Degenerative Disc Disease

Spine Anatomy

The cervical spine has shock absorbing discs between each bone that provide cushioning for movements and body loads. The discs and bones in a healthy neck allow bending from side to side and front to back, and turning left to right. Disc problems can start from over-use, an accident, or just the wear and tear of daily life. Degenerative changes in the discs may result in damage that can cause pain. When a disc degenerates it can have tears or cracks that lose water, which cause it to become thinner and provide less padding to absorb movement. Degenerated discs can also bulge (herniate) and pinch the spinal cord or nerves, which causes loss of feeling, weakness, pain, or tingling down the arms and hands. The medical term for this is RADICULOPATHY.  If the disc in the neck is causing pressure on the spinal cord, it can also lead to weakness, and numbness or tingling in all 4 limbs and abnormal gait, which is termed myelopathy.

Symptoms
  • Aching lower back pain
  • Stiffness in back
  • Radiating pain that descends into the legs
  • Pain is usually worse with activity or prolonged sitting or standing
Causes
  • Normal changes in disc during the natural aging process
  • Trauma (injury)
  • Repetitive lifting
  • Smoking, obesity and hereditary factors lead to advanced degeneration
Possible Treatment Options
Non Operative Treatment

Activity modification, cognitive and physical rehabilitation, medications, manual therapy or spinal injections are indicated for pain relief. Surgery can be considered for those who do not improve.  There are also an array of stem cell injections that are being investigated.

Micro-Decompression/ Microdiscectomy

This surgical procedure involves removing small portions of the lamina, removing bone spurs and/or enlarging foramina to relieve pressure or compression on the nerve roots or spinal cord. This pressure is often the cause of the pain.

Decompression & Posterior Fusion

Often times, in addition to a decompression, your surgeon will perform an instrumented fusion by inserting a series of screws and rods coupled with the placement of bone graft. This fusion provides increased spinal stability.

Anterior Cervical Fusion (ACDF)

The surgical approach is from the front of the neck. Once the exposure is made, surgical instruments are used to remove the disc material causing the nerve compression. Once this material is removed, an interbody cage or bone spacer is placed at the disc site filled with bone graft and secured with additional screws, plates or keels. The vertebral bodies above and below are frequently put under compression to aid in the subsequent spinal fusion.

Posterior Laminoplasty

This procedure is used to treat multiple segments from the posterior approach for decompression of the spinal cord and nerve roots.

Disc Replacement

This is the removal of the spinal disc, and replacement with an artificial prosthesis. Before artificial discs were available, patients would often receive an Anterior Cervical Discectomy and Fusion (ACDF) procedure to alleviate the pain from a herniated disc. In a fusion surgery, the disc is removed and either a bone spacer or a plastic implant will be placed in the disc space to restore disc height and remove pressure on the pinched nerves or spinal cord. A metal plate and screws can be placed on the front of the neck to hold the implant in place. The result of this procedure will be a segment that no longer moves, or is “fused”. The potential downside of a fusion procedure, in addition to the loss of motion, is that it can create additional stress on the spinal levels above and below it. This can cause degeneration at those levels and potentially result in another future surgery.

An example of an artifcial disc is the Mobi-C  which is an alternative option to fusion that will also be placed inside the disc space to restore height and remove pressure on the pinched nerves. However, the Mobi-C device is designed to allow the neck to maintain normal motion and potentially prevent the adjacent levels from degenerating, possibly preventing future surgeries. Mobi-C is the first and only cervical disc in the U.S. approved to treat more than one level of the cervical spine. It received FDA approval for one and two-level indications in August 2013.