Degenerative disc disease occurs in the intervertebral discs that lie between any two unfused vertebrae in the spine. Since the cervical vertebrae in the neck offer the greatest flexibility in the spine, a degenerated disc in the neck can cause significant problems when moving the head. The most severe problems result when a disc herniates and impinges on neural tissues.
Degenerative Disc Pathology
The reason a disc degenerates is not well understood. Environmental, autoimmune and genetic factors may be involved. Repetitive activities and cigarette smoking can contribute to degenerative disc disease. While the biological mechanism is still being sought, the end result is that the outer disc wall develops defects. The Mayfield Clinic says these defects become so pronounced that the inner, softer disc material herniates through the defect. This creates a bulge in the disc, and when that bulge compresses the nearby spinal cord or spinal nerves, pain and other neurological symptoms may result.
Who Is at Risk
According to the Mayfield Clinic, there is considerable variation between individuals as to when and how the disease appears. Patients can have the disease yet be symptom free for many years. In others pain and other symptoms can be devastating right from the beginning. Also, pain and other neurological symptoms can start suddenly or progress slowly. Centra Care Health Library says that it is uncommon for patients in their 60s to develop degenerative disc disease in the neck. Rather, it usually starts between the ages of 20 and 40.
Disease Progression
Most patients with degenerative disc disease in the neck complain of pain. The symptoms commonly appear after a sudden trauma, such as a blow to the head, and the resulting pain may seem unrelated to the trauma. Sometimes even a slight trauma produces tremendous pain. It is also not uncommon for pain to begin without a triggering event.
Symptoms
Each person with cervical degenerative disc disease can have symptoms different from the next person. The Merck Manual reports that symptoms also are different if the disc herniates at high vs. low cervical levels. The most common symptom is pain, which is generally proportional to the degree of disc herniation. According to a 2001 article in the "British Medical Journal," the bulging disc can produce pain and sensory dysfunctions, called parasthesias, from the head to the hands and feet. Cervical disc herniation also can injure the sympathetic nervous system. With more severe damage, partial paralysis of the diaphragm or muscles on half of the body can result. With even more severe herniation, walking can be affected. Generally speaking, the more degenerated the disc the more it herniates, and the more severe the symptoms.
Treatment
Degenerative disc disease is treated when the disc herniates and causes symptoms. There are essentially two ways to treat the herniated disc. Conservative or non-surgical therapies include rest, medications, physical therapy and chiropractic. When such therapies fail, surgery is usually recommended. Surgery's goal is to remove part or the entire disc. According to the Mayfield Clinic, a discectomy is performed by approaching the cervical vertebrae from either the front or back of the neck. If the entire disc is removed, often the adjacent vertebrae will be fused to achieve stability.
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
- The Merck Manuals: Compression of the Spinal Cord
