Cervical Disc Prolapse - A Slipped Disc in the Neck

The discs in the spine are the soft tissue structures that lie between the bones (vertebral bodies). They function as both a spacer and a shock absorber. A disc is made up of a ring of outer fibres (the annulus), and central jelly-like substance (the nucleus). As a disc ages, the outer ring of fibres weakens and the nucleus dries out. This results in a weaker disc that is more prone to injury. A number of factors are thought to influence the rate of disc degeneration including inherited factors, previous injury, and smoking. The annulus may eventually rupture allowing the nucleus to prolapse through it. This is a disc prolapse.


Disc prolapses can irritate the nerve roots that pass behind the disc in the spinal canal. This nerve root irritation occurs by direct pressure of the prolapsed material on the nerve root. This nerve irritation stops the nerve from functioning normally and can cause arm pain, numbness, pins and needles, and weakness. These symptoms are called cervical radiculopathy. The arm pain radiates in the distribution of the nerve that is being irritated. It may be associated with neck pain.

The Natural History of a Disc Prolapse

Cervical disc prolapses are common, though not as common as lumbar disc prolapses. When a disc prolapse does occur it tends to cause a sudden onset of severe pain. Over the first few weeks this pain may resolve completely or settle down and plateau at a more manageable level. In many cases the symptoms completely resolve without treatment.

Assessment of Cervical Radiculopathy

Assessment involves taking a detailed history of your symptoms, followed by a physical examination. The history will include questions about the onset of symptoms, as well as the current level of symptoms. It is normal to be asked about your bladder and bowel function. This inquiry relates to loss of control rather than change in regularity. It is not uncommon for patients taking painkillers to become constipated. There should also be questions aimed at excluding other causes of your symptoms. You will also be asked about other medical problems, medications that you are taking, whether or not you have any allergies, and if you smoke.


The examination will include checking your arms for strength and sensation, as well as assessing your reflexes. If there are any concerns about loss of control of bladder or bowel function, then it may be necessary to perform a rectal examination.


Whilst the history and examination findings are frequently suggestive of a diagnosis, the diagnosis needs to be confirmed by an MRI scan.

​Treatment Options

Non-Operative Treatment

Most patients with cervical radiculopathy crave effective pain relief. Simple painkillers and anti-inflammatory tablets are the most commonly prescribed, though stronger, opioid-based painkillers may be required. Patients with intense nerve type pain may also respond to medications that specifically act to reduce the sensitivity of the nerves (gabapentin / amitryptyllline / pregabalin). Physiotherapy / osteopathy / chiropractic treatment may be beneficial, but may also aggravate symptoms. Other simple interventions such as massage and heat may also help. In some patients it is appropriate to consider an injection of steroid and local anaesthetic around the nerves and the spinal cord. . The injection would be either a cervical epidural or a cervical nerve root block, depending on the site of the disc prolapse.


Most patients with a cervical disc prolapse causing arm symptoms respond to conservative management within 3 months.

Surgery

Surgery is indicated in patients who have persisting pain not relieved by non-operative treatment, or who develop progressive neurological signs and symptoms. Surgery involves the disc being removed through the front of the neck to take the pressure off the cervical nerve roots and the spinal cord. The disc is then replaced with an artificial spacer. This spacer is either a metal cage or a cervical disc replacement. The majority of patients undergoing an anterior cervical discectomy and fusion or cervical disc replacement are cured of their symptoms after surgery.

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Thank you for all you have done for me during the last few weeks. I am most grateful not only for the main work but also the extras like telephoning to keep me informed. April 2018

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I was at all times given all necessary information, listened to, and I had confidence that Mr Langdon would complete the operation successfully. August 2018

Highly skilled and intuitive. October 2018

He was brilliant, I felt so comfortable that he would look after me even though I felt so anxious, and he made sure to give me all the information I needed. Also, every nurse and employee of Spire had nothing but brilliant things to say about Mr Langdon – I didn’t even need to ask. They would look on my notes and see I had Mr Langdon and say I was in excellent hands, and so I felt extremely happy. My partner also has disc problems so I will very much be pointing him to Mr Langdon October 2018

Very understanding and caring chap from start to finish, and a great bedside manner, unusual for some consultants. He is trying hard to understand my problems and working with me on a treatment plan for the present, and the future. November 2018

My consultant is obviously a very competent person and comes across as such. My procedure was fully explained both before and after my surgery. He also has a professional sense of humour, which helped as I was very nervous November 2018

