Definition and Overview

Cervical discs are fluid-filled discs that rest between the cervical vertebrae. They act as shock absorbers. To understand cervical disc disorders (CDDs), it is helpful to know how the spine works.

The spine is made up of 33 vertebrae. These bones are stacked on top of the other. In between them are discs. These discs prevent them from rubbing against one another. Six of the discs are found in the cervical spine (neck). They enable the neck to support the weight of the head. They also allow the head to move and rotate 180 degrees.

The spinal discs have a soft jelly interior. They also have a tough exterior. They are about 80-85% water. If the amount of water is reduced (often due to ageing), the discs become thin. This can make them more prone to damage. They can herniate or rupture.

CDDs are often caused by normal wear and tear. They can develop very slowly, often in a span of many years. But they can also occur suddenly if caused by traumatic injuries to the neck.

Causes of Condition

Many CDDs are caused by the natural ageing process. As a person gets older, his or her spinal discs become thin. This makes them more prone to a number of disorders, such as:

  • Degenerative disc disease - This begins to develop when the amount of water inside the disc decreases. This causes the disc to become thin. Eventually, it can collapse. This can lead to the compression of the spinal cord.

  • Cervical spinal stenosis - The narrowing of the spinal canal in the neck. It is most common in people aged 50 years and older.

  • Cervical osteoarthritis - The degeneration of the cartilage and bones of the neck.

Other causes of CDDs are traumatic injuries to the neck and rheumatoid arthritis (RA). RA is an autoimmune disease. It occurs when the body’s own immune system attacks healthy organs, tissues, and joints.

Key Symptoms

Signs of CDDs are:

  • Bladder control problems or incontinence. This occurs when there is pressure on the spinal cord.

  • Difficulties with mobility

  • Fatigue

  • Loss of function in joints

  • Muscle spasm

  • Neck pain radiating to arms and hands

  • Numbness and weakness in legs

  • Stiffness that gets worse over time

  • Swelling

  • Tingling sensation in the neck, shoulders, arms, and hands

Who to See and Types of Treatments Available

CDDs are treated by bone specialists. To diagnose the disorder and determine the best treatment for the patient, the doctor will:

  • Review the patient’s medical history.

  • Assess the severity of symptoms.

  • Carry out a neurological exam. This helps assess the extent of the condition.

  • Order imaging tests, such as an MRI and a CT scan – These are used to visualise the spinal cord. They help doctors identify which disc has been damaged.

Treatment options for CDDs are:

  • Pain management - Most patients with CDDs complain of neck pain. This can be treated with oral painkillers. In more severe cases, oral steroids or muscle relaxants can be used. Patients also have the option to have cervical epidural injections.

  • Manual manipulation - This involves applying manual force to the affected part of the neck. It can be used to improve mobility. It can also loosen up restricted connective tissue, joints, or muscles.

  • Physical therapy (PT) - PT complements any CDD treatment. It focuses on helping patients increase the strength and flexibility of their neck.

Meanwhile, surgery is recommended if:

  • Non-surgical therapies have failed to improve symptoms.

  • Patients suffer from neurological symptoms that prevent them from performing their daily activities.

  • Patients have lost bowel control or have difficulty walking.

  • Results of diagnostic tests suggest that patients are at risk of permanent nerve damage.

Surgical procedures used to treat CDDs are:

  • Anterior cervical discectomy and fusion (ACDF) - ACDF is carried out to remove a damaged cervical disc. The disc space is then filled with a bone graft. The bone graft is held in place using plates, rods, and screws. ACDF is used to treat bone spurs, disc degeneration, and herniated discs.

  • Cervical disc replacement (CDR) - This procedure is performed to remove and replace the diseased disc with an artificial or manufactured disc. The artificial disc is made from cobalt or titanium. It is composed of two endplates that move and slide on a central core.

Both procedures are performed under general anaesthesia. They require an incision on the front of the neck.

After surgery, patients are expected to feel pain or discomfort for a few weeks. Thus, they are often provided with painkillers. Their activity will also be limited until they fully recover. They must return to their doctor six weeks after surgery. Their doctor will take x-ray images to see how their bones are healing. They must also undergo physical therapy. They will work with a physical therapist who will help them strengthen the muscles of their neck and upper back. This speeds up the healing of their neck.

References:

  • Rhee JM, Yoon T, Riew KD. Cervical radiculopathy. J Am Acad Orthop Surg. 2007; 15(8): 486-94.

  • McCormick, M. T., Robinson, H. K., Bone, I., McLean, A. N., & Allan, D. B. (2007). Blunt cervical spine trauma as a cause of spinal cord injury and delayed cortical blindness. Spinal Cord.

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