Cervical Degenerative Disc Disease

As we age, our vertebral discs, which serve as shock absorbers for the spine, gradually dry out, affecting their strength and resiliency. This can lead to degenerative disc disease (DDD). DDD of the cervical spine is a relatively common condition for aging adults. However, many people who have cervical degenerative disc disease don’t even know it. They may only become aware of the condition when being examined for another health problem or during a routine checkup.

Symptoms of Cervical DDD
Disc degeneration is a normal part of aging, and is not usually a problem. However, DDD can cause the discs to lose height and to become stiff. When disc height is lost, nerve impingement, bone and joint inflammation, and resultant pain can occur. Disc degeneration causes loss of the joint space, similar to arthritis pain and inflammation. In severe cases, this pain may be constant.

Diagnosing Cervical DDD
All effective treatments are built upon accurate diagnosis. The physicians at our practice utilize a combination of their expertise and state-of-the-art diagnostic technology to ensure a correct diagnosis. The diagnostic process includes:

• Medical history. We will talk to you about your symptoms, how severe they are, and what treatments you have already tried.
• Physical examination. You will be carefully examined by one of our spine specialists for limitations of movement, problems with balance, and pain. During this exam, we will also look for loss of reflexes in the extremities, muscle weakness, loss of sensation or other signs of neurological injury.
• Diagnostic tests. Generally, we start with plain x-ray films, which allow us to rule out other problems such as tumors and infections. The films also allow us to see if there is any loss of disc space between the vertebrae.

In some cases we also use a selection of other tests including:

• MRI - to help us evaluate the soft tissues of your spine accurately
• A CT Myelogram - so that we can identify how the nerve structures are interacting with other parts of your spinal anatomy
• Diagnostic injections - diagnostic injections, including discography, involve injecting medications, a contrast dye, or other agents into a disc or around neural structures to help us gain a better image of the anatomy or determine the source of pain.

MRI of the Cervical Spine

Treatment of Cervical DDD

Non-operative Care
For acute or sudden neck pain, we can prescribe pain relief medications such as acetaminophen, anti-inflammatory agents, and muscle relaxants. Temporary bed rest or a brace may also be suggested. But patients are encouraged to get up and gradually increase their activities of daily living.

In addition to pain relief, muscle relaxants and a gradual return to activity, your physican may prescribe one or more of the following non-operative treatments:

• Physical Therapy
  At SDCSD we prescribe physical therapy for many patients. Our practice is affiliated with an exceptional physical therapy facility at the same location as our office, and the PT care you will receive will be outstanding. The physical therapist may prescribe stretching exercises that can improve flexibility and extension thus helping maintain the spine’s natural curve. Hot/cold therapy and gentle massage can also be beneficial for neck pain.
  
  After acute symptoms subside (usually within two to three weeks), patients are encouraged to begin a daily exercise regimen. This may include low impact aerobics three times per week as well as daily neck exercises.

• Cervical Collar
  Occasionally we recommend use of a soft cervical collar for several weeks. The collar can provide support, and also restricts movements that might further irritate your neck.

• Interventional Pain Management
  At SDCSD we believe managing your pain is vitally important. Accordingly, in some cases of cervical DDD we will prescribe an interventional pain management program to help reduce your pain. This treatment includes injections of special medications onto or near the nerves in your neck. The injected medication may include a steroid, narcotic and/or local anesthetic. The most common type of treatment in this category is know as a nerve block.

Surgical Treatment
If symptoms of cervical DDD persist despite these non-operative treatments, and there is evidence of one or more herniated discs, surgery may be necessary. Your surgeon will consider various surgical options.

A common technique that we utilize is an anterior cervical discectomy and fusion (ACDF). This involves an anterior (from the front) approach, removal of the offending disc and then fusion of the adjacent vertebrae usually with instrumentation. However, there are also other surgical options that will be considered, including a PCDF (a similar procedure to an ACDF but done from the back of the spine) and a foraminotomy (enlarges the area through which the nerve roots exit the spine). Your surgeon will carefully discuss these options with you.

Recovery
While cervical DDD is a natural part of aging, it does not mean you have to live with neck pain. We can help you return to a healthy, active life. For most patients this can be accomplished with non-surgical treatments. But even if surgery is needed, be assured that we will discuss with you all aspects of the procedure and provide you with the best care possible.