The aging process often brings about various forms of degeneration in the body. This is a natural result of the wear and tear that a body experiences throughout a normal life of twisting, lifting, bending, and turning. When degeneration occurs within the discs that are located between the vertebrae of the spine, it is known as Degenerative Disc Disease, or DDD. When DDD is located in the neck, that is in the seven vertebrae of the cervical spine, it can often cause pain, stiffness, and a loss of mobility.
Vertebral discs are the small cushions between the vertebrae. They act as shock absorbers in spine. The outer section of a disc is called the disc wall, or more technically, the annulus fibrosus. Sometimes the tissue and cartilage in the discs can suffer tears, weakening the disc wall. In addition, the more that the disc wall is injured, the more likely it is that the center of the disc, known as the nucleus pulposus, will also be damaged.
The disc center is a jelly-like substance that has a high water content. If it becomes damaged, it will lose water and dries out. When dry, the nucleus cannot effectively act as a cushion, and it may collapse under the pressure of the spine.
The collapse of the vertebral disc causes the vertebrae surrounding it to move closer together. This movement can result in several symptoms. As the vertebrae lose their soft shock absorbers, the neck can become very stiff. They may rub against each other at the facet joints. Over time, this can create painful bone spurs.
When the vertebrae come together due to the loss of disc height, the nerves may also be pinched, causing neck pain, or even pain, numbness, or tingling in the shoulders, arms, and hands.
This pain is often similar to arthritis and inflammation. The pain may only be present when the patient turns his or her head or it may be constant. Some patients will have no other sign of cervical DDD than a stiff neck. They may only discover that they have the disease in the course of a normal checkup.
All examinations begin with a discussion between the doctor and patient. The doctor will ask questions about the patient’s medical history. He or she will be looking for information about family history of neck problems, any neck injuries the patient has experienced, the severity and exact location of the neck pain, and any treatments that the patient has already attempted.
The doctor will then move on to a physical examination. The patient will stand, sit, and go through several simple tests to demonstrate whether he or she suffers from a limited range of motion. Simple neck exercises will show whether the patient can turn his or her head from side to side or whether that motion is restricted by pain or stiffness. To rule out possible neurological damage, the doctor will also test the reflexes in the extremities, especially the arms and hands.
Diagnostic tests are then carried out to reveal what is happening within the cervical spine. X-ray pictures will rule out other possible causes of neck pain, such as tumors. These images will also show if disc height has been lost and if the vertebrae have moved closer together than normal.
An MRI may also be taken in order to get a clearer picture of the soft tissues, including the damaged disc. A myelogram may also be helpful. This test relies on a colored dye that is injected into the spine. Before it dissipates, a CT scan is taken and the dye helps to create a clearer image of what is happening within the spine. It will show if the nerves are being pinched and help the doctor to locate the site of the pain more accurately.
In many cases, patients will not need surgery to reduce the pain of cervical DDD. Often, other treatment methods will be effective. The doctor may begin by recommending over the counter pain medication. These medications may reduce pain and inflammation both.
If the patient is in great pain, the doctor may alternatively issue a prescription for pain relief. To manage pain, medicine may also be injected into the neck. Medication such as steroids, narcotics, or local anesthetic may be recommended.
A brace or a soft cervical collar may also be used to stabilize the neck until the pain has subsided. Gradually, the patient will be encouraged to return to his or her normal activities. Physical therapy is often suggested as a way to learn to stretch and strengthen the neck muscles. A therapist will help the patient to improve flexibility and extension in the neck.
If the non-operative treatments are ineffectual, the doctor may recommend surgery. The lack of response to non-operative treatment could be a sign of a herniated disc. Additionally, if neurological damage is present, surgery may be a necessity to reduce pain and prevent further problems.
A common surgery for Cervical DDD is an anterior cervical discectomy and fusion (ACDF). With ACDF, the surgeon begins by making an incision on the front (anterior) of the neck. This surgical treatment first removes the damaged disc. Any existing bone spurs may also need to be removed at this time. Then, a bone graft is placed into the space where the disc was located. As the body heals, the graft causes the vertebrae to fuse together.
This fusion may be assisted by implants or instrumentation beyond just the bone graft. A metal plate may stabilize the vertebrae around the graft. Screws or hooks may also be used for additional support.
Alternately, a PCDF approach may be preferred. This is similar to the ACDF, but it is an approach from behind (posterior). Also, an artificial disc may be preferred over a bone graft. Made from biocompatible metal such as titanium or a pliable material such as polyethylene, this disc will replace the damaged vertebral disc and fill in the space between the vertebrae without requiring a fusion of the bones.
Dr. Rahman has a broad training and experience with cervical spine surgery, from the most basic cervical cases to some of the most complex.