Degenerative disc disease (DDD) is a condition that affects the discs that separate the spinal bones (vertebrae). As you grow older, the discs begin to dry and shrink, and your spine starts showing signs of damage. Degeneration of the discs, particularly at the cervical and lumbar levels, is a natural process of "aging." When this "aging" process occurs rapidly or prematurely, it is considered "degeneration".
The normal intervertebral disc contains cells which make a number of substances, including proteoglycans. These proteoglycan molecules help to attract water to the disc which in turn helps to maintain disc height and disc health. It is the loss of these cells, and in turn the loss of proteoglycan, that leads to the loss of water and loss of disc height.
Dehydration of the discs reduces their flexibility and height. Over time, these changes can lead to arthritis (for example facet joint arthritis), spinal stenosis (narrowing of the spinal canal) or disc herniation (prolapsed disc).
Pressure on the spinal cord or the nerves surrounding it can be painful and can cause a variety of symptoms including numbness, pins and needles, weakness (or paralysis) and bladder or bowel dysfunction. While medication, self care, and physical therapy are some of the treatments to significantly reduce the symptoms of DDD, surgery is also an option if the pain is chronic.
When a cervical (neck) disc prolapses, it typically causes arm pain (brachialgia). When a lumbar (low back) disc prolapses, it typically causes leg pain (sciatica).
What is Cervical Degenerative Disc Disease
Cervical degenerative disc disease develops when the cushioning discs in the cervical spine start to break down due to loss of the normal cells within the disc. You can think of it as normal wear and tear.
Some of the common symptoms include neck pain (cervicalgia) and arm pain (brachialgia). While genes are highly likely to play a role in some people experiencing more rapid degeneration, injury can cause and accelerate degenerative changes. There are a number of other risk factors as well, including smoking and obesity.
The cervical discs are made of six gel-like materials, in between the cervical vertebrae, that absorb shock and provide height for the nerves as they leave the spinal cord into the arms. Each of these discs are made of woven cartilage strands that are tough but flexible. The outer layer surrounds an inner gel-like layer called the nucleus pulposus. The shock absorption property of the discs is provided by this nucleus pulposus.
When we’re young, the discs are made up of about 85% water but tend to naturally lose their hydration as we age. As the disc loses hydration, it becomes more prone to wear and tear due to friction. It also loses its ability to repair itself due to the loss of direct blood supply. A tear in the disc at this stage will either not heal or will result in a weaker scar tissue that is prone to allow a herniation of the nucleus pulposus - a disc prolapse, also called ‘slipped disc’.
Let’s take a look at the common symptoms for Cervical Degenerative Disc (CDD) disease:
Neck Pain & Stiffness: Possibly one of the most common symptoms of cervical degenerative disc disease is a painful, stiff neck. When the pain lasts longer than 3-6 months, we call this chronic neck pain. The pain may only last a few days or weeks though..
Nerve Pain: Nerve pain can be identified as a radiating sharp pain straight down from the shoulder to the fingers. Depending on which finger is involved, your spine surgeon may be able to have an idea of which disc is causing the problem. Nerve pain usually occurs only on one side of the body. If you have symptoms on both sides of the body, then it could be a very large disc prolapse compressing the spinal cord, a condition called cervical myelopathy.
Numbness or ‘pins and needles’: If you feel a tingling sensation (paresthesia) in your shoulders or arms and have difficulty doing daily activities such as getting dressed or holding objects, it could be a sign of cervical degenerative disc disease.
Weakness: if the cervical disc is compressing the nerve or spinal cord significantly, you may experience weakness in your arms or legs.
Pain during movement: Since the discs are degenerate, other joints in the area also become degenerate - and this leads to pain on movement.
While pain from the degenerative disc itself is likely to subside on its own within a few weeks, if the symptoms are chronic, treatment might be required if the facet joints in the neck also start to degenerate. If the cervical spine degenerates further overtime, the spinal cord may be put at risk. Spinal cord compression could lead to symptoms such as trouble with coordination, loss of bowel or bladder control, numbness beneath the neck, and difficulty with arm or leg movement.
Causes of Degenerative Disc Disease
While DDD can affect even young adults who are active and healthy, it usually develops slowly over time and does not show symptoms until much later in life; although, smokers and people with sedentary jobs are at a greater risk for developing it.
