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Cervical Disk Spondylosis, Part 3

A common cause of neck pain and radiating arm pain, Cervical Disk Spondylosis develops when one or more of the cushioning discs in the cervical spine (neck) starts to break down due to wear and tear.                                                                                                            

            Last week, we began to explore Cervical Disk Degeneration (Spondylosis) in detail. We went over definitions, and then examined the causes and symptoms of this specific condition.

            In this final segment, we will delve into the development of cervical disc degeneration, as well as treatment options and even prevention measures patients can take to avoid or lessen this uncomfortable condition.

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. 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.

          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, 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 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.

The Course of Cervical Disk Spondylosis:

          Cervical degenerative disc disease is not technically a disease, but rather a description of the 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 degenerative disc disease, even though a high percentage of these adults still shows signs of disc degeneration on an MRI somewhere on the spine. One study found that about half of people start showing some signs of disc degeneration on an MRI by their early 20s. Another study found that about 75% of people under age 50 have disc degeneration while more than 90% of people over age 50 have it.

          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.

          In cases where cervical degenerative disc disease does cause pain, it can happen in various ways. In some instances, the disc itself can become painful. People are more likely to experience this type of discogenic pain in their 30s, 40s, or 50s.

          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 herniated 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.

Treatment

          There are different alternatives to surgery available for patients with degenerative disc disease and pain. The first line in treatment for cervical disc disease is over-the-counter pain medications, including acetaminophen (Tylenol), and nonsteroidal anti-inflammatory medications such as ibuprofen (Motrin, Advil) and naproxen (Aleve). These medications can help reduce pain and inflammation. Your doctor might prescribe steroids or narcotic painkillers if over the-counter medications aren't working.

          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, and injections around the nerves or epidurals can be tried.

          Physical therapy is another treatment option for cervical disc disease. The therapist can use cervical traction, or gently manipulate your muscles and joints to reduce your pain and stiffness. The physical therapist can also help you increase your range of motion and show you exercises and correct postures to help improve your neck pain.

          Your neck pain should improve with these conservative treatments, but if you also have significant numbness or weakness, contact your doctor right away. You and your doctor will need to consider the next step in your treatment.

          If non-surgical options fail to treat the symptoms, surgical intervention may be helpful. Depending on the diagnosis, an anterior or posterior decompression and fusion can be performed. The goal of surgery is typically to take the pressure off the nerves and stabilized the degenerated levels.

          The main surgery for degenerative disc disease is called a discectomy. During this procedure, the surgeon removes the deteriorating disc. Discectomy is often followed up by artificial disc replacement, in which a metal disc is inserted in place of the disc that was removed. Discectomy may also be followed by cervical fusion, in which a small piece of bone is implanted in the space between the vertebrae. As the bone heals, it fuses with the vertebrae above and below it.

          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 both in the disc and the screws from a posterior approach. With painful degenerative discs that cannot bear the patient's weight without severe pain, spinal fusion is highly successful in eliminating pain. 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 degenerative level is cervical disc replacement. As compared to the gold standard of anterior cervical decompression and fusion (ACDF), the disc replacement technology theoretically decreases the risk of wearing out the disc above and below the treated level by preserving motion.

          It can take anywhere from a few weeks for your neck pain to improve on its own, to three months to a year for the bone to heal after surgery.

Prevention Measures:

          Unfortunately, there is no way to permanently prevent cervical spondylosis because it is a normal function of age progression. The good news is that there are measures that you can take to lower the chance of recurrence.

          To make sure you keep your spine as healthy as possible, eat a balanced diet and exercise regularly. Don't smoke, because, aside from its other effects on your health, smoking is a risk factor for cervical disc disease. Also watch your posture, always keeping your neck straight and your back well supported.

          Although neck pain from cervical disc disease can return, you'll lower the chances if you take good
care of your neck and the rest of your body.

 

          We hope that you have gained a greater understanding of Cervical Disk Spondylosis. Although it will affect all of us in our lifetimes, we still have options to maintain a quality way of life.

          If you believe you are experiencing Cervical Disk Spondylosis, don’t wait for your family physician; visit Excel Rehabilitation Services on Burnside Ave. in Gonzales, Louisiana. You will receive one-on-one care from an experienced physical therapist!

 

Sources:

http://spinecenter.ucla.edu/cervical-degenerative-disc-disease

https://emedicine.medscape.com/article/1144952-overview

https://www.laserspineinstitute.com/back_problems/spondylitis/cervical/

https://www.spine-health.com/conditions/degenerative-disc-disease/cervical-degenerative-disc-disease

https://www.spine-health.com/conditions/lower-back-pain/spondylosis-what-it-actually-means

https://www.webmd.com/pain-management/features/neck-pain#1

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