Neck pain due to nerve root entrapment (Cervical disc prolapse)

This is caused by an acute cervical disc prolapse or pressure on the root from spondylotic osteophytes narrowing the root canal. Acute cervical disc prolapse presents with unilateral pain in the neck, radiating to the inter-scapular and shoulder regions. This diffuse, aching dural pain is followed by sharp, electric shock-like pain down the arm, in a nerve root distribution, often with pins and needles, numbness, weakness and loss of reflexes. Cervical spondylosis occurs in the older patient with posterior osteophytes compressing the nerve root and causing root pain, commonly at C5/C6 or C6/C7; it is seen on oblique radiographs of the neck. An MRI scan shows facet joint OA and any associated disc prolapse clearly.


Treatment of cervical disc prolapse

A support collar, rest, analgesia and sedation are used as necessary. They should be advised not to carry heavy items. It usually recovers in 6-12 weeks. MRI is the investigation of choice if surgery is being considered or the diagnosis is uncertain . A cervical root block administered under direct vision by an experienced pain specialist may relieve pain while the disc recovers. Neurosurgical referral is essential if the pain persists or if the neurological signs of weakness or numbness are severe or bilateral. Bilateral root pain is a neurosurgical emergency because a central disc prolapse may compress the cervical spinal cord.

See the other causes of neck pain