Degenerative Cervical Discopathy: Causes, Risk Factors, Symptoms, Diagnosis and Treatment

It is a common cause of neck pain and arm pain.

It originates when the cushioning discs located in the cervical spine begin to wear out.

The lesions can also accelerate and sometimes lead to the development of degenerative changes.

Causes of cervical degenerative disc disease

Typically, there are six gel-shaped cervical discs (one between each of the vertebrae in the cervical spine) that absorb shock and prevent the vertebral bones from rubbing against each other while moving the neck.

Each disc is made up of a tough but flexible outer layer of woven cartilage strands, called the annulus fibrosus.

Sealed within the annulus fibrosus is a soft interior filled with a mucoprotein gel called nucleus pulposus. The nucleus gives the disc its shock absorbing property.

In children, the discs are about 85% water. Discs naturally begin to lose hydration during the aging process.

Some estimates indicate that the water content of the disc usually drops to 70% by the age of 70, but in some people the disc can lose hydration much more quickly.

As the disc loses hydration, it offers less cushioning and becomes more prone to cracks and tears.

The disc cannot truly repair itself because it does not have a direct blood supply (rather than obtaining nutrients and metabolites through diffusion with adjacent vertebrae through the cartilaginous end plates).

As such, an injury to the disc will not heal or will develop weaker scar tissue that could rupture again.

Cervical degenerative disc disease is a degenerative process that discs located in the cervical spine go through.

Essentially all people who live long enough will develop degenerated discs.

Studies show that a plurality of adults have no symptoms related to cervical degenerative disc disease, although a high percentage of these adults still show signs of disc degeneration on an MRI somewhere in the spine.

When cervical degenerative disc disease develops in the cervical spine, it can occur in any of the cervical discs, but is slightly more likely to occur at the C5-C6 level.

In cases where cervical degenerative disc disease causes pain, it can occur in a number of ways.

In some cases, the disc itself can become painful. People are most likely to experience this type of discogenic pain in their 30s, 40s, or 50s.

When the symptoms of cervical degenerative disc disease become chronic, the pain and / or symptoms are likely related to conditions associated with disc degeneration, such as a herniated disc, osteoarthritis, or spinal stenosis.

Depending on the cause, the pain can be temporary or it can become chronic.

To give an example, the pain from a herniated disc will likely go away on its own, but osteoarthritis pain may require chronic treatment.

Risk factors for developing cervical degenerative disc disease

While almost everyone eventually gets CDD with age, there are a few factors that can make it more likely to develop sooner and / or become symptomatic.

These risk factors could include:

Genetics

Some twin studies indicate that genetics play a more important role than lifestyle in determining when cervical degenerative disc disease develops and whether or not it becomes painful.

Obesity

Being overweight is a risk factor for developing cervical degenerative disc disease.

Smoking

This habit can prevent nutrients from reaching the discs and cause them to lose hydration more quickly.

Injuries

Also, an injury to the spine, as well as a herniated disc, can sometimes initiate or accelerate cervical degenerative disc disease.

Symptoms of cervical degenerative disc disease

Some common features of cervical degenerative disc disease symptoms include:

Neck Pain

Low-grade pain from a stiff neck is the most common symptom of cervical degenerative disc disease.

However, sometimes the pain can flare up and get worse, perhaps lasting a few hours or days.

Nerve pain

This type of pain tends to be sharp or electrical, and can radiate down the shoulder to the arm, hand, and / or fingers.

Usually nerve pain would only be felt on one side of the body.

Neurological symptoms in the arm, hand and / or fingers

The tingling, numbness, and / or weakness from the pins and needles can radiate down the shoulder into the arm, hand, or fingers.

These types of symptoms can interfere with daily activities, such as writing, dressing, or holding objects.

Pain worsens with movement

In general, pain caused by the degenerative disc itself tends to be aggravated by movement and relieved by rest.

If the pain is coming from the degenerative disc, it will likely go away on its own in a few weeks or months.

However, other symptoms of cervical degenerative disc disease are more likely to become chronic and require treatment if the facet joints in the neck also begin to degenerate and / or a spinal nerve is pinched.

The more the cervical spine degenerates, the more likely the spinal canal is to narrow and put the spinal cord at risk.

If the spinal cord is compressed, myelopathy could result and include symptoms such as:

  • Difficulty moving arms and legs.
  • Coordination and balance problems.
  • Loss of bowel and bladder control.
  • Weakness and numbness anywhere in the body below the neck.
  • Bumping pains through the arms or legs, which may be worse if you lean forward.

Cervical myelopathy is cause for concern and requires immediate medical attention. It usually occurs in people over 50 years of age.

Diagnosis of cervical degenerative disc disease

The condition is typically diagnosed by the following process:

Medical history

First, a doctor will review the patient’s medical history in addition to learning about current symptoms.

