Acute and degenerative disc prolapse can also occur in the cervical spine producing neck pain and potentially nerve root compression

Clinical features

• With nerve root compression, patients complain of shooting neuralgic pain down a dermatomal distribution with weakness and loss of reflexes depending on the nerve root affected
• Typically, the lower nerve root is involved (i.e. C7 root for C6/7 disc, C8 root for C7/T1 disc)
• A large central prolapse can compress the cord leading to a myelopathy with upper motor neurone symptoms and signs

Investigations

• Clinical findings
• MRI
  • The number of patients with asymptomatic disc prolapse increases with age resulting in a higher rate of false positives/incidental findings on MRI scanning - ensure clinical findings correlate with MRI findings before considering surgery

Management

• Analgesia and physiotherapy
• Surgery may be considered in cases resistant to conservative management