Multilevel cervical degenerative disc disease refers to a condition where two or more intervertebral discs decay from disease. Scientists do not know what causes degenerative disc disease. Nor do scientists know why it causes pain in some people while others with similar pathology may feel nothing. The result of the pathology is that the discs bulge onto the spinal cord and spinal nerves, causing pain and other symptoms. Discectomy is usually required to remove the herniated discs and spinal fusion often follows.
Disc Degeneration
Although the causes of degenerative disc disease are not well understood, doctors believe that an autoimmune process may be involved. According to the Mayfield Clinic, factors such as heredity and the environment may combine and contribute to the underlying pathological mechanism. Smoking and repetitive activities may contribute to the disease process as well. The end result is that the intervertebral disc degenerates at one or more levels. The degeneration is associated with weakness in the disc and eventually its outer fibrous portion ruptures or tears. When the rupture occurs, the softer inner disc material pushes or herniates through the tear and into the space occupied by spinal nerves or the spinal cord. The result is pain and other symptoms of a compressed nervous system.
Who is Afflicted
Cervical disc degeneration is rare in persons in their 60s, according to Centra Care Health Library. It mostly occurs in people in their third and fourth decades of life. The disease affects men and women equally and the symptoms can appear suddenly and become completely debilitating or may take years to become recognizable.
How it Begins
Pain is the primary concern with cervical degenerative disc disease. Sometimes the pain can begin as a result of trauma to the head or neck, where the pain can appear unrelated to the trauma. Sometimes a relatively insignificant injury can result in disproportionately severe pain, according to Centra Care Health Library. As the bulging disc presses on spinal nerves, symptoms of radiculopathy begin. If the disc presses directly on the spinal cord then symptoms of myelopathy appear.
Symptoms
Symptoms of multilevel cervical degenerative disc disease are highly variable and affect people differently, according to the Merck Manuals. Also, radiculopathy and myelopathy symptoms may be different at higher versus lower cervical levels. Generally speaking, as the disc degenerates further it pushes more extensively on the neural tissues and this usually worsens the pain. According to the "British Medical Journal," cervical disc degeneration can produce paresthesias and pain symptoms anywhere from the head to the feet. Symptoms also can produce disturbances in gait, and generally speaking the more the disc degenerates and herniates, the more pronounced the symptoms are. Damage to the sympathetic nervous system also can produce Horner's syndrome. Hemiparesis and hemidiaphragm paralysis can occur as well.
Treatment
According to Centra Care Health Library, nonsurgical methods to treat cervical degenerative disc disease target pain relief and activity modification. Pain medicines and corticosteroid injections can be used to relieve pain. When pain is severe or when function is compromised, surgery is usually recommended. Surgery focuses on eliminating the primary mechanical causation of pain, which is the herniated disc itself. A single or multilevel discectomy is performed and usually multilevel vertebral fusion is needed to stabilize the vertebrae.
References
- Centra Care Health Library: Cervical Degenerative Disc Disease
- Mayfield Clinic: Degenerative disc disease
- "British Medical Journal"; Degenerative cervical disc disease causing cord compression; P. Bently, et. al.; February 2001
- "Journal of Neurology, Neurosurgery and Psychiatry"; Midcervical central cord syndrome: numb and clumsy hands; M. Nakajima and K. Hirayama; June 1995
- Merck Manuals: Compression of the Spinal Cord