Physical exam

Next, a doctor will perform a physical exam by palpating (palpating) the neck and testing the neck’s range of motion.

During the exam, patients may be asked to perform certain movements and report whether neck pain increases or decreases.

If the pain is severe or if there are neurological symptoms, such as pain, tingling, or weakness in the shoulder, arm, or hand, your doctor will likely order an imaging study.

Image confirmation

If the doctor determines that an imaging study is needed to detect a possible disc problem, an MRI will likely be ordered.

An MRI, X-ray, or possibly CT scan can confirm if and where degeneration is occurring, as well as identify other conditions (such as osteoarthritis or stenosis) that could be causing the symptoms.

Once an accurate diagnosis of cervical degenerative disc disease is confirmed, as well as any other associated conditions, then the source of the symptoms can be understood and an effective treatment program can be created.

Treatment options for cervical degenerative disc disease

If the pain and symptoms of cervical degenerative disc disease worsen, steps can be taken to help alleviate the problem.

The first steps are usually personal and non-surgical treatment options, and these will usually control pain effectively.

In rare cases, when pain and symptoms persist or worsen despite several months of treatment, or if the health of the spinal cord is at stake, surgery may be considered.

Non-surgical treatment options

For neck pain resulting from cervical degenerative disc disease, a doctor will generally recommend one or a combination of the following treatment options:

Rest or lifestyle modification

Certain activities can be more painful for the neck, such as reaching forward to look at the computer monitor or a specific swimming injury.

Abstaining or modifying certain activities for a few days or weeks will generally reduce the pain.

In addition, it is recommended to maintain a strong posture, instead of bending over while sitting or bending your neck forward while driving, looking at a cell phone, among others.

Eating healthy, staying hydrated, and quitting smoking are also beneficial daily life changes for disc health.

Pain management with medications or injections

Over-the-counter pain relievers such as acetaminophen such as Tylenol, ibuprofen such as Advil, Motrin, or others may be beneficial.

Otherwise, stronger pain medications such as oral steroids or muscle relaxants (such as Vicodin) may be prescribed.

Other options might include an injection that delivers medication directly to a certain part of the neck, such as a cervical epidural steroid injection or a cervical facet injection.

Ice and heat therapy

Some people find pain relief by applying an ice pack or hot gel pack to the uncomfortable part of the neck.

Exercise and physical therapy

Most non-surgical treatment programs for neck pain will include some form of exercise and stretching.

A physical therapist or other trained healthcare professional can prescribe a stretching and exercise regimen that meets the specific needs of the patient.

In general, increasing strength and flexibility in the neck can reduce the risk of pain.

Manual handling

The cervical spine can be manually adjusted by a chiropractor or other qualified healthcare professional in an effort to improve range of motion and reduce pain.

Depending on the person’s symptoms, a physical examination and imaging study should be performed prior to manual manipulation of the neck.

Many other options could also be considered, such as massage therapy, TENS electrical stimulation unit, booster, or acupuncture.

Surgery for cervical degenerative disc disease

Surgery to treat cervical degenerative disc disease is generally considered in two cases:

Neurological symptoms

Whether neurological symptoms are present, such as persistent arm numbness and weakness, or trouble walking or bowel control.

If neurological symptoms are caused by cervical degenerative disc disease, there is a risk of permanent nerve damage, and surgery may be recommended to relieve pressure on the nerve.

Chronic pain

Chronic pain is severe and not adequately relieved after at least six months of non-surgical treatments, and daily activities become difficult to execute.

Better surgical outcomes are predicted for patients with chronic pain along with other findings such as cervical instability and radiculopathy.

Types of surgery

The two most common types of surgery for cervical degenerative disc disease are:

Anterior cervical discectomy and fusion

This procedure is done through the front of the neck and involves the removal of the disc where the problem occurs.

Decompression of the nerve root and insertion of a bone graft or metal cage device to help maintain or restore normal disc space height.

If there are neurological symptoms of spinal cord compression, surgery may also include removing part of a vertebra or widening the spinal canal to give the spinal cord more room before the fusion is done.

Cervical artificial disc replacement

This surgery involves removing the problem disc and replacing it with an artificial disc.

The goal of this surgery is to preserve movement at that level of the spine.

The results of artificial disc replacement may be better in patients with minimal arthritic changes in the posterior facets.

To relieve pressure on the nerve roots and spinal cord and thus reduce neurological symptoms such as arm pain or weakness, neck surgery tends to have a good success rate; some estimates in the literature are between 80% and 90%.

However, neck surgery has a lower success rate in relieving pain that only occurs in the neck.

If the disc space cannot be verified as the likely pain generator, it may be reasonable to avoid surgery and continue to try various types of non-surgical care to control pain in that area.