indicated. In situations where there is muscle loss or sensation loss due to a compressed, nerve, surgery is considered much earlier. Compression that continues for too long can cause permanent nerve damage. The longer the duration of the symptoms, the less is the chance of success when operating to decompress nerves.

Invasive (surgery) - the indications for surgery are:
1.) Failed conservative management
2.) Pain that does not respond to any other treatment modality and is sufficiently severe to limit your daily activities and quality of life. This includes local neckpain, referred pain and radicular pain.
3.) Muscle weakness due to nerve compression (radicular weakness)
4.) Spasticity.

The most frequently used operation is called an anterior cervical discectomy. Another operation that is used is a foraminotomy.