In most cases, people with DDD might have family members who suffer from the same condition as well. Besides this, age, injury, arthritis, and certain genetic and environmental factors also contribute to the disc degeneration.
Additionally, weight gain has been linked to developing disc degeneration as well. Even a spine injury or a herniated disc can accelerate further degeneration.
Can Cervical Degenerative Disc Be Reversed?
While disc degeneration in its entirety cannot be reversed, there is evidence that a healthy lifestyle, plenty of physical movement and exercise, and good posture can contribute to alleviating the pain of degeneration. It can also prevent further degeneration of your back. For extremely painful and chronic conditions, your doctor may recommend medication, injections or surgery.
Non surgical treatments
Let’s take a look at some of the non-surgical treatments for a degenerative disc:
Self care: Stress flares up the symptoms of degenerative disc disease and does not help with you managing your pain and and keeping it under control. Indulging in deep breathing, visualization, and meditation can help you manage the pain better.
Medication: Your spinal surgeon may prescribe medications such as pain relievers, nonsteroidal anti-inflammatory medications (NSAIDs), or medications aimed at targeting nerve pain.
Spinal injections: Your spinal surgeon may suggest a number of different injections depending on your symptoms (arm vs neck pain). Steroid injections work well because they calm down the inflammatory component of the disease. A steroid injection around a nerve being pinched for example can help to calm down pain radiating along the arm. A steroid injection into the facet joints can help to treat neck pain. If the injections are helpful and last for a significant period of time, they can be repeated. For cases of neck pain that return, denervation of the facet joints might be considered.
Physiotherapy: Physiotherapy can be a very useful adjunct to pain-killers in helping to overcome neck pain or arm pain. In-between physiotherapy sessions patients are asked to continue with their own home exercises.
Chiropractic: Chiropractors use spinal adjustment as a treatment for patients with neck or back pain. In this case, pressure is applied to the area that isn’t moving as intended. Chiropractic adjustment is essentially trying to return the joints to a more normal motion. This helps with pain reduction and the possibility of muscle spasms. Dr Sherief Elsayed does not typically recommend chiropractic treatments for neck problems.
Surgery is only recommended if your condition does not resolve on its own or if your symptoms have not improved with non-surgical treatments.
Sometimes, surgery needs to be done urgently though, or even as an emergency, if:
There is weakness which may become paralysis
There is loss of bladder, bowel or sexual function
There is severe pain which is not responding to pain-killers, exercise and so on
Let’s take a look at the surgical treatments for disc degeneration:
Spinal Fusion Surgery: This treatment essentially joins the vertebrae together to inhibit any kind of painful motion between the bones. After removing the disc, and thus the pressure the disc is causing, a special cage along with bone graft is inserted into the collapsed disc space. Over the course of several months, the bone graft will fuse the two vertebrae into one solid bone piece. Sometimes your surgeon may also use metal rods and screws to aid the fusion procedure.
Motion Preservation Surgery - Cervical Artificial Disc Replacement: Also known as cervical arthroplasty, the aim of the surgery is also to remove the disc but instead of undertaking a fusion, a cervical disc replacement is inserted. This is thought to reduce the risk of adjacent level degeneration / disease which may be caused by fusion.
Cervical disc surgery is recommended to reduce pressure on the spinal cord and the nerve roots. This helps improve symptoms such as weakness and arm pain. However, neck surgery does not really help with relieving pain if the pain is only in the neck. It is advised to stick to non-surgical treatments unless the disc space is clearly identified as the pain generator.
Future treatments - Stem Cells in Degenerative Disc Disease?
Stem cells are cells which have the potential to turn into a variety of other cells, for example bone cells or nerve cells. An increasing number of healthcare professionals are experimenting with the use of stem cells in degenerative disc disease (and other spinal conditions).
There is no clear evidence as yet that stem cells in degenerative disc disease are helpful - either in terms of changing the MRI appearance or in terms of helping the patient’s symptoms.
If you are considering stem cell therapy for degenerative disc disease, ensure that your healthcare provider is fully regulated to offer you this treatment.
Degenerative disc disease is essentially a benign condition. Even though the disc degeneration may continue, the neck pain may not. What is most important is to treat the patient and their symptoms, rather than to treat the appearance of the MRI scan.
To learn more about cervical disc degeneration, contact Dr. Sherief Elsayed at https://www.spinesurgeondubai.com/.