We need you! See something you could improve? Make an edit and help improve WikSM for everyone.

Cervical Disc Disease

From WikiSM
Jump to: navigation, search

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
Authors:
Last edited:
29 June 2021 17:32:56
Categories: