Full Answer
What are my treatment options for Cervical degenerative disc disease?
The above list does not include all treatment options for pain related to cervical degenerative disc disease. Many other options could be considered as well, such as massage therapy, electrical stimulation TENS unit, bracing, or acupuncture. Surgery to treat cervical degenerative disc disease is generally considered in two cases:
What education should patients with cervical disc degeneration receive about their diagnosis?
Patients concerned with cervical disc degeneration should receive education about their diagnosis. A diagnosis early on is imperative and can avoid potential impairments or restrictions. Primary physicians should also educate themselves to avoid missing common physical exam signs.
What is cervical disc replacement?
That is, discs that are degenerating at levels above or below the fusion can be adversely affected, leading to more rapid degeneration of those discs than might have occurred without the adjacent fusion. A newer option used to maintain motion in the degenerative level is cervical disc replacement.
What is the role of surgery in the treatment of degenerative cervical?
Overwhelming clinical evidence demonstrates that neck pain in patients with degenerative cervical radiculopathy or myelopathy can be subsided rapidly by anterior cervical surgery, further indicating that this neck pain stems from the pathology of cervical disc itself.
Why is intervertebral disc important?
It is believed to be important clinically because there is an association of disc degeneration with back pain. Current treatments are predominantly conservative or, less commonly, surgical; in many cases there is no clear diagnosis and therapy is considered inadequate. New developments, such as genetic and biological approaches, may allow better diagnosis and treatments in the future.
What are the intervertebral discs?
They are the main joints of the spinal column and occupy one-third of its height. Their major role is mechanical, as they constantly transmit loads arising from body weight and muscle activity through the spinal column. They provide flexibility to this, allowing bending, flexion and torsion. They are approximately 7–10 mm thick and 4 cm in diameter (anterior–posterior plane) in the lumbar region of the spine [7,8]. The intervertebral discs are complex structures that consist of a thick outer ring of fibrous cartilage termed the annulus fibrosus, which surrounds a more gelatinous core known as the nucleus pulposus; the nucleus pulposus is sandwiched inferiorly and superiorly by cartilage end-plates.
What is the outer ring of the intervertebral disc?
The intervertebral discs are complex structures that consist of a thick outer ring of fibrous cartilage termed the annulus fibrosus, which surrounds a more gelatinous core known as the nucleus pulposus; the nucleus pulposus is sandwiched inferiorly and superiorly by cartilage end-plates. Open in a separate window.
How does loss of proteoglycan affect degenerate discs?
The loss of proteoglycan in degenerate discs [33] has a major effect on the disc's load-bearing behaviour . With loss of proteoglycan, the osmotic pressure of the disc falls [41] and the disc is less able to maintain hydration under load; degenerate discs have a lower water content than do normal age-matched discs [33], and when loaded they lose height [42] and fluid more rapidly, and the discs tend to bulge. Loss of proteoglycan and matrix disorganization have other important mechanical effects; because of the subsequent loss of hydration, degenerated discs no longer behave hydrostatically under load [43]. Loading may thus lead to inappropriate stress concentrations along the end-plate or in the annulus; the stress concentrations seen in degenerate discs have also been associated with discogenic pain produced during discography [44].
Which enzyme breaks down the matrix of a disc?
Several families of enzymes are capable of breaking down the various matrix molecules of disc, including cathepsins, MMPs and aggrecanases. Cathepsins have maximal activity in acid conditions (e.g. cathepsin D is inactive above pH 7.2). In contrast, MMPs and aggrecanases have an optimal pH that is approximately neutral.
Can spinal stenosis cause disability?
In the long term it can lead to spinal stenosis, a major cause of pain and disability in the elderly; its incidence is rising exponentially with current demographic changes and an increased aged population.
Is back pain a sign of degeneration?
Back pain is strongly associated with degeneration of the intervertebral disc [3]. Disc degeneration, although in many cases asymptomatic [4], is also associated with sciatica and disc herniation or prolapse. It alters disc height and the mechanics of the rest of the spinal column, possibly adversely affecting the behaviour of other spinal structures such as muscles and ligaments. In the long term it can lead to spinal stenosis, a major cause of pain and disability in the elderly; its incidence is rising exponentially with current demographic changes and an increased aged population.
