Cervical disc protrusion, commonly known as disc bulge occurs when the spinal discs and associated ligaments are intact, but may form a bulge that will press on the spinal nerves. This condition causes pain in the neck, shoulder and the arms. Usually, the symptoms include a dull, aching, or sharp pain in the neck or the shoulder blades. Sometimes, the pain may radiate along the arms to the hands and fingers. Tingling sensation and numbness may be felt at the fingertips. It generally develops in individuals in age group of 30-50 years as a result of trauma to the cervical spine.

Diagnosis

It is necessary to seek medical care before your symptoms get worse. Initial visit to your doctor may include a physical examination, evaluation of your symptoms and medical history and a neurological examination. A computed tomography (CT) scan or magnetic resonance imaging (MRI) may be advised to assess the disc damage.

Treatment

Both surgical and non-surgical treatment approaches are available for management of cervical disc protrusion.

The first line of treatment your doctor may suggest is conservative methods such as cold or heat therapy. During the first 2-3 days, applying ice (wrapped in a towel) can reduce swelling and pain by limiting the blood flow. Heat therapy can be started after 3 days to increase the blood circulation and relax the soft tissues. Cold/heat therapy should not be continued for more than 20 minutes each time. Medications such as non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants may be prescribed. Physical therapy treatments which include massage, stretching exercises and neck traction may be recommended. Most of the time, these self-care measures alleviate your pain in about 4-6 weeks. If the condition is severe that cannot be treated with conservative approaches or in case of spinal cord compression, your doctor may recommend surgery. Cervical disc protrusion can be corrected by partial discectomy, discectomy (removal of disc), or laminotomy. These spine surgeries can be done using the minimally invasive method involving smaller cuts and tiny instruments.

Neck pain

The first 7 vertebral bones on the spinal column form the cervical spine and are located in the neck region. The neck bears the weight of the head, allows significant amount of movement, and is also less protected than other parts of the spine. All these factors make the neck more susceptible to injury or other painful disorders. Common neck pain may occur from muscle strain or tension in everyday activities including poor posture, prolonged use of a computer and sleeping in an uncomfortable position.

Causes

The most common cause of neck pain is injury to the soft tissues (muscles, ligaments, or nerves) or prolonged wear and tear. Traumatic accidents or falls and contact sports can cause severe neck injuries causing pain in the neck. Neck pain can also come from infections, tumors or congenital abnormalities of the vertebrae. Common conditions producing neck pain include:

  • Rheumatoid arthritis: It is an auto-immune disease in which the body's immune system attacks healthy joints, tissues and organs. The condition occurs most often in the upper neck area causing inflammation of the lining (or synovium) of joints resulting in neck pain, stiffness, swelling and loss of function.
  • Cervical disc herniation: Disc herniation is the bulging or rupture of the soft fibrous tissue, discs, cushioning the vertebrae. Cervical disc herniation refers to herniation of discs in cervical spine region or neck region. As a result of this the soft central portion called nucleus pulposus bulges out through the tear in the capsule. The condition can be caused by the normal ageing or by traumatic injury to the spine. The condition results in painful, burning, tingling or numbing sensations in the neck.
  • Cervical Spondylosis: Cervical spondylosis refers to abnormal degeneration of the cartilage and bones in the neck region. The condition results in neck pain radiating to arms or shoulder and neck stiffness that gets worse over time.
  • Cervical Stenosis: Cervical stenosis refers to narrowing of the spinal canal that protects the spinal cord and its branching nerves. The condition causes neck pain radiating to arms and hands.
  • Degenerative disc disease: Degenerative disc disease refers to gradual deterioration of the disc between the vertebrae and is caused due to ageing. As people age, intervertebral discs lose their flexibility, elasticity and shock absorbing characteristics, resulting in neck pain.

Diagnosis

Diagnosis of neck pain is made with physical examination and other imaging techniques including electromyography (EMG), X-ray, MRI scan, CT scan, blood tests and bone density assessment.

Treatments

Treatment options include rest, ice application, elevation of the injured area, using a soft neck collar and neck immobilization using a splint, cast, or sling. Medications such as anti-inflammatory drugs, analgesics and muscle relaxants may be prescribed to reduce the pain and inflammation. Certain stretching and strengthening exercises may be recommended to strengthen the neck muscles.

Surgical treatment by anterior cervical discectomy with spinal fusion is typically recommended only after non-surgical treatment methods fail to relieve the pain. An anterior cervical discectomy is a surgical procedure performed to remove a herniated or degenerative disc in the cervical (neck) spine. Spinal fusion may be performed to provide stability to the spine.

The following steps may help you prevent or improve your neck pain:

  • Practice relaxation exercises to prevent undesirable stress and tension to the neck muscles
  • Perform stretching exercises for your neck before and after exercise
  • Keep good posture if you work at a computer and adjust the monitor at your eye level. Stretch your neck frequently.
  • If you use the telephone a lot, use a headset
  • Use a pillow that keeps your neck straight
  • Wear seat belts and use bike helmets to reduce injuries
  • American Association of Neurological Surgeons
  • American Board of Neurological Surgery
  • American Medical Association
  • The Congress of Neurological Surgeons
  • College of Physicians and Surgeons of Newfoundland & Labrador
  • North American Skull Base Society
  • North American Spine Society