Conditions & Treatments

Cervical Disc Disease: Oh My Aching Neck!
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The disc is a structure that is made of cartilage and acts as a cushion between the bony vertebrae of the spine. The disc itself is composed of a tough, outer layer known as the annulus fibrosis and a softer inner layer known as the nucleus pulposis. When the disc is young and healthy, it is well hydrated with water and easily dissipates forces as loads are placed across it, essentially acting as a “shock absorber” for the spine. As the disc ages it becomes degenerative and arthritic, losing it’s normal water content and becomes much less efficient in dissipating forces transmitted to it by the vertebrae. As the disc continues to degenerate, its walls can weaken and tear, allowing the inner material (nucleus pulposis) to escape, or herniate, out into the nerve canal.
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The process of disc degeneration can lead to chronic neck pain and headaches. If a disc herniation occurs onto a nerve, or a degenerative bony spur develops that pinches on a nerve, then the patient can develop severe pain, numbness, and/or weakness running from the neck into the arm. Figure 1 shows an MRI image of a patient who has had a herniation (“rupture”) of disc material onto the spinal cord (arrow) and presented with severe neck and arm pain.
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The treatment options for treatment of patients with cervical disc problems is based upon the severity of their symptoms and the result of a physical exam. Mild cases can be treated with rest and time and can simply resolve over time. More moderate cases can be treated with medications or non-invasive, “hands on” treatments such as physical therapy, chiropractic care, or traction/disc decompression. If a patient is in severe pain, a procedure known as an epidural steroid injection may be used. In this procedure, an injection of steroid is given into the neural canal under fluoroscopic guidance.
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Surgery for cervical disc disease is considered for three reasons. First, if the patient’s pain is bad enough and the patient has failed non-operative care, then surgery can be done to relieve their pain. Secondly, if the person is not able to take the time to rest and recover from a disc herniation that is sometimes needed, such as in someone that is self employed, that person may request surgery rather than wait the weeks to months to see if their herniation will heal. Thirdly, there is a subset of patients who begin experiencing “nerve damage” from a large disc herniation and surgery is recommended to try to enhance recovery. Large herniations can cause numbness, weakness, clumsiness, difficulty walking and bowel/bladder problems. If surgery is not done on these patients they have a good chance of gradually getting worse and sometimes losing the ability to walk altogether.
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If surgery is recommended, it should be noted that there are many new and less invasive alternatives to the traditional approach of taking out the disc and inserting a piece of bone in from the hip or the bone bank. This includes the introduction of the BAK cervical system in which a cylindrical cage is inserted in the place of the disc (Figure 2). All options for treatment should be thoroughly discussed with your treating physician and a plan made which serves your particular best interests.

Treatments for Cervical Disc Disease

Dr Hellman is a spinal surgeon practicing in Tifton, Georgia at Georgia Sports Medicine & Orthopedic Clinic. He is double board certified in both the fields of orthopedic surgery and spinal surgery. Dr. Hellman is a member of the American Academy of Orthopedic Surgeons; a member and has been a faculty presenter for the North American Spine Society; and a member of the International Spine Intervention Society. Dr. Hellman’s special interests include the use of less invasive alternatives in neck and back surgery; the use of motion sparing techniques in spinal surgery such as the artificial disc and the “x-stop”; and the treatment of complex spinal deformities such as scoliosis.