What are the factors that affect intervertebral disc disease?
Intervertebral disc disease results from a combination of genetic and environmental factors. Some of these factors have been identified, but many remain unknown. Researchers have identified variations in several genes that may influence the risk of developing intervertebral disc disease. The most commonly associated genes provide instructions for producing proteins called collagens. Collagens are a family of proteins that strengthen and support connective tissues, such as skin, bone, cartilage, tendons, and ligaments. Collagens form a network of fibers that create structure and stability within the intervertebral discs. Specific variations in several collagen genes seem to affect the risk of developing intervertebral disc disease by impairing the ability of collagens to interact with each other, decreasing the stability of the disc and leading to its degeneration.
Why are genes associated with intervertebral disc disease?
Normal variations in genes related to the body's immune function are also associated with an increased risk of developing intervertebral disc disease. These genes play a role in triggering an immune response when the body detects a foreign invader such as a virus.
How many people have intervertebral disc disease each year?
Frequency. Intervertebral disc disease is estimated to affect about 5 percent of the population in developed countries each year. Most individuals experience disc degeneration as they age; however, the severity of the degeneration and the pain associated with it varies.
How does collagen affect the disc?
Specific variations in several collagen genes seem to affect the risk of developing intervertebral disc disease by impairing the ability of collagens to interact with each other, decreasing the stability of the disc and leading to its degeneration. Normal variations in genes related to the body's immune function are also associated ...
What are the non-genetic factors that contribute to the risk of intervertebral disc disease?
These factors include aging, smoking, obesity, chronic inflammation, and driving for long periods of time (for example, as a long-haul trucker or taxi driver). Learn more about the genes associated with Intervertebral disc disease.
What is the condition of the back and neck?
Description. Intervertebral disc disease is a common condition characterized by the breakdown (degeneration) of one or more of the discs that separate the bones of the spine (vertebrae), causing pain in the back or neck and frequently in the legs and arms. The intervertebral discs provide cushioning between vertebrae and absorb pressure put on ...
What happens if a disc degenerates?
If the bone spurs compress the spinal cord, affected individuals can develop problems with walking and bladder and bowel control. Over time, a degenerating disc may break down completely and leave no space between vertebrae, which can result in impaired movement, pain, and nerve damage .
What are the mechanoreceptors in cervical discs?
Immunohistochemical studies show that a large number of mechanoreceptors, especially Ruffini corpuscles, are present in degenerated cervical discs. The available evidence suggests a key role of Ruffini corpuscles in the pathogenesis of dizziness caused by cervical degenerative disease (i.e. cervical discogenic dizziness).
Where is the 3D of Orthopedics?
3Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing 100039, China. [email protected].
Can cervical surgery cause dizziness?
Clinical studies have found that patients withcervical degenerative disease are usually accompanied by dizziness. Anterior cervical surgery can eliminate not only chronic neck pain, cervical radiculopathy or myelopathy, but also dizziness.
What is cervical degenerative disc disease?
Degenerative disc disease (DDD) of the cervical (neck region) spine indicates that the intervertebral disc has undergone degenerative, wear-and-tear (arthritic) changes, which may or may not lead to significant neck pain and spinal problems. The discs of the spine are joints, and just like all joints in the human body, the discs undergo arthritic changes during the course of life. In 1990, Boden conducted a research study in normal people without neck pain. Magnetic resonance imaging (MRI) tests showed 20% of the people tested over 45 years-old have a disc bulge or degenerative disease, and nearly 60% of people over 65 years-old had degenerative disc disease. Despite being so prevalent, the vast majority of people never develop significant chronic neck pain as a result of this condition. The concept of a lumbar discogenic injury and degeneration causing back pain can also be applied to the cervical spine. As the intervertebral disc becomes dehydrated, it will have a decreased height and lose its viscolelastic properties as a cushion. The cervical spine will become less lordotic, and osteophytes (bone spurs) will form and may encroach upon the neurologic structures in the spinal canal. These degenerative changes may occur alone, or in combination with other cervical disorders such as a herniated disc or cervical spinal stenosis.
