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Cervical Degenerative Disc Disease
Cervical Degenerative Disc Disease is a very common disorder that we see in the clinic pretty regularly. It occurs most commonly in people between the ages of 40 and 60, but it can also happen in your 20s, 30s 70s or 80s. It is typically marked by degeneration of the intervertebral discs in the cervical spine, which sets on a path of degeneration with both back joints called the facet joints and the uncovertebral joints which are where the actual vertebral bodies themselves articulate.
Cervical degenerate disc disease is as much a disorder as it is a disease. There are many factors that play into who gets it and why they get it. It’s genetic to some extent; it’s environmental; and it’s what you do for recreation. So depending on how you live your life, the stresses you take through your body, this break down can occur and you can get this disorder or disease. It’s multi-factorial in the end.
The typical presenting symptoms of this disorder include neck pain, shoulder pain, and potentially pain that radiates down the arm and to the hand. Typically the first line of treatment includes activity modifications, oral medications (particularly anti-inflammatory medications), potentially steroids, and then very importantly, physical therapy to focus on modality, stretching, and therapeutic exercise.
When physical therapy begins to wean in effectiveness or patients are getting worse, we recommend injection therapy as a second line of treatment. Injection therapy can be both diagnostic and therapeutic. From a diagnostic perspective, we want to see a positive response to the injections in order to help clarify the pain generator or irritated nerve root level.
The third line of treatment is typically surgical. When it comes to this type of disorder, surgery is more often done from the front. We go in and clean up the disc space and decompress the neural elements that are causing the nerve related symptoms. With the space that remains a fusion with bone grafting along with plates and screws or disc replacement surgery is performed. The surgery chosen depends on the amount of arthritis that a patient may have in their joints and whether the patient would be a good candidate.
With fusion surgery in the cervical spine, the early to mid-term recovery time is typically between six weeks and six months, with long term recovery going into one year point. There are restrictions in place for the first few weeks such as wearing a cervical collar and avoiding any strenuous or impact activities. At the four to six week point, we typically wean out of the cervical collar and begin increasing activity, still being careful to avoid impact or any type of situation where you could get hurt. This is because we’re shooting to get to that six month point because approximately 85 percent of the fusion strength is typically obtained by six months. At the six month point we can go forward with safely knowing that things are healed and going the way we want them to and typically lift activity restrictions.
When performing disc replacement surgery for this type of disorder, the recovery is somewhat different because it’s a motion-maintaining type of procedure. As such, we’ll typically put a brace on for a couple weeks to let the soft tissues in the muscles settle down and heal, but then we want the motion to continue because that’s the whole point of the surgery. It’s a small nuance but in the end we still want the bone to grip and grab on to that metal backing that has been specially treated to allow that to happen to maintain the best stability that we can with the implant.
For more information on Cervical Degenerative Disc Disease, watch this video.