cervical disc prolapse

Last edited 06/2018

Prolapsed cervical disc may be precipitated by local strain or injury: often unguarded flexion and rotation. Usually there is a predisposing abnormality of the disc with increased nuclear tension.

Cervical radiculopathy is a clinical condition caused by the compression of the cervical nerve roots.

• patients may complain of pain, sensory deficits, motor deficits, diminished reflexes, or any combination of the symptoms (1).

Annual incidence is reported to be 107 per 100,000 men, and 64 per 100,000 women

• incidence seems to peak during the 4th and 5th decades of life (2)

Several risk factors have been identified:

• white race
• cigarette smoking
• prior lumbar radiculopathy
• other proposed risk factors include:
• lifting heaving objects
• frequent diving from a board
• driving equipment that vibrates
• playing golf (2)

The condition is caused by compression of the nerve root. Cervical nerve root may be compressed by:

• herniated nucleus pulposus - in 25% of patients
  
  
• three main types of disk herniation have been described:
  
  
• intraforaminal - most common type, results in predominantly sensory radicular symptoms
  
  
• posterolateral - results in weakness and potentially muscle atrophy
  
  
• midline - rare, result in symptoms of myelopathy, such as upper extremity numbness, weakness, gait disturbance, ataxia, and urinary incontinence
  
  
• C7 root (C6-7 herniation) is the most commonly affected, followed by the C6 (C5-6 herniation) and C8 (C7-T1 herniation) nerve roots
  
  
• forminal encroachment/degenerative changes (cervical spondylosis) - in 75% of patients
  
  
• spondylosis of uncovertebral joint's located anterior to the nerve root tends to affect the anterior aspect of the nerve root while facet joint arthritis affects the posterior aspect of the nerve root.
• decreased disk height due to degenerative loss may also decrease the diameter of the foramen and cause nerve root impingement (1,2,3)

Reference:

• (1) Onks CA, Billy G. Evaluation and treatment of cervical radiculopathy. Prim Care. 2013 Dec;40(4):837-48, vii-viii.
• (2) Iyer S, Kim HJ. Cervical radiculopathy. Current Reviews in Musculoskeletal Medicine. 2016;9(3):272-280.
• (3) Childress MA, Becker BA2. Nonoperative Management of Cervical Radiculopathy. Am Fam Physician. 2016;93(9):746-54.