What is the procedure to check for degenerated discs?
Special Tests. A discogram is a test that is performed to help identify which degenerated disc, if any, is causing a patient’s neck pain. A doctor performs this procedure by injecting radiopaque dye, under pressure, into the discs of the cervical spine. The procedure is performed using fluoroscopy, a special x-ray machine ...
What happens to the cervical spine when it becomes less lordotic?
The cervical spine will become less lordotic, and osteophytes (bone spurs) will form and may encroach upon the neurologic structures in the spinal canal. These degenerative changes may occur alone, or in combination with other cervical disorders such as a herniated disc or cervical spinal stenosis.
What is disc bulge?
The discs of the spine are joints, and just like all joints in the human body, the discs undergo arthritic changes during the course of life. In 1990, Boden conducted a research study in normal people without neck pain. Magnetic resonance imaging (MRI) tests showed 20% of the people tested over 45 years-old have a disc bulge or degenerative ...
What is the best treatment for cervical pain?
The majority of patients with significant pain generally improve with time, as well as non-operative treatments such as oral medications, physical therapy, and other modalities. A short period of immobilization with a soft cervical collar (neck brace) may also be helpful.
Why do you need an MRI for disc herniation?
An MRI is generally recommended so as to identify if there is an associated disc herniation or spinal stenosis, which would impact the treatment regimen. An MRI will also clarify the severity of degenerative disc disease.
Is cervical degenerative disc disease nonspecific?
The physical findings for cervical degenerative disc disease are nonspecific. Patients may have cervical tenderness if the pain is severe. Often, the neck range-of-motion is decreased, but the neurologic examination is normal. Special tests such as the Spurling’s test and Hoffman’s sign are usually negative.
What is the treatment for cervical degenerative disc disease?
Pain, or in combination with other neurological symptoms, may require surgical intervention. Treatment options range from nonoperative measures to decompression, instrumented fusion, or a combination of both laminoplasty or instrumentation or a combination of both. This chapter will examine the anatomy, natural history, etiology, pathophysiology, evaluation, and treatment options. This activity outlines the cause, prevention, and treatment of patients with cervical disc disease and highlights the importance of the need for an interprofessional team.
How to treat cervical disc disease?
Treatment for cervical disc disease is centered around decreasing pain, improving function, and minimizing recurrence and duration of symptoms. Treatment typically beings with nonoperative care and can lead to operative intervention.
What is the surgical approach to cervical spine?
There are a variety of surgical approaches to the cervical spine. Commonly, the neural structures become compressed anteriorly; therefore, an anterior approach is necessary to directly remove a disk, causing decompression and will most likely include a fusion (ACDF). The approach of choice in patients with normal to kyphotic alignment is the anterior approach as a laminectomy in these patients may further cause kyphosis secondary to the destabilization that occurs.[36] During an ACDF, compressive and degenerative structures are removed with a fusion across the segments adjacent to the decompression. Furthermore, several disks can be removed with multi-level fusions (with or without strut graft). A corpectomy with strut grafting may be necessary for multi-level decompressions. An anterior cervical plate can be inserted to increase stability and earlier mobilization. Distraction across the disk space with an interbody implant can lead to further indirect decompression of the neural foramen.
What is the intervertebral disc?
The intervertebral disc (IVD) is found from the C2-C3 level down, aids in cervical spine mobility and stabilization. In contrast to the thoracic and lumbar vertebrae, the cervical vertebrae have a unique bony prominence called the uncinate process, which articulates with the adjacent level to form the joint of Luschka or uncovertebral joint. This joint helps to reinforce the IVD and provides additional stability and motion.[1] The IVD is an intricate structure composed mainly of two parts, the peripherally located annulus fibrosus (AF) and the centrally located nucleus pulpous (NP) which are responsible for its’ load distribution function. The anterior and posterior longitudinal ligaments reinforce the IVD.
What is the most common disc level in cervical degeneration?
