Cervical Disc Prolapse: Symptoms and Treatment

A cervical disc prolapse occurs when part of an intervertebral disc in the neck protrudes beyond its normal position. If the prolapsed disc irritates or compresses a nearby nerve root, it can cause pain travelling into the shoulder or arm, together with tingling, numbness or weakness.

Some cervical disc prolapses cause relatively few symptoms and many improve without surgery. Treatment depends upon the severity of pain, neurological findings and whether imaging shows nerve or spinal cord compression that corresponds with the symptoms.

What Is a Cervical Disc Prolapse?

The cervical spine contains intervertebral discs between the vertebrae. These discs help distribute load and allow movement in the neck.

Each disc has a tougher outer layer surrounding a softer central portion. If disc material protrudes through or beyond the outer part of the disc, this may be described as a:

cervical disc prolapse
herniated cervical disc
slipped disc in the neck
disc herniation

The term "slipped disc" is commonly used by patients, although the whole disc does not literally slip out of position.

What Causes a Cervical Disc to Prolapse?

A cervical disc prolapse can develop through a combination of age-related disc change and mechanical stress.

Possible contributing factors include:

disc degeneration
loss of disc hydration and elasticity
repetitive loading
sudden movement or strain
injury in some cases

In many patients, there is no single identifiable event that caused the prolapse.

What Symptoms Can a Cervical Disc Prolapse Cause?

Symptoms depend upon where the disc has prolapsed and whether it affects a nerve root or the spinal cord.

Possible symptoms include:

neck pain
shoulder pain
arm pain
shooting or burning pain
tingling
numbness
altered sensation
muscle weakness

Some patients have predominantly arm symptoms with relatively little neck pain.

How Does a Cervical Disc Prolapse Cause Arm Pain?

The spinal nerves that supply the arms leave the cervical spine through small openings between adjacent vertebrae.

If prolapsed disc material irritates or compresses one of these nerve roots, pain can travel along the course of the affected nerve into the shoulder, arm, hand or fingers.

This is known as cervical radiculopathy.

What Does Arm Pain from a Cervical Disc Prolapse Feel Like?

Patients may describe the pain as:

sharp
shooting
burning
electric
stabbing
deep aching

The pain may begin in the neck or shoulder and extend into the upper arm, forearm, hand or fingers.

Can a Cervical Disc Prolapse Cause Numbness or Tingling?

Yes.

If a nerve root is compressed, altered sensory signals can cause:

pins and needles
tingling
numbness
burning sensations
reduced sensation

The location of these symptoms can help indicate which cervical nerve root is affected.

Can a Cervical Disc Prolapse Cause Weakness?

Yes.

If the compressed nerve controls motor function, weakness may develop in muscles of the shoulder, arm, wrist or hand.

A patient may notice:

reduced grip strength
difficulty lifting the arm
difficulty bending or straightening the elbow
weakness in the wrist or fingers

New, significant or progressively worsening weakness should be medically assessed promptly.

Can a Cervical Disc Prolapse Cause Symptoms Without Neck Pain?

Yes.

The main symptoms may be experienced in the arm or hand rather than in the neck itself.

This is because the prolapsed disc may principally affect a nerve root rather than the structures responsible for local neck pain.

Can You Have a Cervical Disc Prolapse Without Symptoms?

Yes.

Disc bulges and prolapses can be seen on MRI scans in people who have no significant neck or arm symptoms.

The presence of a disc abnormality on imaging therefore does not automatically mean that it is clinically important.

The scan needs to be interpreted together with the patient's symptoms and examination findings.

Can a Cervical Disc Prolapse Compress the Spinal Cord?

Yes.

If disc material protrudes centrally into the spinal canal, it can reduce the space available for the spinal cord.

Significant spinal cord compression can cause neurological symptoms that extend beyond one arm.

Possible features include:

clumsiness of the hands
difficulty with fine finger movements
balance problems
unsteady walking
leg stiffness or weakness

These symptoms may indicate cervical myelopathy and require medical assessment.

What Is the Difference Between a Cervical Disc Prolapse and Cervical Stenosis?

A cervical disc prolapse is one specific structural abnormality in which disc material protrudes beyond its normal position.

