Introduction
Cervical degenerative disc disease is a condition where the spinal cord and nerves in the neck are compressed due to the breakdown of the intervertebral discs. These discs are located between the vertebrae, the small bones that form the spine, and function as shock absorbers. With age, these discs can lose fluid, collapse, and even rupture. As the discs deteriorate, they affect the surrounding vertebrae, which can put pressure on the spinal cord and nerves, leading to pain and functional impairment.
Anatomy
The cervical spine, located in the neck, connects your head to your trunk and supports less weight compared to other spinal regions. It provides the greatest range of motion, allowing the neck to bend forward, backward, tilt sideways, and rotate. The cervical spine is made up of seven vertebrae, with the back portion forming the lamina, which acts as a roof over the vertebral canal.
Between each vertebra is an intervertebral disc, consisting of tough connective tissue. The outer layer of the disc is known as the annulus fibrosus, and its gel-like center is the nucleus pulposus, which contains about 80% water. These discs, along with small joints, allow for movement and provide stability while also absorbing shock to protect the vertebrae.
The upper section of the cervical spinal canal is quite spacious, offering more room for the spinal cord and minimizing the risk of compression during neck movements. The spinal cord, nerves, and blood vessels that supply the body run through this protective canal. The cervical spine includes segments C1 through C8, with nerves that control the shoulders, arms, and hands.
Causes
The exact cause of cervical degenerative disc disease is unclear, though factors such as aging, trauma, and arthritis are believed to contribute. Genetics, environmental factors, and autoimmune conditions may also play a role. Lifestyle factors like smoking or engaging in strenuous repetitive activities, such as gymnastics or heavy lifting, can contribute as well.
As discs age, they lose water, becoming narrower and less flexible. Injured discs can deteriorate further, leading to instability in the cervical spine. This loss of cushioning causes bone-on-bone friction, resulting in pain. Abnormal bone growths, known as bone spurs or osteophytes, can also develop, further limiting movement and contributing to pain. These changes can lead to conditions like spondylolisthesis, where a vertebra shifts out of place, and spinal stenosis, where the spinal canal narrows and compresses nerves, causing pain and functional loss.
Degenerative disc disease can also result in herniation, where the outer disc layer tears and the nucleus pulposus leaks out, irritating nearby nerves and causing swelling and pain.
Symptoms
Cervical degenerative disc disease may cause varying levels of discomfort. Some individuals experience neck pain, either after an injury or gradually over time. The pain can be intense enough to interfere with daily activities. Symptoms may include a burning sensation, pressure, numbness, or tingling that radiates to the shoulders, arms, or fingertips.
Diagnosis
A doctor can diagnose cervical degenerative disc disease by reviewing medical history, performing a physical exam, and using imaging techniques. Your doctor will test muscle strength, joint motion, and stability, and may also conduct a neurological exam to assess nerve function. X-rays provide a look at the vertebrae, while a myelogram, with injected dye, can highlight pressure on the spinal cord or nerves caused by disc herniation or bone spurs.
CT scans and MRI scans offer detailed views of the cervical structures. A CT scan shows cross-sectional images of the spine, while MRI provides highly sensitive images of discs, ligaments, spinal cord, and nerve roots. A discogram may be performed with a dye injection to examine the disc’s internal structure, followed by a CT scan.
Treatment
Non-surgical treatments for cervical degenerative disc disease focus on pain relief and maintaining function. Over-the-counter or prescription medications can help, and corticosteroid injections may be used if symptoms persist. However, non-surgical treatments cannot correct structural problems like spinal canal narrowing.
Surgery is typically recommended when non-surgical treatments fail or if the disc is pressing on a nerve or spinal cord, causing functional impairment. Anterior cervical decompression and fusion (ACDF) surgery is a common surgical procedure where the abnormal disc and bone are removed through an incision in the front of the neck. A bone graft or fusion cage is then inserted to support the spine, with hardware like plates and screws to hold the vertebrae in place.
After surgery, recovery varies but may take several weeks. Patients often experience rapid relief from arm pain, although arm weakness or numbness may take longer to improve. Physical therapy is typically recommended to restore flexibility and strength once the neck heals.
Prevention
Adhering to post-surgical restrictions and exercise programs is crucial to preventing complications. Proper body mechanics, avoiding smoking, and seeking help for smoking cessation if needed can improve recovery outcomes. Smoking can increase the risk of surgical complications and hinder bone fusion.
Risk Factors
Several factors increase the risk of developing cervical degenerative disc disease:
- Physically active young and middle-aged adults are at a higher risk.
- Trauma to the spine raises the likelihood of developing the condition.
- Arthritis and the natural aging process also contribute to the risk.
Complications
Untreated cervical degenerative disc disease can result in irreversible neurological damage when there are persistent neurological signs and symptoms.
Advancements
Research is ongoing to find alternatives to traditional spinal fusion and total disc replacement surgeries. Nucleus replacement technologies are showing promise in the treatment of lumbar disc disease, and studies of cervical disc arthroplasty are being conducted to compare long-term results with more conventional methods.
