Cervical Disc Prolapse

 

Cervical Disc Herniation or prolapse:

Cervical disc prolapse has virtually the same aetiology or causes as lumbar disc prolapse in terms of degeneration, occupational and genetic factors. Trauma can be also more pronounced factor in the cervical region.

Cervical disc prolapse is more serious when compared to prolapse in the lumbar region due to the risk of spinal cord compression which can be much more serious and irreversible.

The lines of management are also conservative to start with in most cases particularly in soft disc prolapses where most of the cases settle with the help of pain management and physical therapy. The indications for surgical treatment of cervical disc prolapse are the same as in the lumbar region (intolerable disabling neck and arm pain, poor hand function, arm numbness and arm weakness) with less tolerance to canal stenosis due to the risk of spinal cord compression. Careful assessment of spinal cord function including proprioception, sensory function, motor function, and abnormal reflexes will help to take the correct decision for each patient.

Conservative management in soft disc prolapse cases are very successful, on the other hand most calcified disc are likely to require surgery even after a period of conservative management.

Epidural injection in cervical disc prolapse pathology:

Epidural injection in the cervical region is indicated in some cases, but it should certainly be done in perfect hands due to the risk of spinal cord injury. It is useful in my opinion in certain cases of nerve root symptoms and contra indicated if there is any sign of spinal cord impending compression. The clinical examination is the perfect guide for a perfect decision.

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Surgical treatment of Cervical Disc Prolapse:

The anterior discectomy and decompression is the surgical treatment of choice once surgery is indicated. In some cases posterior surgery is preferred particularly with multiple levels of spinal cord compression.

 Anterior cervical Discectomy and decompression:

This surgery is carried out through anterior neck approach (Smith –Robinson). The access is very easy and straight forward. The disc will be excised to decompress the anterior part of the spinal cord and nerve roots. The procedure is delicate and facilitated by the use of microscope or eye loops if required to increase visibility. Once discectomy and decompression are completed, anterior fusion using cage and/or plate will be performed. Artificial disc replacement is  also another choice to be carried out. This is, in my opinion, a preferred option as motion segment preservation technique.

 Cervical Spine Motion preservation surgery technique:

The idea of motion preservation technique is to maintain mobility in the intervertebral disc after excision to maintain the load distribution across the whole neck rather than being shifted to the adjacent intervertebral disc in case of fusion option of the disc. This is achieved by inserting an artificial disc (Total disc arthroplasty), which allows motion. This is particularly important when more than one intervertebral disc are involved. The surgical technique is also simple and postoperative rehabilitation is generally quicker compared to cervical spinal fusion. The clinical studies about total disc arthroplasty support its use, and outcome measures of more than 10 years follow up are very encouraging. We are strong advocate of total cervical disc arthroplasty surgery.

The risk of complication in anterior cervical disc surgery is only 3-4 %, including difficulty swallowing, hoarse voice, haemorrhage, infection, dural tear, neural injury, and implant failure. The success rate is above 90% in most cases.  

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