Cervical spinal stenosis describes narrowing of the spinal canal or spaces around the spinal nerves.

A prolapsed disc can contribute to stenosis, but stenosis may also result from:

disc degeneration
osteophytes
facet joint changes
thickening of ligaments

How Is a Cervical Disc Prolapse Diagnosed?

Diagnosis begins with the clinical history and examination.

A clinician may ask:

where the pain starts
where it travels
whether there is numbness or tingling
whether weakness is present
whether hand function has changed
whether balance or walking has changed
how long symptoms have been present

Neurological examination may assess muscle strength, sensation, reflexes and hand function.

Do I Need an MRI for a Cervical Disc Prolapse?

Not everyone with neck or arm pain requires immediate MRI imaging.

An MRI may be appropriate when:

significant symptoms persist
there is neurological weakness
numbness or tingling is persistent or worsening
spinal cord involvement is suspected
the diagnosis is uncertain
surgery or another intervention is being considered

MRI can show the cervical discs, spinal nerves, spinal cord and areas of narrowing in detail.

What Does a Cervical Disc Prolapse Look Like on MRI?

MRI may show disc material extending beyond the normal boundary of the intervertebral disc.

The important questions include:

which spinal level is affected
whether the prolapse is central or towards one side
whether a nerve root is compressed
whether the spinal cord is compressed
whether the imaging corresponds with the patient's symptoms

An MRI abnormality should not be interpreted in isolation.

Does the Size of a Cervical Disc Prolapse Determine How Severe the Symptoms Are?

Not necessarily.

The apparent size of a disc prolapse does not provide a direct measurement of pain severity.

Symptoms depend upon factors including:

where the prolapse is located
whether it contacts a nerve root
whether the spinal cord is affected
the amount of inflammation or irritation
individual anatomical differences

A smaller prolapse in a critical location may cause significant symptoms, while a larger-looking abnormality may sometimes cause little discomfort.

Can a Cervical Disc Prolapse Heal Without Surgery?

Many patients improve without an operation.

Symptoms can settle as nerve irritation reduces and the prolapsed disc changes naturally over time.

Non-surgical management is therefore often appropriate initially when neurological function is stable and there are no signs requiring urgent treatment.

How Is a Cervical Disc Prolapse Treated?

Treatment depends upon the symptoms, neurological findings and effect on everyday function.

Management may include:

remaining appropriately active
exercise and rehabilitation
physiotherapy where appropriate
appropriate pain management
temporary modification of aggravating activities
surgery in selected patients

The treatment plan should be based upon the clinical problem rather than the MRI appearance alone.

When Might Surgery Be Considered?

Surgery may be considered when significant symptoms persist and imaging demonstrates nerve or spinal cord compression that corresponds with the clinical findings.

Factors may include:

persistent severe arm pain
substantial functional limitation
significant or progressive muscle weakness
persistent neurological symptoms
failure to improve with appropriate non-surgical treatment
evidence of spinal cord compression

The potential benefits and risks of surgery need to be considered individually.

What Operations Are Used for Cervical Disc Prolapse?

The operation depends upon the location of the disc prolapse and the structures being compressed.

Possible procedures include:

anterior cervical discectomy and fusion
cervical disc replacement
posterior cervical decompression in selected cases

The appropriate approach depends upon the patient's anatomy, the spinal level involved and whether the nerve root, spinal cord or both are affected.

What Is an Anterior Cervical Discectomy and Fusion?

An anterior cervical discectomy and fusion, or ACDF, is an operation performed through the front of the neck.

The affected disc is removed to relieve pressure on the nerve or spinal cord.

The operated level is then stabilised and fused.

ACDF is one established treatment option for selected cervical disc prolapses, but it is not required for every patient.

What Is Cervical Disc Replacement?

Cervical disc replacement involves removing the affected disc and inserting an artificial disc designed to preserve movement at the treated level.

It may be suitable for selected patients, depending upon factors including:

the location of the disc problem
the degree of degeneration
facet joint condition
spinal alignment
individual anatomy

Not every cervical disc prolapse is suitable for disc replacement.

Does Cervical Disc Surgery Always Require Fusion?

No.

