Cervical Degenerative Disc Disease

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As we age, our vertebral discs, which serve as spine’s shock absorbers, 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 do not know they have it.  They may only become aware of the condition when being examined for another health problem, or during a routine checkup.

Symptoms

Disc degeneration is a normal part of aging, and usually is not a problem.  However, DDD can cause discs to lose height and 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, pain may be constant.

Video: Degenerative Disc Disease
Click below to view a video from our library about this condition.

Diagnosis

An accurate diagnosis of cervical DDD is required for appropriate treatment. This diagnosis should be made by an expert in spinal disorders. Steps in the diagnosis may include.

• Medical History 
  The physician asks you about your symptoms, their severity, onset, and treatments you tried.

• Physical Examination
  Movement limitations and problems with balance are evaluated.  He tests your reflexes, muscle strength, sensation, and signs of neurologic dysfunction.

• Diagnostic Tests
  X-rays can help to rule out other problems such as a tumor or infection.  X-rays may also reveal the loss of disc space between the vertebrae.  In some cases, discography is performed to confirm a diagnosis. Discography involves injecting contrast dye into the affected disc (or discs) to create a clearer image and temporarily replicate symptoms.

Non-operative Treatment

Most cases of cervical degenerative disc disease do not require surgery.

• Medications: an anti-inflammatory drug reduces swelling and pain, muscle relaxants to calm spasm, and occasionally non-narcotic or narcotic painkillers to alleviate pain.  
• Cold/heat therapy, especially during the first 24 to 48 hours.
• Spinal injections (i.e. epidural) may help relieve neck and related upper extremity pain.
• Physical therapy: gentle massage, stretching, therapeutic exercise, bracing, or traction to decrease pain and increase function.
• Chiropractic or alternative therapy (i.e., acupuncture).

During physical therapy, patients will be educated in proper posture and body mechanics.

Surgical Treatment

If symptoms of cervical degenerative disc disease persist, despite non-operative treatment, further diagnostic tests may be necessary.  Additional tests may include a CT scan, MRI, myelography, or discography.  If the surgeon discovers that one or more of the intervertebral discs have herniated, surgery may be necessary.   

A common procedure is anterior cervical discectomy and fusion (ACDF).  This involves an anterior (from the front) approach, removal of the damaged disc, and fusing the adjacent vertebrae using bone graft and instrumentation (i.e., screws, plates).  However, there may be other surgical options that can be considered.

Conclusion

While cervical degenerative disc disease (DDD) is a natural part of aging, patients with cervical DDD do not need to live with chronic pain. Many safe and effective treatment options are available. Those who suspect they may have cervical DDD or who suffer from the above-described symptoms should consult with a spinal expert to obtain an accurate diagnosis and learn about appropriate treatment choices.