A cervical disc subligamentous protrusion occurs when the inner gel-like core of an intervertebral disc (nucleus pulposus) bulges out through a tear in the outer fibrous ring (annulus fibrosus) but remains contained beneath the posterior longitudinal ligament. This containment differentiates it from an extrusion or sequestration, where disc material breaches the ligament and may migrate into the spinal canal. Subligamentous protrusions can compress nearby nerve roots or the spinal cord, leading to pain and neurological signs. RadiopaediaNCBI
Anatomy of the Cervical Intervertebral Disc
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Structure & Location:
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The cervical spine consists of seven vertebrae (C1–C7).
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Intervertebral discs sit between vertebral bodies from C2/3 down to C7/T1, cushioning and permitting movement. Wikipedia
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Composition:
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Nucleus pulposus: Central gelatinous core that distributes pressure.
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Annulus fibrosus: Tough outer ring of collagen fibers that contains the nucleus.
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Endplates: Hyaline cartilage interfaces that connect disc to vertebral bone. SpringerOpenMedscape
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Blood Supply & Nutrition:
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Discs are avascular; they receive nutrients via diffusion through the vertebral endplates.
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Degeneration accelerates when diffusion is impaired. Medscape
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Nerve Supply:
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Innervated by the sinuvertebral nerves, which carry pain signals from the outer annulus and adjacent ligaments. NCBI
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Six Key Functions:
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Shock absorption during movement and loading.
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Load distribution across vertebral bodies.
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Allowing flexibility—bending, twisting, and extension.
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Maintaining intervertebral spacing for nerve root exit.
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Protecting the spinal cord from mechanical stress.
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Facilitating motion while preserving stability. WikipediaNCBI
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Types of Cervical Disc Abnormalities
Disc herniations are subtyped based on morphology and ligament integrity:
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Bulge: ≥25% of disc circumference, intact annulus.
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Protrusion: Localized ≤25% circumference, base wider than herniation.
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Subligamentous Protrusion: Protrusion beneath posterior longitudinal ligament.
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Extrusion: Narrow base, nuclear material passes annulus but may remain under ligament.
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Sequestration: Free fragment of disc material separated from parent disc. RadiopaediaRadiopaedia
Common Causes
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Age-related degeneration (disc dehydration) Miami Neuroscience Center
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Repetitive neck flexion/extension
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Heavy lifting with poor posture
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Traumatic injury (e.g., motor vehicle accidents)
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Vibration exposure (heavy machinery operators)
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Smoking (accelerates degeneration)
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Genetic predisposition
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Obesity (increased axial load)
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Poor ergonomics (computer/phone posture)
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Occupational stress (long drives)
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Vigorous sports (wrestling, diving)
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Connective tissue disorders (e.g., Ehlers–Danlos)
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Previous cervical surgery (adjacent segment disease)
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Inflammatory conditions (e.g., rheumatoid arthritis)
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Spinal stenosis (altered biomechanics)
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Osteophyte formation (bone spur impingement)
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Facet joint hypertrophy
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Sedentary lifestyle (poor muscle support)
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Occupational vibration (jackhammer operators)
Symptoms
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Neck pain (localized)
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Radicular pain (shooting into arm)
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Paresthesia (tingling/numbness in hand)
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Muscle weakness (in specific myotomes)
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Reduced cervical range of motion
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Headaches (occipital region)
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Neck stiffness
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Unsteady gait (if myelopathy)
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Loss of fine motor skills (buttoning clothes)
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Shoulder pain
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Intermittent electrical shocks down arm
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Muscle spasm
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Sensory loss (dermatomal)
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Reflex changes (hyperreflexia or hyporeflexia)
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Clumsiness, dropping objects
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Neck muscle wasting (severe/chronic)
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Balance problems (if spinal cord compression)
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Autonomic changes (rare, bladder/bowel)
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Pain worse with coughing/sneezing
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Neck pain alleviated by lying down MedscapeRadiopaedia
Diagnostic Tests
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Clinical examination (Spurling’s, Lhermitte’s sign) NCBI
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Cervical X-ray (alignment, osteophytes)
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MRI (gold standard for soft tissue) Radiopaedia
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CT scan (bony details, if MRI contraindicated)
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CT myelogram (contrast in spinal canal)
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Electromyography (EMG) (nerve conduction)
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Nerve conduction studies
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Discography (provocative disc injection)
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Ultrasound (guidance for injections)
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Bone scan (exclude infection/tumor)
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Flexion-extension X-rays (instability)
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Neurological exam (motor/sensory/reflex)
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Laboratory tests (inflammatory markers)
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Spinal endoscopy (rare)
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Somatosensory evoked potentials (cord function)
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Vertebral artery Doppler (exclude vascular cause)
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CT angiography (if vascular symptoms)
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Psychosocial screening (yellow flags)
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Quality-of-life questionnaires
