Cervical Degenerative Disc Disease
Cervical degenerative disc disease can be caused by a twisting injury to a disc space in the cervical spine. This can begin the degenerative process and lead to chronic neck pain. This degenerative condition is less common in the cervical spine than in the lumbar spine because there is substantially less torque and force across the cervical section of the spine.
It should be noted that the term degenerative disc disease is somewhat misleading. Although the disc will be likely to continue to degenerate with age, that does not mean the pain will worsen. In fact, the pain will usually diminish over time. Also, it is not really a disease, but instead it is a condition that will sometimes (but not always) cause pain resulting from a damaged disc or natural aging.
This disc degeneration is very common and will occur in most people as they age; however, not all will experience symptoms. In addition to natural occurrence of disc degeneration due to aging, other factors that can contribute to degenerative disc disease are:
- Poor nutrition
- Atherosclerosis (hardening and narrowing of the arteries)
- Physical activities
The main symptom of cervical degenerative disc disease is neck pain. Of course, there are many things that can cause neck pain, so having this symptom does not automatically indicate this condition. A patient with this condition can also experience some radicular pain (pain that radiates) in the arm and shoulder.
Most people will undergo some degree of degeneration of their discs as they grow older, simply as a function of aging, sometimes exacerbated by their lifestyle. However, not everyone with degenerative discs will experience symptoms.
Degenerative disc disease can often be seen with a Magnetic Resonance Imaging (MRI) scan. The MRI is very specific for diagnosing degenerative disc disease. A CT myelogram (CT scan and injected dye) may sometimes also be ordered if nerve root pinching is suspected from a disc herniation (disc material extrudes out and “pinches” or presses on a cervical nerve) or stenosis (narrowing of the cervical disc space) but is not well visualized on the MRI scan.
An imaging scan may show degeneration of a disc in a patient who isn’t experiencing any symptoms. Seeing normal degeneration due to aging is very common, and does not indicate a problem unless neck or shoulder pain or stiffness is being experienced. Therefore, a diagnosis of this condition must include a good history of the patient’s symptoms and a physical examination in conjunction with the imaging scan. As a matter of fact, myofascial pain syndromes such as fibromyalgia are more likely to cause chronic neck pain than degenerative disc disease of the cervical spine. The symptoms have to be well correlated with any imaging findings before a diagnosis can be confirmed.
The physician will probably also do a neurological examination to determine if there is any neurological damage, and also a study of the shoulders to be sure the pain isn’t originating there instead of in the spine.
Treatment for cervical degenerative disc disease
Treatment for cervical degenerative disc disease will usually be non-surgical. However, if conservative treatment fails, surgery may be a reasonable option. Surgery for neck pain is much less reliable than surgery for arm pain, as it is sometimes difficult to tell what is generating a patient’s neck pain. Nerve root compression causing arm pain is a more accurate diagnosis.
Conservative (non-surgical) treatments
The conservative treatment options are either passive (done to the patient) or active (done by the patient). Usually a combination of treatments will be used, as passive treatments are rarely effective on their own-some active component is almost always required.
Common passive treatments include:
- Medications. Over-the-counter pain medicine such as acetaminophen (e.g. Tylenol) can help decrease pain and can be used in conjunction with an anti-inflammatory medication such as ibuprofen (e.g. Advil, Nuprin and Motrin).
- Chiropractic/osteopathic manipulations. These can be useful to relieve joint dysfunction that can be associated with the pain. Manipulations work best when combined with an active exercise program.
- Epidural injections. Epidural injections can be used to help decrease inflammation when there is severe pain. The injection is done by inserting a needle into the space around the thecal sac (epidural space) and then injecting a steroid medication. This helps reduce inflammation in the spinal canal and can reduce pain in about 50% to 70% of patients. The injection should be used as part of rehabilitation, as the pain relief can allow the patient to begin an exercise and physical therapy program. If the injection works, but the pain returns, it can be repeated up to three times in a 6-month period.
- Trigger point injections. Tender areas in the muscles can be injected with a small needle and lidocaine to relieve muscular stress and tension, which should relieve the tenderness.
- TENS units. Transcutaneous Electrical Stimulation (TENS) units can be used to provide electrical stimulation to the painful areas of the back. A low current electrical charge is transmitted to the skin. Although the mechanism for how this relieves pain is not exactly known, it has been proven effective for some patients and allows them to function better with less medication. It is suspected that the electrical signals help override the pain signals.
In addition, traction may be useful and a home traction unit may be prescribed for use at home.
Common active treatments include:
- Physical therapy. Exercises and stretching can be very helpful in strengthening and stabilizing the affected area, thus reducing pain. It is very important, however, to work with a professional health provider on the appropriate exercises as each person responds differently, and what helps one person may actually harm another.
- Quitting smoking. It has been proven that there is a link between smoking and the ability for the spine to heal. Since there is no benefit to smoking, quitting is highly advisable.
Rarely, a one (or possibly two) level fusion may be required to help control symptoms and allow a patient to function more fully. This should only be considered if non-surgical treatments have failed, and the pain the patient is experiencing is severe enough to limit his or her activity level or ability to function.
The goal of this surgery is to stop the motion at a painful motion segment. A small metal plate and a bone graft are placed between the affected vertebrae of the spine. As the bone fuses together, the spine stabilizes in that area and eliminates the movement, which in turn should decrease the patient’s pain.