Some cervical procedures involve fusion, while others may preserve movement at the affected level.

The choice depends upon the underlying anatomy and the objective of the operation.

What Symptoms Is Surgery Intended to Improve?

When surgery is performed for a cervical disc prolapse compressing a nerve root, the main aim is typically to relieve nerve-related arm symptoms.

This may include improvement in:

arm pain
shooting or burning pain
neurological symptoms associated with nerve compression
functional limitation caused by the compressed nerve

If the spinal cord is compressed, the objective may also include preventing further neurological deterioration.

The likely effect on local neck pain can be different and should be discussed separately.

Can Numbness or Weakness Persist After Surgery?

Yes.

Nerve-related pain can sometimes improve more quickly than numbness or weakness.

If a nerve has been compressed for a prolonged period or has sustained significant injury, neurological recovery may be incomplete.

The extent and speed of recovery vary between individuals.

When Should I See a Spine Specialist?

Specialist assessment may be appropriate when:

neck or arm pain is severe or persistent
tingling or numbness persists
weakness develops
symptoms substantially affect daily activities
symptoms are getting worse
the diagnosis is uncertain
an MRI or surgery is being considered

When Do Cervical Disc Symptoms Require Urgent Assessment?

Most cervical disc prolapses do not require emergency treatment.

However, symptoms suggesting significant spinal cord compression or neurological deterioration require prompt assessment.

Seek prompt medical advice if symptoms are associated with:

new or progressively worsening weakness
increasing clumsiness of the hands
difficulty with buttons, handwriting or fine finger movements
new balance problems
unsteadiness when walking
weakness or altered sensation affecting the legs
new bladder or bowel disturbance associated with neurological symptoms

These features may indicate spinal cord involvement rather than an isolated nerve-root problem.

Frequently Asked Questions About Cervical Disc Prolapse

Is a cervical disc prolapse the same as a slipped disc in the neck?

Yes. "Slipped disc" is a common non-medical term used to describe a prolapsed or herniated intervertebral disc.

Can a cervical disc prolapse cause arm pain?

Yes. If the disc compresses a cervical nerve root, pain can travel into the shoulder, arm or hand.

Can a cervical disc prolapse cause numb fingers?

Yes. Nerve-root compression can cause tingling or numbness in particular areas of the hand and fingers.

Can a cervical disc prolapse cause weakness?

Yes. Significant nerve compression can affect muscle function. New or worsening weakness should be medically assessed.

Does a cervical disc prolapse always need surgery?

No. Many patients improve without an operation. Surgery is generally considered when significant symptoms persist or neurological compression is clinically important.

Does a cervical disc prolapse always show on MRI?

MRI is very useful for identifying cervical disc abnormalities and their relationship to the spinal nerves and spinal cord. However, the imaging findings need to correspond with the patient's symptoms.

Can a disc prolapse in the neck affect walking?

It can if the prolapse significantly compresses the spinal cord. Symptoms such as balance problems, leg stiffness or difficulty walking require medical assessment.

Can a cervical disc prolapse get better naturally?

Yes. Many patients improve over time without surgery as nerve irritation settles and the disc prolapse changes naturally.

About This Article

This article provides general information about cervical disc prolapse, its symptoms, diagnosis and treatment. It is not intended to diagnose an individual's symptoms or replace personalised medical advice.

Medically reviewed by Professor Nasir A. Quraishi
Consultant Spinal Surgeon & Honorary Professor

Clinical sources: NHS information on cervical spondylosis and neck pain, NICE guidance on neurological symptoms, and established clinical guidance on cervical nerve-root and spinal cord compression.

Further Information About Cervical Disc Problems

If neck or arm symptoms are persistent or associated with numbness, weakness, hand clumsiness or walking problems, specialist assessment can help determine whether a cervical disc prolapse is responsible and whether further investigation or treatment may be appropriate.

Learn more about Cervical / Neck Pain

What Causes Neck Pain?
Neck Pain and Arm Pain: Could It Be a Trapped Nerve?
Cervical Radiculopathy: Symptoms, Causes and Treatment
Cervical Spinal Stenosis: Symptoms and Treatment
When Does Neck Pain Require Surgery?