21/01/2026
Could the C2-3 Disc Still be Alive and Up to Mischief?
Join the conversation as Watson and his colleague revisit a long-held assumption in cervical spine thinking: that the C2–3 disc is largely inert and irrelevant after early adulthood.
Drawing on newer imaging and ultrastructural evidence, the conversation gently dismantles this dogma, showing that the nucleus pulposus does not disappear but persists as a distinct, viscous structure even in older individuals.
Notably, C2–3 retains high water content and a clear nucleus, annulus boundary, suggesting it preserves pressure dynamics long thought to be lost.
This persistence matters because pressure implies behaviour. The posterior annulus at C2–3, though thin, is richly innervated and structurally delicate. Subtle, asymmetric pressure shifts within a still-viscous nucleus could tension this posterior wall, provoke afferent signalling, and initiate segmental rotation and stress across upper cervical segments, potentially offering a plausible mechanism for alternating, side-specific head pain that eludes conventional imaging.
Rather than viewing the unique structure of the upper cervical disc as a limitation, Watson reframes it as an enabler of a quieter, more elusive form of disc behaviour. The C2–3 disc may not be an exception to disc mechanics, but their most delicate expression, easy to overlook, yet clinically meaningful.
The conversational blog ultimately invites curiosity, restraint, and a willingness to question what we thought was settled knowledge.
Click the link https://bit.ly/4aNhESK to go to OC3 in Headache Matters to read Edition 45 - "Could the C2-3 Disc Still be Alive and Up to Mischief?" [3 minute read time].
