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Saturday, December 7, 2013

Patient Information: Cervical Degenerative Disc Disease (Disc Degeneration of the Neck): Part - 1

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                        Cervical Degenerative Disc Disease
                                                    (Disc Degeneration of the Neck)

             What is Cervical Degenerative Disc Disease?

Degenerative Disc Disease (DDD) is the result of wear and tear on the spine over time. Gravity, motion and weight-bearing combine to take a toll on the spine. While the development of DDD is normal and expected, some patients will develop this process earlier in life or to an extent beyond what would be expected.

This is a Reference Image which shows the Cervical Spine (neck) in reference to the whole body. The area shown in red is a degenerated disc. This disc is narrow and is surrounded by bone spurs.

At What Age do Patients Develop Cervical Degenerative Disc Disease?

Some patients have signs of DDD as early as their 20’s whereas it would not be expected until they reach their 30’s or 40’s. Similarly, some patients have 3 degenerated cervical discs in their 40’s, whereas widespread DDD like this would not be expected until their 70’s.
                             Do All Patient with Cervical DDD have Pain?

It is important to know that just because someone has signs of                                      DDD on an X-Ray,  does not mean they have to have pain. Studies have shown that up to 1/3rd of patients in their 40’s will have some signs of DDD on an MRI, yet only a small fraction of them will complain of any symptoms. Overall, 25% of the population under the age of 40 who do not have symptoms, have evidence of degenerative disc disease on an MRI scan. 60% of the population over the age of 40 who do not have symptoms, have findings of degenerative disc disease on an MRI scan.

                                 How does a Cervical Disc Degenerate?

At birth our disc contains 80% water. The water content of the disc can be a measure of its ability to function appropriately as a shock absorber. Starting in our 3rd decade of life, we begin to lose some of this water content. Also, some of the important proteins which make up the core of the disc (nucleus) diminish. They are often replaced by collagen (a tough fiber) which does not attract much water to the disc. As a result, the disc gets progressively drier and harder in nature, and subsequently loses its function as a shock absorber. Another consequence of this process is the loss of the height of the disc. This is one of the reasons why we lose height as we age.

At the same time, the disc’s outer ring (annulus fibrosus) becomes more brittle and less elastic. It can develop cracks and begin to bulge outward potentially causing more problems for the spinal nerves or spinal cord.

                                   Do Degenerated Discs Cause Bone Spurs?

The Color X-Ray above shows the Cervical Spine (Neck) from the side. The jaw can be seen in the left upper hand corner. A degenerated disc is shown in red. It has developed bone spurs.
When discs degenerate and get harder, the top and bottom sides (endplates) of the respective vertebrae above and below the diseased disc encounter more resistance. Rather than pushing against a soft shock absorber they begin to grind against a harder material. Eventually this can lead to bone spurs which develop as a result of bone coming into contact with hard material. This stimulates more bone growth, which means bone spurs. Depending on their location, these bone spurs can cause irritation or compression of spinal nerves or the spinal cord.
 Does Disc Degeneration Cause Joint Pain?
When a disc loses its height and function, the facet joints in the back of the spine are often also affected. Each spinal segment consists of two vertebrae with a disc in between them and two facet joints in the back of the spine. Since the disc has motion, it can be thought of as a joint as well. In essence then, the disc and the two facet joints form a triangle, each representing a mobile joint. As a consequence, degeneration and loss of height at the “disc joint” will have an effect on the facet joints. Specifically, as the disc loses height, more and more weight is transferred from the “disc joint” to the facet joints. This causes significant stress over time and often results in degeneration of the facet joints.
This Color X-Ray Image shows the Cervical Spine (Neck) from the side. The front of the Spine is to the left. A disc suffering from Degenerative Disc Disease (DDD) is shown in red. On the back of the Spine, a Facet Joint has also degenerated (red) which is called "Facet Disease".
Who is at Risk to get Cervical Degenerative Disc Disease?
The following are people at risk for developing DDD.
1.       Smokers
2.       People exposed to significant vibration such as driving a vehicle for a living
3.       Genetics. DDD tends to run in families through genes passed from one generation to the next.
4.       Patients with a history of spine trauma
5.       Patients of advanced age
6.       Patients with obesity

Next Blog: Part - II of Cervical Degenerative Disc Disease. Stay tuned!

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