By Bryan A. Fox, MD
Patients with one of the most common types of spinal damage, cervical disc disease, often fear the prospect of surgery. However, they should be aware that while surgery is indeed a last option, it is a very good one: effective in 85 to 90 percent of cases, and with minimal post-operative pain or complications.
Cervical disc disease is marked by the degeneration of one or more of the cushioning discs in the upper spine. This osteoarthritic damage is often due to age-related wear and tear and/or genetic factors, but it also can develop after a traumatic injury.
The most common symptoms are neck pain and radiating arm pain, the latter caused by nerve compression. In many cases, patients report worsening discomfort with certain head and neck motions or at night. Some also may experience gradual weakness in the affected arm.
The best first step is to visit a primary care physician for a preliminary evaluation. Initial treatments may include physical therapy and medications such as anti-inflammatories, muscle relaxants, oral steroids, or drugs targeted to relieve nerve irritation.
If those therapies are unsuccessful, patients should undergo an MRI to obtain a more detailed diagnosis. Epidural steroid injections also can provide relief in some cases.
Those who do need surgery have two options, based on their MRI results, age and overall health: a discectomy and fusion, or a discectomy and cervical disc replacement. With either procedure, most patients wake up with their arm pain gone and experience only temporary neck pain at the surgical site.
Fusion patients generally must avoid high-impact activities such as running or contact sports for six to 12 weeks, while disc replacement patients may have a shorter four- to six-week restriction period. Most patients then can return to all regular activities. After all, NFL quarterback Peyton Manning played in two Super Bowls after fusion surgery.
Currently, only a small portion of patients are eligible for disc replacement surgery, which has developed over the last 10 to 15 years. They tend to be younger and have acutely herniated discs without significant degenerative changes.
A replacement can preserve more motion and thus may reduce the rate of future degeneration in adjacent levels of the spine. As physicians collect more long-term results on this procedure, I expect the candidate pool of patients will expand.
In the meantime, the introduction of smaller, zero-profile fusion devices during the past decade also have reduced the risk of adjacent segment disease, in my experience.
Finally, patients should feel confident that orthopaedic spine surgeons are well-trained and qualified to address cervical disc disease.
People experiencing symptoms of this condition should not hesitate to seek medical attention, and they should be optimistic about a positive outcome whether or not surgery is required.
Dr. Fox is a Board certified orthopaedic spine surgeon with Sports Medicine & Orthopaedic Center in Suffolk, as well as Medical Director of the Back & Neck Center at Sentara Obici Hospital. smoc-pt.com.