In a Japanese study evaluating 497 asymptomatic patients, Matsumoto et al. showed almost 90% of patients (men and women) over 60 years of age had abnormal findings while 17% and 12% of men and women respectively, in their 20s demonstrated abnormalities. [10] Several studies have acknowledged the most common disc-level involved in degeneration was C5-6, and the second most common being C6-7. Research has also demonstrated that cervical DDD was associated with lumbar degenerative changes in both men and women but did appear later in life. An association has also been found in the pain distribution in the neck-shoulder-brachial region in patients with moderate to severe cervical DDD. [9][10][11]
What are the stages of cervical spine degeneration?
The degenerative process of the cervical spine classifies into three distinct stages: (1) dysfunction, (2) instability, and (3) stabilization. Dysfunction occurs between the ages of 15 to 45 years old. During this stage, radial and circumferential tears can occur in the annulus accompanied by facet joint localized synovitis. Instability (2) can occur in individuals between the ages of 35 to 70 years old. This stage is characterized by disruption of the inner disc with progressive resorption, as well as facet joint degeneration. This condition leads to the final stage of the process, stabilization, occurring most commonly after 60 years of age. Here, hypertrophic bone develops around the facet joints as well as the disc, promoting stiff and possible ankylosing spine.
How to treat a spasm in the neck?
Physical therapy should start early in the treatment algorithm. Passive modalities should be used and include but are not limited to heat, mechanical traction, massage, and a soft cervical collar.[26] Heat has shown to decrease pain and reduce muscle spasms. [27][28] Evidence suggests cryotherapy can help decrease inflammation and reduce muscle guarding. [29][30] Massaging the area of intensity allows for mechanical stimulation leading to an increase of circulation and the promotion of muscle relaxation.[31] Cervical traction may allow for joint distraction and potentially relieving pressure off nerve roots/disks; this may improve epidural blood flow in the area and reduce pain, inflammation, and spasms.
How to diagnose cervical degenerative disc?
Your doctor can diagnose a cervical degenerative disc by reviewing your medical history, performing a physical examination, and viewing medical images of your neck. You should tell your doctor about your symptoms. Your muscle strength, joint motion, and joint stability will be tested.
What causes degenerative disc disease?
Causes. Doctors are not sure of the exact cause of degenerative disc disease. It appears that the aging process, trauma, and arthritis may contribute to the condition. Doctors suspect that genetic, environmental, and autoimmune factors may play a role.
What is ACDF surgery?
Anterior cervical decompression and spine fusion (ACDF) surgery is commonly used to treat cervical degenerative disc disease. ACDF surgery is performed through an incision at the front of the neck.
What is the condition that can compress the spinal cord and nerves in the neck?
Introduction. Cervical degenerative disc disease is a condition that can compress the spinal cord and nerves in the neck. Intervertebral discs are shock-absorbing pads located between vertebrae, the small bones that make up your spine. Aging can cause the discs to lose fluid, collapse, and sometimes rupture.
Why is the top section of the cervical canal so spacious?
The top section of the cervical spinal canal is very spacious. It allows more room for the spinal cord than any other part of the vertebral column. The extra space helps to prevent pressure on the spinal cord when you move your neck.
What is the back part of the vertebra?
The back part of the vertebra arches to form the lamina. The lamina creates a roof-like cover over the back of the opening in each vertebra. The opening in the center of each vertebra forms the spinal canal. Intervertebral discs are located between the vertebrae in the cervical spine.
How does aging affect the spinal cord?
As the disc deteriorates, it affects the structure of the vertebrae. The structural changes can put pressure on the spinal cord or spinal nerves, resulting in pain and loss of function.
What are the best treatments for degenerative disc disease?
Avoidance of painful positions and/or use of a neck brace are all options to try to reduce tension by the affected discs. Various pain management options including anti-inflammatory medications, steroid pills, ...
What is the procedure to remove degenerative discs?
The traditional surgical technique for reduction or elimination of pain from degenerative discs is spinal fusion.
What is cervical disc degenerative disorder?
Symptoms. Cervical disc degenerative disorder can be characterized by neck pain. This neck pain can be most prevalent when the patient is upright or moving the head and can be reduced by lying down or reclining. Often the disc will be associated with osteophytes or bone spurs.
What is the best diagnostic imaging for cervical disc disease?
