In this MRI picture, the cervical vertebrae and the intervening discs (short white arrow) are seen, with the spinal cord (long white arrow) surrounded by CSF (double white arrow).
The diagnosis is made by performing an MRI of the cervical spine. Other tests that may be required are flexion/extension Xrays of the neck, and cervical CT myelography.
The treatment of cervical disc prolapse depends on:
- The presence of myelopathy or radiculopathy
- The duration of symptoms
- The age of the patient
- Associated medical problems
- The severity of the disease
For those with radiculopathy, treatment by the general practitioner and physiotherapist is used for 6-8 weeks. With appropriate pain relief (analgesic medication), strict attention to posture, and a regular walking programme, most patients’ symptoms settle during this time. If symptoms fail to settle during this time, or symptoms become worse, then surgery is required.
In all patients with cervical myelopathy, surgery is required to prevent progression to total quadraplegia.
There are many different types of surgery used in the cervical spine. The type of surgery used in each case depends on the extent of injury seen on the MRI, the posture of the cervical spine, the patient’s age, and the surgeon’s experience/preference. The operations are generally divided into 2 groups, (i) anterior (from the front), and (ii) posterior (from the back).
Some surgeons overseas have tried using a different spacer, called a disc arthroplasty or disc replacement. Careful analysis of disc arthroplasty has not demonstrated any benefit compared with ACDF with a cage, and therefore, it is not recommended.
XRays demonstrating a single cervical cage (left) and a cage with a cervical plate (right).
XRays demonstrating postoperative result with C6-7 ACDF