Cervical disc degenerative disease (2023)

Degeneration means wear and tear, usually caused by the aging process. This wear and tear can affect any joint in the body, including the cervical spine or neck.

This aging process can start at a variable rate in different people, depending on individual characteristics, genetics, modifiable factors such as injuries, smoking and systemic diseases, among others. Cervical spondylosis can affect any of three joints, namely the facet joint and the intervertebral space.

Usually all three diseases are involved at the same time, but disc degeneration is more often symptomatic and requires treatment. Disc degeneration can be accelerated by trauma in the form of a single accident or exposure to microtrauma over a period of time. Systemic diseases such as rheumatoid arthritis can also accelerate the degenerative process.

Computed tomography of the cervix.

Osteoarthritis of the cervical spine usually involves the most mobile segment, i.e. C5-C6, followed by the disc levels C6-C7 and C4-C5. Degeneration causes a reduction in the water content of the disc or desiccation, leading to rupture of the outer annulus or annulus fibrosus.

These tears allow the central nucleus pulposus to herniate into the periphery. When these hernias are at the back of the disc, they can compress the spinal cord or nerve root, leading to a variety of symptoms and appearances


The vast majority of patients with cervical osteoarthritis are asymptomatic and remain asymptomatic for life. A small percentage of patients experience symptoms of neck pain or nerve root compression on one side, manifested by radicular pain radiating through the skin to the hand, tingling, numbness, and rarely weakness in the muscles innervated by it. specific nerve root.

These radicular symptoms are caused by a herniated disc on the side of the back of the disc, thus compressing the nerve root. In rare cases, patients may develop a midline herniated disc, which can compress the spinal cord and cause symptoms in one or all four limbs, including tingling, numbness, radicular pain, shock, bowel impaction, or bladder and gait disturbances.

These patients may also have problems with the dexterity of the hands, manifested among other things by dropping objects, weakening grip strength, changing handwriting. Patients may suffer from multilevel degenerative disc disease, which causes multilevel cervical stenosis. Overgrowth and calcification of the ligament at the back of the spinal cord can also occur, contributing to stenosis.

Patients with congenital cervical stenosis may be predisposed to the disease. These patients may experience an acute worsening of neurological symptoms after minor or blow-type neck trauma.

Examination in patients with radicular pain may show weakness in specific muscles and blunted reflexes, while in patients with spinal cord compression it may show increased muscle tone, weakness, decreased sensation and hyperreflexia.


Patients experiencing back or neck pain due to any of the following conditions should seek medical attention as soon as possible.
1. Cancer, neoplasm or malignant tumor.
2. Unexplained weight loss of more than 10 kg within the past 6 months.
3. Immunocompromised comorbidities such as chemotherapy or radiotherapy, or diseases such as HIV or AIDS, or long-term treatment with corticosteroids.
4. People who inject drugs.
5. FOR.
6. Fever over 100 degrees Celsius.
7. Significant personal injury from a fall or accident.
8. Bowel or bladder problems such as incontinence or urinary retention.
9. Weakness in the main joint of the arm or leg.


Most people with cervical osteoarthritis are asymptomatic and remain asymptomatic for life.

These patients may never see a doctor because of the symptoms associated with cervical osteoarthritis. Some of these patients may have their necks x-rayed for unrelated reasons and may be diagnosed with degenerative disc disease.

Such patients do not require active treatment. Patients who experience occasional neck pain can also be treated with exercise and occasionally medication.

Patients with symptoms of radiculopathy are usually treated conservatively for 4 to 6 weeks, providing an excellent chance of symptom resolution. These patients are usually treated with physical therapy and medication. The neck collar can be used for a short time. If medical treatment fails, an MRI scan is usually performed to confirm the severity of the disease and correlate with clinical findings.

These patients are offered surgical treatment to relieve pain. Surgical treatment of cervical degenerative disease involving compression of the anterior nerve root or spinal cord usually involves anterior cervical fusion or disc replacement. Another option is to make a small posterior opening from behind, which is a minimally invasive (no fusion) procedure.

Patients with posterior spinal cord compression may require back surgery to relieve the pressure. Spinal surgery may involve removing the bony components of the back, decompressing and fusing the cervical spine at multiple levels (laminectomy and fusion), or opening up the bony components of the back with multiple plates to increase the space available for the spine (laminoplasty).

The decision between different surgical procedures is usually made on the basis of the patient's characteristics and presentation. Patients with spinal cord compression may require an urgent treatment plan, especially if their neurological status worsens or is acute in onset, to limit neurological damage and allow for possible recovery.