Mr Langdon was always prepared to fully explain what was wrong and what he could do about it, he gave me a lot of confidence to make the decision to operate, and so far so good. Albeit early days. November 2018

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Excellent surgeon, great manner, explained procedure well. December 2018

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Mr Langdon, very professional and calm, did not push the treatment on me which I really liked, but advised and let me make up my own mind. January 2019

James Langdon is a really good person to have on your side. He’s smart, attentive and very dedicated. January 2019

I felt very safe with Mr Langdon, he fully explained the procedure, the risks and the recovery. January 2019

A very professional consultant. Showed great care and understood me as a person and patient. Saw me pre procedure and after in recovery room and own room. Visited again before going home in late evening and yet again first thing the next morning. It felt like I was Mr Langdon’s only patient which I know is far from the truth. Unfortunately, I am a nervous patient but could not have been in better hands. Many thanks January 2019

Explained everything in detail, understood my concerns, excellent bedside manner, very professional. January 2019

James Langdon is very patient – he answers questions and really listens to you and explains again if you haven’t quite got something. March 2019

Mr James Langdon was in every way, courteous, clearly good at his particular area of expertise, took time out every day to see me and check that all was ok. Was happy to answer any questions I had. April 2019

Mr Langdon was very understanding about my condition and talked me through every procedure that could help me get more mobile again. I was always at ease with him with his caring attitude. A true professional thanks. April 2019

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Very attentive, understood exactly what I was saying and made me feel confident that what I was doing was the right thing. June 2019

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Everything went off so smoothly. So pleased that the operation was so successful & the next day I was able to walk around without pain. July 2019

In overall terms he was absolutely brilliant. Clearly he is a brilliant surgeon but also a wonderful and understanding human being who, whilst pointing out the risks involved in the operation, filled me with absolute confidence that if success was possible, it would definitely be achieved – and I am delighted to say that it was. He is certainly a hero to me! It was also abundantly clear that all the staff at the hospital have absolute confidence in him and hold him in the highest regard. August 2019

Excellent, he fitted me in with an early appointment and treated me extremely well. September 2019

Extremely helpful explained everything very clearly. September 2019

Mr Langdon has been very clear and concise about the treatment he would be providing and the possible outcome. He has a very professional manner and I felt very at ease with him. He provided me with lots of information and visited me numerous times after my operation to see how I was and to explain what was done and what I should expect. I would be very happy to see Mr Langdon again in the future should I have a need to. September 2019

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Mr Langdon gave me the confidence to go ahead with surgery that I was very worried about. He is very professional and thoroughly explained all the pros, cons and side effects that could possibly happen. All of the above helped me to make a more informed decision. October 2019

James Langdon was the consummate professional. He explained his diagnosis in plain language that was easy to understand and interpret from a layman’s point of view. He was careful to manage expectations and clear about potential risks keeping them in perspective and proportionate to the circumstances. His manner was direct whilst always retaining a caring attitude listening to the patient and answering questions clearly; even taking time out to follow up with my wife whilst I was still in post Op recovery. Very thorough and I would highly recommend James. October 2019

Fully explained the treatment I required and the reasons why. I felt very confident I was in good hands. October 2019

Professional, inspires confidence. October 2019

He was very understanding explaining everything very carefully and advising me on altering medication for the procedure and when to restart normal regime. November 2019

He was courteous, listened, understood the issue very quickly. Explained everything well and was sure to confirm I understood and asked if I had questions. I didn’t feel hurried. He provided an effective and efficient service. I’d definitely recommend him. November 2019

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Very approachable and knowledgeable. Felt I was in very safe hands. December 2019

Very professional throughout. December 2019

Mr Langdon diagnosed my problem, explained fully the options I had regarding treatment also all the risks involved if I chose to have an operation. Mr Langdon organised a scan to confirm his diagnosis, and explained to me prior to my operation all that was involved in the procedure. Post operation Mr Langdon visited me in my room to check on my recovery and gave me the opportunity to ask any questions on the operation. I am very satisfied with Mr Langdon and his team on my treatment. December 2019

My marks of 10 across all questions reflect my opinion of James Langdon. Brilliant in all respects, in particular his explanation to a non medical man of my problem and his solution. December 2019

The consultant was fantastic. He explained everything I needed to know at each stage and I felt very confident that I was in good hands. December 2019

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