Cervical Degenerative Disc Disease: How to Manage?

Overview

Cervical degenerative disc disease is a term used to describe the degenerative process that occurs in discs in the cervical spine. It may be associated with spinal wear and tear, age, or injuries. As you know, in the spine, there are seven cervical bones. The cervical spine, from C1 to C7, has a wide range of mobility and function. The upper cervical spine, namely C1 and C2, are highly specialized, allowing for rotation, flexion, extension, and side-bending. The spinal cord, nerve roots, blood arteries, trachea, and esophagus are all structures close to the cervical vertebrae.

The intervertebral disc is a huge spongy mass that connects two cervical vertebrae. It acts as a cushion between two vertebrae, resisting the downward forces placed on them and protecting them from misalignment. It comprises three components: the annulus (AF), the nucleus pulposus (Np), and the cartilaginous endplates.

Almost everyone who lives long enough develops deteriorated discs. According to several studies, the most common one is the degenerative disc disease in neck c5-6 and c6-7, with C6-7 coming in second. About 27% of the Medicare population is diagnosed with cervical degenerative disc disease every year.

While we connect cervical disc disease as age-related, it could also be due to motor vehicle accidents. A car collision might not cause cervical degenerative disc disease, but it can exacerbate the symptoms of cervical disc degeneration. If cervical disc degeneration is limited to a single localized disc site in the neck, it is typically a symptom of an earlier injury, which might hasten the disc’s degeneration. Bone spurs visible on the edges of degenerated discs indicate that the degeneration of cervical intervertebral disc has been present for some time. In such cases, it may be considered a pre-existing condition, especially in personal injury claims.

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​Cervical degenerative disc disease may be associated with three stages of disc degeneration.

• Dysfunction
• Instability
• Stabilization

Dysfunction is a condition that affects people between 15 and 45 years of age. It causes radial and circumferential annulus rips and localized synovitis in the facet joints. Instability affects people between the ages of 35 and 70, and it involves the rupture of the inner disc, which leads to gradual resorption and degeneration of the facet joints. Stabilization is the ultimate stage, which often occurs beyond 60 years of age. Hypertrophic bone forms around the facet joints and the disc, causing a rigid and ankylosing spine. During disc degeneration, each spine segment would be at a distinct state of degeneration, which need not be uniform. To be more specific, one spine section may experience dysfunction while another is experiencing instability.

The most common symptoms of degenerative disc disease in the neck are neck pain and stiffness, burning sensation in the neck, tingling, numbness, etc. In the majority of the cases, the degeneration is exhibited as a self-limited complaint, whereas in some cases, symptoms of cervical spine disorders demand effective treatment methodologies.

This blog will take you through the different cervical degenerative disc disease treatment options available for addressing the issue. Consultation with a physician and competent supervision is required for any cervical degeneration treatment suggested in this blog.

Non-Surgical Treatment for Cervical Degenerative Disc Disease

What to do for degenerative disc disease in the neck? Non-surgical techniques are recommended as a first-line treatment for individuals experiencing mild pain and discomfort. For patients living with degenerative disc disease in the neck and suffering from intractable neck pain, a cervical collar may be advised. Depending on the physician’s advice, the methods listed below could be employed separately or combined.

Lifestyle Modification

No single element in your daily life can be changed to help with cervical degenerative disc degeneration. To treat the symptoms and achieve effective outcomes, it should include a combination of factors, along with adequate rest. They are discussed below.

1. Intake of healthy food, including fruits and vegetables with anti-oxidizing properties. Caffeine intake should be avoided.
2. Avoid strenuous activities that trigger your symptoms. This may include lifting heavy objects, repetitive movements involving the neck, over usage of cell phones, etc.
3. Intake of fluids should be increased to avoid dehydration, which is a crucial factor in cervical disc degeneration.
4. Studies indicate that there is a connection between smoking and cervical degenerative disc disease. Individuals with cervical degenerative disc disease should quit smoking as it interferes with the body’s natural healing process. Smoking blocks the oxygen supply to the intervertebral discs, thereby triggering further degeneration. Smoking also causes the bloodstream to absorb carbon monoxide, which prevents the discs from absorbing calcium and other nutrients from the blood.
5. Erect posture should be maintained during sitting, walking, reading, or using computers.

