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Cervical Disc Disease

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Other Names

  • Cervical Disc Degeneration
  • Degenerative disc disease (DDD)
  • Acute disc herniation
  • Cervical degenerative disc disease
  • Cervical Spondylosis
  • Cervical Disc Herniation (CDH)

Background

  • This page refers to cervical intervertebral disc disease as the cause of neck pain
    • This can be acute herniations due to trauma or chronic, degenerative changes

History

  • First described by Stookey in 1928 as a cause of neck pain and referred pain[1]

Epidemiology

  • The annual and lifetime prevalence of neck pain is estimated to be 37.2% (range 16.7%–75.1%), and 48.5% (range 14.2%–71%) respectively[2]
  • Degenerative disc changes are detected in up to 85% of patients over 70, although the majority are found to be asymptomatic[3]
  • Acute herniations tend to occur in younger individuals 30s-40s, degenerative disc disease in individuals over 60[4]

Pathophysiology

  • Degeneration/ Chronic
    • Occurs due to loss of water content
    • Leads to degeneration of intervertebral disc
    • Primarily due to aging process, senescence, repetitive microtrauma
  • Traumatic/ Acute
    • Typically in sports or motor vehicle accidents
    • Leads to herniation of disc
    • Mechanism: flexion and compression or rotational motion can cause the annulus to rupture[5]
  • Can manifest as neck pain, cervical radiculopathy, and/or myelopathy
  • Cervical spondylotic changes affect the middle and lower cervical spine (C3-7) in 94% of cases[6]
  • Presentation can be loosely divided into 4 different clinical syndromes
    • Neck pain
    • Radiculopathy
    • Myelopathy
    • Miscellaneous (headache, vertebrobasilar insufficiency, sympathetic dysfunction)

Pathoanatomy

  • Intervertebral Disc
    • No disc in occipitoatlantal or atlantoaxial joint
    • Discs between C2 all the way to C7
    • Allows for flexibility and mobility of the cervical spine

Associated Injuries

Risk Factors

  • Increased age[7]
  • Genetic factors[8]
  • Tobacco Use Disorder[9]
  • Diabetes Mellitus
  • Infection
  • Autoimmune disorders
  • Sports
    • Football, especially tackling and blocking[10]
    • Rugby

Differential Diagnosis

Clinical Features

  • General: Physical Exam Neck
  • History
    • Important to clarify natural history of trauma and any inciting events
    • Will endorse neck pain with or without radicular features
    • May also endorse stiffness, loss of range of motion, myofascial pain
  • Physical Exam
    • Important to test strength and range of motion of cervical spine
  • Special Tests
    • Naffzingers Test: pain reproduced by coughing, which is instigated by lying patient supine and applying pressure on the neck veins
    • Spurlings Test: axial load applied to extended, rotated head towards the affected limb

Evaluation

Radiographs

MRI

  • Imaging modality of choice for any soft tissues
  • Can better assess integrity of disc and any herniation
    • Best seen on weighted T2 images
  • Findings include
    • Decreased disc height
    • Reduced signal intensity
    • Osteophytes
  • Also evaluate spinal cord

CT

  • May be useful to better evaluate osseous pathology
  • Consider myelography if MRI contraindicated

EMG/NCS

  • May be indicated to better clarify etiology of symptoms
  • I.e. radiculopathy, myelopathy, peripheral neuropathy, etc

Classification

  • N/A

Management

Prognosis

  • Heckman: in a group of 60 patients with radiculopathy[11]
    • 39 (65%) patients treated conservatively and 21 (35%) treated operatively
    • After 5.5 years the results in the conservative group were at least as good as those in the operative group
  • Hsu: Retrospective review among NFL players suggested higher return to play rate, longer career after operative treatment for acute cervical disc herniation[12]
  • 90-95% of population does well after 1 level cervical disc surgery[13]

Nonoperative

Operative

  • Indications
    • Failure of conservative management to control pain
    • Myelopathy or neuropraxia
    • Progressive neurological symptoms
  • Technique
    • Anterior cervical discectomy with fusion (ACDF)
    • Posterior laminoplasty or laminectomy
    • Total disc replacement

Rehab and Return to Play

Rehabilitation

  • Goals: decrease pain, improve range of motion, strengthen muscles, and improve spinal biomechanics
  • Emphasis on stability and flexibility are two core components of prevention and rehabilitation[19]
  • truncal stability and flexibility training prevent hyperextension, relieve some pressure on the posterior annulus
  • Neck stability and flexibility minimizes the forced axial loading when the player’s neck is in hyperextension or hyperflexion
  • Emphasis on using proprioceptive, strengthening, endurance, or coordination exercises[20]