Instruments used in ACDF

ACDF board (three-layer fusion)

The images above show the ACDF (anterior cervical decompression and fusion) plate and the instruments used for cervical fusion from the front of the neck. Surgery helps decompress the spinal cord/spinal cord and prevent movement between segments to relieve symptoms and achieve stability.

Prognosis and recovery after cervical disc degenerative disease

Patients treated conservatively usually have a good chance of complete resolution of symptoms within 4 to 6 weeks. Patients who fail conservative treatment may require surgical treatment to relieve symptoms.

Patients who undergo surgical treatment for radicular pain in the form of cervical discectomy and fusion, intervertebral disc replacement, or posterior foramen surgery usually achieve almost complete recovery with resolution of symptoms.

Patients with spinal cord compression may have a cautious prognosis. Recovery is inversely proportional to the severity of the neurological deficit before surgery. Although surgery can optimize and provide good conditions for spinal cord regeneration, partial or almost complete recovery can take many months or years.

Sometimes, despite all measures, the patient cannot recover. Patients with spinal cord compression have a prolonged recovery period and are at risk for many other problems, including but not limited to UTI, pulmonary infection, deep vein thrombosis, pulmonary embolism, aspiration pneumonia, respiratory depression, and death.

RISKS AND COMPLICATIONS in cervical spine surgery

As with all surgical procedures, there are some, but rare, risks associated with anesthesia, including cardiac arrest, stroke, paralysis, and rarely death.

The risks of cervical spine surgery may include, but are not limited to:
• Hematoma or bleeding
• Damage to the carotid arteries or vertebral arteries, which can lead to stroke or excessive bleeding or even death
• Blindness
• Damage to the pharyngeal nerve resulting in hoarseness or difficulty swallowing
• Damage to the digestive or air tract
• Damage to the meninges resulting in a leak of cerebrospinal fluid
• Graft, cage, implant or plate failure, loosening or traction
• Wound infection
• Fusion error
• Damage to the spinal cord or nerve roots resulting in the onset or worsening of pre-existing pain, weakness, paralysis, loss of sensation, loss of bowel or bladder function, sexual dysfunction, etc., which may or may not resolve.
• Some of these conditions may require another operation

Certain patient populations are at higher risk of complications, including but not limited to:
• Smoking
• Seizures
• Obstructive sleep apnea
• Obesity
• High blood pressure
• Diabetes
• Other conditions related to the heart, lungs or kidneys
• Medicines such as aspirin that can increase bleeding
• History of heavy alcohol consumption
• Drug allergy
• History of side effects from anaesthesia


Good candidates for surgical treatment are patients with radicular pain involving one or more nerve roots in whom medical treatment has failed.

Surgical treatment stops the development of symptoms and provides an optimal environment for nerve root healing, recovery and resolution of symptoms, and restoration of muscle strength.

Patients who experience an acute worsening of neurological symptoms or an acute onset of symptoms have a good chance of halting the progression as well as allowing the spinal nerve root and neurological function to be restored.

Patients with prolonged neurologic deterioration may not benefit from surgery, especially if symptoms are stable.

While surgery can provide an environment for the spinal cord to heal and regenerate, recovery may not be complete. Patients with pain usually experience significant relief, for patients with numbness and tingling it may take some time.

What other surgeries for cervical disc degenerative disease?

Surgical procedures for cervical degenerative disease include discectomy and cervical fusion (ACDF), anterior tuberotomy and cervical fusion (ACCF) or a hybrid procedure involving ACDF and ACCF, posterior microperforation, total cervical disc replacement, posterior vaginectomy, and plastectomy. .


Exercises based on strengthening the muscles of the cervical spine, that is, the front and back muscles of the neck, help stabilize the cervical spine.

They should usually be performed under the supervision of a doctor or physiotherapist, especially in patients with degenerative disease of the cervical intervertebral disc.

All trauma, sudden movements, head and neck loads and excessive neck movements should be especially avoided in patients with degenerative disc disease in the neck.


Degenerative diseases of the cervical disc are a common phenomenon among the aging population. In the vast majority of the population, patients are asymptomatic and require no treatment.

Symptomatic patients can usually be treated conservatively with a successful outcome. Patients who have failed conservative treatment and patients with sudden or rapid onset or worsening of neurological symptoms can be treated surgically with good results.

In patients with profound neurological changes, recovery may be delayed even after surgical treatment.


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