Cervical Degenerative Disc Disease Signs and Symptoms
by Saqib A. Siddiqui, MD
Cervical degenerative disc disease and cervical herniated disc are very common conditionsthat affect the spine. Symptoms experienced by apatientsuffering from a cervical herniated disc or a degenerative cervical disc may be neck pain, pain in the shoulder, arm, forearm or hand, numbness in the fingers, hand or arm, weakness in the fingers, hand, wrist or arm, or pins and needles in the upper extremity. In some advanced cases a patientmay have loss of balance, a “wobbly gait”, difficulty with bladder control, and weakness, numbness, or pins and needles even in the lower extremities. In this case the patient is said to havea condition knows as cervical myelopathy.
On examination your Doctor may notice that you have a gait disturbance or that you have noticeable weakness when he tests your strength in your upper or lower extremities. You may also be found to have changes in your reflexes and sensation in your upper or lower extremities.
Tests and Investigations
Patients suspected of having a cervical disc herniation, cervical myelopathy or cervical disc degenerative disc disease should have a set of plain radiographs taken. These should include flexion and extension views taken with you bending your neck forwards and then backwards to look for cervical spinal instability.
An MRI is very helpful in finding the level of cervical disc herniation, cervical disc degeneration or cervical spinal stenosis (which is a narrowing of the cervical spinal canal), Degenerative cervical discs will show up as a darker color on the T2 images due to their abnormally low water content. An MRI will also show the level and side of a cervical disc herniation and any nerve compression as well as bony spurs present. In the case of cervical myelopathy and cervical spinal stenosis, the spinal canal and the amount of room available for your spinal cord may be seen to be diminished. This may result in visible signal changes in the substance of the spinal cord in the case of patients with cervical spinal stenosis and cervical myelopathy.
If your pain is not extremely severe and your spinal cord is not critically threatened then a conservative approach is always recommended at first. Providing you have no significant weakness, loss of bladder control or other signs of myelopathy your cervical disc herniation and cervical degenerative disc disease may be treated with some physical therapy and anti-inflammatory medications. After 4 to 6 weeks of physical therapy, if your symptoms still persist you may be a candidate for cervical epidural steroid injections.
In certain cases where there is no effect from non-operative measures then a surgical option may be considered. Surgery is recommended sooner in case of extremely severe pain, which cannot be controlled, severe weakness, signs and symptoms of myelopathy or radiculopathy in both upper extremities.
In cases of radiculopathy only with little neck pain, a percutaneous nucleoplasty may be tried. This is an outpatient procedure, which is done through a needle under local anesthesia and intravenous sedation. With the decompression that results in the disc nucleus, the radiculopathy may resolve without the need for more drastic measures. This procedure is extremely safe with little or no pain in the post-operative period and has a very low complication rate. The patient leaves the surgery center with only a band-aid on their neck.
The most common surgical procedure for cervical myelopathy, severe cervical degenerative disc disease or moderate to large cervical disc herniation is cervical fusion done from the front also known as Anterior Cervical Discectomy and Fusion. In this procedure, a small incision is made in the neck along the lines of the skin creases. Because of this, these incisions usually heal very well with very little visible scar. The disc at the affected level is removed and commonly either a piece of bone allograft or a carbon fiber cage filled with graft gel is placed between the vertebrae where the disc used to be. A metal plate and screws are used to secure the fusion level and provide initial stability and also to block the graft from being extruded forwards. The fusion may take many months but in most cases patients can resume a normal life within a few weeks depending on their occupation and activity level. In most cases if the patient is healthy, an anterior cervical Discectomy and fusion may be safely performed in an outpatient surgery center.
In some cases of multiple level cervical myelopathy a procedure known as cervical laminoplasty may be considered. In this procedure, which is done from the back of the neck, the lamina are modified so that the canal is wider to allow more room for the cervical spinal cord. Motion is retained at the levels operated on.
More recently, single level degenerative disc disease or a single level cervical herniated disc may be treated with cervical artificial disc replacement or cervical spinal arthroplasty as it is also called. In this procedure, a metal and plastic implant is positioned in place of a bone or carbon fiber cage. The idea of cervical disc replacement is to maintain the motion at that level and avoid adjacent segment disease. At this time in the USA we will soon have approval to use the cervical artificial disc for only isolated one level disease similar to the lumbar spine.