Ice/ Heat Therapy

Neither heat nor cold will penetrate far enough to reduce the inflammation in cervical degenerative disc disease. Hence the individual can choose whichever he feels the best and most comfortable. Ice therapy reduces inflammation and helps to reduce pain to some extent, whereas heat therapy helps to relax muscles, thereby decreasing stiffness. However, these methods will not have a long-term effect on pain relief.

A plastic bag filled with ice, an ice pack, or even a bag of frozen peas could be used for ice therapy. Never apply ice directly to the neck as it may lead to ice burn. A moist heating pad, hot water bottle, or a towel soaked in hot water can be used for heat therapy. Ice/ heat therapy should be used for 10-15 minutes every few hours.

Pain Medications and Injections 

Non-steroidal anti-inflammatory drugs (NSAIDs), antidepressants, Acetaminophen, oral steroids, and muscle relaxants are the commonly prescribed medications for cervical degenerative disc disease.

NSAIDs, or non-steroidal anti-inflammatory drugs like aspirin, ibuprofen (such as Advil, Motrin), and Naproxen (such as Aleve, Naprosyn) are used to relieve pain-related symptoms of cervical degenerative disc disease. It may be used either as over-the-counter or prescription medication. For periodic painful outbreaks, acetaminophen like Tylenol may be prescribed. It is a relatively safe and effective pain treatment.

Muscle relaxants such as Carisoprodol Cyclobenzaprine and Diazepam are prescribed to manage the pain caused by muscle spasms. These drugs should not be used on a continuous basis.

Steroid injections for cervical degenerative disc disease are usually effective in managing underlying problems such as stenosis or a herniated disc. Cervical epidural steroid injections or cervical facet injections deliver anti-inflammatory medicine directly into the inflamed spinal nerves that help to provide temporary or lasting pain relief.

Physical Therapy

The physical therapy treatment strategy for cervical degenerative disc disease should involve an expert physical therapist who can give you specialized cervical degenerative disc disease exercises. Stretches and exercises can help reduce pain and stiffness, minimize neck pain, strengthen the neck muscles and joints and reduce further complications. The typical exercises for cervical degenerative disc disease are

• Chin tucks– Lie down on your back, knees bent, feet flat on the floor. Lower your chin to your chest as you gaze up at the ceiling. Hold the position for 5 seconds. This should give you a slight stretch from the neck to the base of your skull. Repeat the movement a total of ten times.
• Side Bending– Lie down on your back, knees bent, feet flat on the floor. Bring your right ear near your right shoulder by lowering your head to the right. You can gently move your head deeper into the stretch with your hand. Hold the position for 20 seconds. The same steps should also be repeated on the left side.

Physical therapy treatment strategies for cervical degenerative disc disease also include passive techniques like deep tissue massage, hot and cold therapy, and spinal traction. The physical therapist designs the treatment plan according to the severity of pain and the general health of the patient.

Chiropractic Therapy

Chiropractic therapy is a non-invasive method to treat cervical spine degeneration. It helps calm the nerves, reduce pain and kindle the blood flow to the injured. This helps increase the circulation in the disc, which would aid in the healing process. There are a variety of chiropractic techniques to manage cervical degenerative disc disease, but one of the most frequent is the spinal adjustment.

Yoga

Yoga is a mind-body integration approach that combines workout movements and meditation techniques. It can help to prevent further degeneration of cervical discs and reduce neck pain. A professional yoga instructor can help the patient practice yoga poses that would help in pain relief and prevent other complications. There are also certain yoga poses to avoid degenerative disc disease.

Matsyasana, Bitilasana, Balasana, and Savasana are some of the common yoga for degenerative disc disease in the neck. It is important to make any required adjustments to your practice and avoid any painful or uncomfortable poses.

Acupuncture

Acupuncture involves inserting very fine needles into your skin at specific locations. Researchers have proved the usefulness of acupuncture in treating cervical degenerative disc disease. This method is commonly used in managing cervical spondylosis, a painful condition caused by intervertebral disc degeneration.

