Degenerative Disc Disease
Treatment of Degenerative Disc Disease in the Neck
Conservative treatment is usually the first course of action recommended by a physician for cervical disc degeneration. For those with neck pain, but no evidence of nerve root compression or muscle weakness, the use of NSAIDs and analgesics, along with physical therapy, is common practice. Muscle relaxants may also be prescribed and ice packs can reduce the swelling and inflammation in the neck. Alternative anti-inflammatories and natural pain relief supplements offer another therapeutic course for those concerned with the side-effects of pharmaceutical medication. Spinal manipulation through chiropractic or osteopathic treatment may be helpful in some cases but should be approached with caution as these types of therapy may serve only to exacerbate an existing underlying condition such as cervical spinal stenosis. A good practitioner will want to take a thorough medical history prior to conducting any treatment and may themselves advise against treatment in some cases. Always make sure the practitioner is accredited by the appropriate governing body.
Cervical Collars, Neck Exercises and Pain Relief Devices
Soft cervical collars may be used briefly in order to give the neck muscles a rest. Longer-term use of the collars is likely to lead to muscle atrophy however, and is, therefore, not recommended. Cervical collars may be used for two days or so to allow rest, but should then be followed by mobilization, gentle, supervised, stretching and strengthening exercises for the neck. Cervical traction may grant some relief from symptoms for some patients and may be achieved at home using neck pain pillows, and devices for neck pain relief. Discussing these therapies with the consulting physician is wise so as to avoid the potential for exacerbating a condition however.
Epidural Steroid Injections
For those who are suffering from muscle weakness and pain from nerve root or spinal cord decompression surgery may be offered as an early option. Muscle weakness demonstrates that the nerves are being injured, making the relief of the pressure on the nerves an urgent priority. Epidural steroid injections are not usually used in the cervical neck as this procedure is more complex than for the lower (lumbar) spine due to the tight spaces involved in the neck structures and the risk of injury to the area. Cervical epidural steroid injections may be used in cases where arm pain and weakness occur through radiculopathy, although outcome is variable and effectiveness has not been demonstrated in the literature.
Degenerative Disc Disease Surgery
If degenerative disc disease does not respond adequately to conservative treatment and there is evidence of associated myelopathy, motor weakness, progressive neurological defects, and evidence of spinal cord compression surgery is the likely course of action. Even if conservative treatment has not alleviated the condition to a manageable degree within six months, surgery is still contraindicated if the attending physicians cannot accurately pinpoint the cervical spinal space that is the site of the problem.
Where discs have herniated, decompression of the spinal cord will be performed, and may be accompanied by a discectomy, or an anterior cervical discectomy and fusion (ACDF). An ACDF is a procedure to remove the affected disc and fuse the associated vertebrae in order to stabilize the spine in that area. Usually just one disc is operated on in this procedure, although surgeons may remove two discs on some occasions and fuse a larger portion of the spine together if warranted. Anterior discectomy (where the surgeon approaches from the front of the neck) is usual, but posterior cervical disc surgery may be preferential in some cases. Total disc arthroplasty presents another surgical option for one or two-level cervical disc removal; it shares the same risk as ACDF for adjacent segment disease (Jawahar, 2010). Laminectomy is another possible procedure which removes an area of bone in the back of the spine in order to enlarge the space in the spinal canal and reduce compression on its structures.
Post surgery the patient should be thoroughly monitored for neurological function. Analgesics and anti-inflammatories are frequently prescribed and, depending on the procedure the patient may be up and ambulatory within a day or two. Some procedures have a longer recovery time, such as the laminectomy which can take months to recover from fully. The resumption of light activities should be discussed with the physician, and any alterations in the condition reported immediately. Scans such as radiographs and further x-rays will be performed to establish the fusion of any bone grafts or plates inserted during the surgery.
Last Updated: 10/04/2010