Cervical degenerative disc disease imposes a pervasive clinical and socioeconomic burden, an issue long attributed to mechanical failure within what was considered an avascular and axiomatically sterile intervertebral disc. This long held assumption has been fundamentally challenged by a contentious body of research, primarily from the lumbar spine, which implicates low virulence anaerobic bacteria such as Cutibacterium acnes in the pathogenesis of degeneration. In stark contrast, the cervical spine, with its unique biomechanical and anatomical context, remains comparatively uncharted territory. This review critically synthesises the current evidence for a cervical disc microbiome, navigating the methodological difficulties that fuel the ongoing debate and exploring plausible pathogenic mechanisms. Moving beyond a simplistic dichotomy of sterile or infected tissue, a more nuanced hypothesis of microbial dysbiosis is proposed, wherein the hostile microenvironment of the disc itself paradoxically selects for a low biomass community of indolent organisms. The sustained presence of these microbes may provoke a low grade, chronic inflammatory cascade, thereby accelerating degenerative processes and potentially influencing adverse outcomes following surgical interventions. Acknowledging this microbial possibility requires a significant shift in aetiological thinking, framing a compelling scientific frontier that may unlock novel preventative and therapeutic strategies to mitigate the immense global burden of this condition.