Return to Play

  • Each athlete should be evaluated on a case-by-case basis and consider the type of sport, player position, imaging characteristics, clinical symptoms, and physical examination

Complications

See Also

References

  1. ↑ Stookey B. Compression of the spinal cord due to ventral extradural cervical chondromas. Arch Neurol Psychiat. 1928; 20 275-291
  2. ↑ Fejer, René, Kirsten Ohm Kyvik, and Jan Hartvigsen. "The prevalence of neck pain in the world population: a systematic critical review of the literature." European spine journal 15.6 (2006): 834-848.
  3. ↑ Abdulkarim JA, Dhingsa RL, Finlay DB. Magnetic resonance imaging of the cervical spine: frequency of degenerative changes in the intervertebral disc with relation to age. Clin Radiol. 2003; 58 980-984
  4. ↑ Hashish R, Badday H. Frequency of acute cervical and lumbar pathology in common types of motor vehicle collisions: a retrospective record review. BMC Musculoskelet Disord. 2017 Nov 09;18(1):437.
  5. ↑ Chao S, Pacella MJ, Torg JS (2010) The pathomechanics, pathophysiology and prevention of cervical spinal cord and brachial plexus injuries in athletics. Sports Med 40(1):59–75.
  6. ↑ Young P. Degenerative cervical disk disorders: pathophysiology and clinical syndromes. In: Young P (ed). Microsurgery of the Cervical Spine. Raven, New York 1991: 49-63
  7. ↑ Trout JJ, Buckwalter JA, Moore KC, Landas SK. Ultrastructure of the human intervertebral disc. I: changes in notochordal cells with age. Tissue Cell 1982;14:359–69.
  8. ↑ Videman T, Leppävuori J, Kaprio J, et al. Intragenic polymorphisms of the vitamin D receptor gene associated with intervertebral disc degeneration. Spine 1998;23:2477–85.
  9. ↑ Akmal M, Kesani A, Anand B, et al. Effect of nicotine on spinal disc cells: a cellular mechanism for disc degeneration. Spine 2004;29:568–75.
  10. ↑ Gray BL, Buchowski JM, Bumpass DB, Lehman RA Jr, Mall NA, Matava MJ (2013) Disc herniations in the national football league. Spine 38(38):1934–1938
  11. ↑ Heckmann JG, Lang CJ, Zöbelein I, Laumer R, Druschky A, Neundörfer B. Herniated cervical intervertebral discs with radiculopathy: an outcome study of conservatively or surgically treated patients. J Spinal Disord. 1999; 12 396-401
  12. ↑ Hsu, Wellington K. "Outcomes following nonoperative and operative treatment for cervical disc herniations in National Football League athletes." Spine 36.10 (2011): 800-805.
  13. ↑ Bohlman HH, Emery SE, Goodfellow DB, et al. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am 1993 75: 1298–307.
  14. ↑ Yonenobu K. Cervical radiculopathy and myelopathy: when and what can surgery contribute to treatment?. Eur Spine J. 2000; 9 1-7
  15. ↑ Jordan, Alan, et al. "Intensive training, physiotherapy, or manipulation for patients with chronic neck pain: a prospective, single-blinded, randomized clinical trial." Spine 23.3 (1998): 311-318.
  16. ↑ Dziedzic, Krysia, et al. "Effectiveness of manual therapy or pulsed shortwave diathermy in addition to advice and exercise for neck disorders: a pragmatic randomized controlled trial in physical therapy clinics." Arthritis Care & Research: Official Journal of the American College of Rheumatology 53.2 (2005): 214-222.
  17. ↑ White, A. R., and E. Ernst. "A systematic review of randomized controlled trials of acupuncture for neck pain." Rheumatology (Oxford, England) 38.2 (1999): 143-147.
  18. ↑ van der Heijden, Geert JMG, et al. "The efficacy of traction for back and neck pain: a systematic, blinded review of randomized clinical trial methods." Physical therapy 75.2 (1995): 93-104.
  19. ↑ Yamaguchi, Jonathan T., and Wellington K. Hsu. "Intervertebral disc herniation in elite athletes." International orthopaedics 43.4 (2019): 833-840.
  20. ↑ Ylinen, Jari, et al. "Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial." Jama 289.19 (2003): 2509-2516.
Created by:
John Kiel on 17 June 2019 14:23:35
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Last edited:
6 October 2022 23:12:02
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