Acupuncture for cervical degenerative disc disease involves specific acupuncture points in the neck. For instance, the acupuncture point GV14 is determined the most effective for the treatment of cervical spondylosis. A practitioner will insert the needles based on your symptoms and exact diagnosis. Multiple needles will be inserted at specific spots along your body’s meridians and left in for 20 to 40 minutes. The insertion of needles at specific points in the body helps in the release of endorphins or serotonin, which helps in pain relief.

Herbal Remedies 

Anti-inflammatory characteristics have been discovered in herbs such as Devil’s Claw and White Willow Bark, which may aid in the treatment of symptoms associated with cervical degenerative disc disease.

Other herbal therapies that have been reported to be useful in mending degeneration, reducing pain, and strengthening neck muscles include fenugreek, celery seeds, dried ginger, ashwagandha, and curcumin.

It is usually good to consult your doctor before utilizing herbal therapies for cervical degenerative disc disease.

Surgical Treatment of Cervical Degenerative Disc Disease

When living with degenerative disc disease in the neck becomes challenging for the patient, surgery is recommended. If you have tried everything to ease your symptoms, or if your pain gets worse, your physician may suggest surgery. Minimally invasive surgical procedures would help the patients recover quickly without further complications. Cervical degenerative disc disease surgery methods include the following procedures.

Anterior Cervical Discectomy and Fusion (ACDF)

The term “discectomy” refers to the procedure of removing or cutting out a damaged disc. To access the afflicted disc, the surgeon accesses the throat area from the front (anterior) of the spine. Depending on how many discs are removed, the technique might be single-level or multi-level. A spacer bone graft is put into the open disc space after the disc is removed. Metal plates and screws hold the bone graft and vertebrae in place. The body’s natural healing process begins after surgery, and new bone cells are formed around the graft.

Cervical Artificial Disc Replacement

Cervical disc arthroplasty is another name for cervical artificial disc replacement. This treatment involves making a 1- to 2-inch cut in the front of the neck and removing the damaged disc. The disc space is restored to its original disc height, and an artificial disc device is inserted into the disc space that has been prepared. Sutures are used to close the incision after the prosthetic disc is joined to the vertebrae above and below.

After a few hours of observation following a cervical artificial disc replacement, the patient may go home. During the healing period, pain medications may be administered for a few days. The patient may have difficulty swallowing or speaking for a few days after surgery.

Posterior Cervical Foraminotomy

An incision of 2-4 cm is made during this surgery. At the junction of the lamina and the facet joint, a small window is created by removing a portion of the bone and ligament. The damaged nerve root is located, and the entire area through which the nerve runs is expanded using a high-speed drill and micro instruments. The nerve root is gradually lifted, and a disc bulge is palpated if one exists.

When a disc bulge is discovered, it is incised, and a tiny section of the disc is usually removed. It is not necessary to remove the entire disc. After injecting cortisone into the nerve root, the operation is finished, and the wound is closed with dissolving sutures for the skin.

Cervical Degenerative Disc Disease & Disability Benefits

Can I get disability benefits for cervical degenerative disc disease?

Yes. You may be eligible for Social Security disability benefits if you are suffering from the effects of the cervical degenerative disc disease and are unable to earn a living. Under the listings of the Social Security Administration, cervical disc degenerative disease is now evaluated under Section 1.15 ‘Musculoskeletal Disorders- Disorders of the skeletal spine resulting in compromise of a nerve root(s)’. 

To claim disability for degenerative disc disease cervical, the claimant should submit the proved nerve root compression with the following supporting evidence.

• Results of spinal examination.
• Specific tests to identify the affected nerve root.
• Imaging studies such as MRIs, X-rays, and CT scans depict nerve root compression.
• Medical records of the claimant.
• Statements from the concerned medical providers.
• Employment records of the claimant depicting the sick days, short-term disability leave, and family medical leave.
• Statements from employer, coworkers, friends, and family.

If the records submitted by the claimant do not clearly reflect the cervical degeneration, the claim may be denied.

Conclusion

Imaging studies have all been shown to be unhelpful in identifying a specific disc or other anatomical aberration as the source of discomfort in cervical degenerative disc disease. As a result, the diagnosis is complex. A combination of appropriate diagnostic tools, such as physical examination, the patient’s previous medical history, and neurological and reflex assessment tests, may assist the physician in developing an effective treatment plan for the patient. The physician must choose the therapy plan based on the diagnosis.

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