Non-Pharmacological Treatments
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Patient education (posture correction)
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Cervical traction (mechanical/manual)
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Physical therapy (therapeutic exercises)
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McKenzie exercises (centralization technique)
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Strengthening (deep neck flexors)
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Stretching (upper trapezius, levator scapulae)
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Manual therapy (mobilization)
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Spinal manipulation (chiropractic)
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Massage therapy
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Acupuncture
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TENS (transcutaneous electrical nerve stimulation)
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Heat/cold therapy
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Ultrasound therapy
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Laser therapy
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Dry needling
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Kinesio taping
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Ergonomic assessment (workstation)
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Yoga (neck-safe poses)
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Pilates (core stability)
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Hydrotherapy (warm pool)
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Cervical pillow (supportive sleep)
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Postural braces (short-term)
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Biofeedback
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Cognitive behavioral therapy (pain coping)
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Mindfulness meditation
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Traction devices (home units)
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Progressive relaxation
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Weighted blankets (sleep comfort)
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Dry heat packs
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Lifestyle modification (smoking cessation) MedscapeScoliosis Reduction Center®
Drugs
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NSAIDs: ibuprofen, naproxen, diclofenac Medscape
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Acetaminophen
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Muscle relaxants: cyclobenzaprine, methocarbamol
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Oral corticosteroids: prednisone taper
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Neuropathic agents: gabapentin, pregabalin
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Tricyclic antidepressants: amitriptyline
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Serotonin-norepinephrine reuptake inhibitors: duloxetine
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Opioids: tramadol (short term)
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Topical NSAIDs: diclofenac gel
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Topical capsaicin
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Lidocaine patch
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Epidural steroid injection (cervical)
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Selective nerve root block
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Facet joint injection
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Trigger point injection
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Botulinum toxin (off-label)
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Calcitonin (rare)
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Bisphosphonates (if osteoporotic)
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Muscle relaxant patch
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Intravenous ketamine (refractory neuropathic pain) MedscapeDeuk Spine
Surgical Options
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Anterior Cervical Discectomy and Fusion (ACDF) Medscape
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Cervical Disc Arthroplasty (artificial disc)
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Posterior Cervical Foraminotomy
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Microsurgical Discectomy
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Endoscopic Cervical Discectomy
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Laminoplasty
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Laminectomy (with or without fusion)
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Posterior Fusion (instrumented)
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Corpectomy (multi-level disease)
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Anterior Cervical Corpectomy and Fusion (ACCF) MedscapeDeuk Spine
Preventive Strategies
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Ergonomic workstation setup
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Frequent posture breaks (every 30 minutes)
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Neck-strengthening exercises
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Regular stretching routine
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Maintain healthy weight
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Quit smoking
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Use supportive pillows
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Lift correctly (bend knees, keep load close)
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Avoid prolonged phone use (text neck)
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Stay active (regular low-impact exercise) Dr. Tony NaldaADR Spine
When to See a Doctor
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Severe or worsening arm weakness
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Sudden loss of bladder/bowel control (possible cauda equina)
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Intense neck pain unrelieved by rest
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Signs of spinal cord compression: gait disturbance, hand clumsiness
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Fever or unexplained weight loss (raise infection/tumor suspicion)
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Chest pain or chest tightness (to rule out cardiac cause) NCBIMedscape
FAQs
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What exactly is a subligamentous protrusion?
A tear in the disc ring lets the inner gel push out, but it stays under the protective ligament. This can press on nerves and cause pain. -
How is it different from a normal bulge?
A bulge spreads evenly around the disc margin without tearing the annulus, while a protrusion pokes through a tear but stays under the ligament. -
Can it heal on its own?
Mild cases often improve with therapy and rest. The body can reabsorb some disc material over weeks to months. -
Will I always need surgery?
No. Most patients get better with non-surgical care. Surgery is for persistent severe pain or neurological deficits. -
Is MRI necessary?
Yes—MRI shows soft tissues, the exact protrusion location, and nerve compression. -
Can I work with this condition?
Many return to work with proper ergonomics and therapy. Heavy manual labor may need accommodation. -
Are steroids safe for injections?
Yes, in moderation. Doctors limit injections due to potential side effects on bone and soft tissues. -
Does smoking make it worse?
Yes—smoking speeds disc aging and slows healing. -
How long until I feel better?
With treatment, many improve in 4–6 weeks. Some take up to 3 months. -
Will physical therapy help?
Absolutely—targeted exercises and manual techniques ease pain and improve function. -
Can I prevent future problems?
Yes—maintaining good posture, exercise, healthy weight, and quitting smoking help. -
Is it painful to sit or lie down?
Sitting often worsens pain; lying with neck support is usually more comfortable. -
Should I wear a neck collar?
Short-term collars can reduce pain, but long-term use weakens neck muscles. -
Can I drive with this condition?
Only if you have enough neck motion and no significant arm weakness. -
When is surgery unavoidable?
If you lose strength, have constant severe pain despite 6–12 weeks of care, or develop spinal cord signs. NCBIMedscape
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members
Last Updated: April 29, 2025.