An MRI is most useful diagnostic imaging for these conditions. The MRI shows if the disc is degenerated and best identifies the impingement on the nerves by bone or soft tissues surrounding thems. Changes in the bony end plates with increased water content in the bone are known as Modic changes.
How to reduce pain from degenerative discs?
The traditional surgical technique for reduction or elimination of pain from degenerative discs is spinal fusion. It can be done from a posterior approach with screws and rods in the spine and adjacent bone graft or anteriorly with removal of the disc and placement of graph materials in the front. Sometimes surgeons will choose to place implants ...
What is the process of degeneration of the discs?
Degeneration of the discs particularly in the moving sections of the spine like the cervical and lumbar levels is a natural process of "aging." When this "aging" process occurs more rapidly or prematurely it is considered "degeneration." The dehydration or desiccation of the disc material reduces the flexibility and typically the height of the disc. In some cases, the degeneration causes pain from loss of disc height and abnormal motion or compression between the vertebra and causing pain.
What are the long term consequences of disc fusion?
One of the long-term consequences of disc fusion can be accelerated degeneration of adjacent discs. That is, discs that are degenerating at levels above or below the fusion can be adversely affected, leading to more rapid degeneration of those discs than might have occurred without the adjacent fusion. A newer option used to maintain motion in the ...
What is the degenerative disc?
Degenerative cervical disc has a rich supply of nerve fibers, is prone to inflammatory reactions, and is susceptible to pain that can be provoked by disc stimulation or distention, and can be eliminated by block.
Can cervical disc degeneration cause neck pain?
Cervical disc degeneration and neck pain. Cervical intervertebral disc has long been considered a common source of neck pain. However, the pain caused by the disc itself has not been clearly defined so far, and its diagnosis and treatment has always been controversial.
Is cervical intervertebral disc a degenerative disc?
Cervical intervertebral disc has long been considered a common source of neck pain. However, the pain caused by the disc itself has not been clearly defined so far, and its diagnosis and treatment has always been controversial. Degenerative cervical disc has a rich supply of nerve fibers, is prone t …
What is cervical degenerative disc disease?
Cervical degenerative disc disease is diagnosed when a damaged disc in the spine becomes symptomatic.
How many cervical discs can degenerate?
How Cervical Discs Can Degenerate. Normally, there are six gel-like cervical discs (one between each of the cervical spine’s vertebrae) that absorb shock and prevent vertebral bones from rubbing against each other while the neck moves. Each disc is comprised of a tough but flexible outer layer of woven cartilage strands, called the annulus fibrosus.
What level of disc disease is most likely to occur in cervical spine?
When 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. 3
What is the outer layer of a disc called?
Each disc is comprised of a tough but flexible outer layer of woven cartilage strands, called the annulus fibrosus. Sealed inside the annulus fibrosus is a soft interior filled with a mucoprotein gel called the nucleus pulposus. The nucleus gives the disc its shock absorption property.
Why is my disc not able to heal?
The disc is not able to truly repair itself because it does not have a direct blood supply (instead getting nutrients and metabolites via diffusion with adjacent vertebrae through the cartilaginous endplates). As such, a tear in the disc either will not heal or will develop weaker scar tissue that has potential to break again.
How much water does a disc lose?
In children, the discs are about 85% water. The discs begin to naturally lose hydration during the aging process. Some estimates have the disc’s water content typically falling to 70% by age 70, 1 but in some people the disc can lose hydration much more quickly.
Can cervical degeneration be chronic?
When symptoms from cervical degenerative disc disease become chronic, the pain and/or symptoms are likely related to conditions associated with disc degeneration, such as a her niated disc, osteoarthritis, or spinal stenosis . Depending on the cause, the pain may be temporary, or may become chronic. To give an example, pain from a herniated disc is likely to eventually go away on its own, but pain from osteoarthritis may require treatment on a chronic basis.
Overview
Causes
Symptoms
Physical Findings
Imaging Studies
Laboratory Tests
Special Tests
Diagnosis
Treatment
- The treatment for degenerative disc disease is primarily conservative. The majority of patients with significant pain generally improve with time, as well as non-operative treatments such as oral medications, physical therapy, and other modalities. A short period of immobilization with a soft cervical collar (neck brace) may also be helpful. Epidur...
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