Natural History of Degenerative Disc Disease of Lower Cervical

 

Overview

Cervical spine degenerative disc disease (DDD) is more common in older individuals and can cause pain and neurological problems. A study found that over 80% of patients above 60 had disc degeneration, while less than 20% of those under 20 showed such signs.

The relationship between aging and cervical spine DDD may be influenced by other health conditions associated with age. Comorbidities like hypothyroidism, smoking, cardiovascular disease, and diabetes are linked to higher incidence of lumbar spine DDD, but their association with cervical spine DDD is unclear.

The relationship between diabetes mellitus and musculoskeletal disorders, specifically disc degeneration, is still a matter of debate. While one study over four years found a link between diabetes and upper lumbar disc degeneration, another study involving twins showed no association when considering age and BMI.

Due to the high prevalence of diabetes in the United States (9.4%), it is crucial to understand how both controlled and uncontrolled diabetes, in combination with aging and other comorbidities, impact the severity and grade of disc degeneration in the cervical spine. Moreover, the anatomical and biomechanical differences between the cervical and lumbar spine suggest that these factors may have distinct effects, requiring separate investigations.

Socioeconomic Impact

The socioeconomic impact of low back and neck pain is significant, with cervical and lumbar spine disorders ranking among the highest healthcare expenses in the US, exceeding $85 billion annually. Understanding the factors that contribute to cervical spine degenerative disc disease (DDD) can help reduce costs and inform strategies for the prevention and treatment of this common musculoskeletal condition.

Factors Influencing Cervical Spine DDD

Various patient-related factors, including aging, specific medical comorbidities, insurance status, and socioeconomic variables, are strongly associated with increased severity and cumulative grade of cervical spine disc degeneration (DDD). Older age, lower median household income, previous cervical spine surgery, Medicare insurance, and certain medical conditions such as ASA classification, cancer, COPD, depression, diabetes, hypertension, hypothyroidism, peripheral vascular disease, and smoking contribute to the cumulative grade of cervical spine DDD.

Racial and Socioeconomic Disparities

Interestingly, a higher severity of disc degeneration is observed in non-white race, although it does not correspond to an increase in cumulative grade of cervical spine disc disease. These risk factors, including increasing age, diabetes, hypertension, and hypothyroidism, align with previous research findings regarding the development of lumbar spine DDD. Currently, there is no established link between cancer, COPD, and median household income with degenerative disc disease (DDD) in either the lumbar or cervical spine.

Psychological Factors

Bivariate analysis reveals a correlation between depression and higher grade and severity of cervical spine disc degeneration. This finding is consistent with previous research that demonstrates a strong association between neck and back pain and depression, suggesting that psychological burden may be a manifestation of chronic pain.

Insurance Status and Medical Comorbidities

In the multivariate analyses, older age, Medicare insurance, self-pay insurance status, and higher ASA classification are significantly associated with increased grade of cervical spine DDD. It is worth noting that diabetes is no longer significantly associated when adjusting for other factors. Additionally, older age and self-pay insurance are associated with increased severity of cervical spine DDD.

Conclusions

Considering the results alongside prior research on lumbar spine degenerative disc disease (DDD), it is probable that the progression of age and the presence of associated medical comorbidities play a role in the increased severity and grade of disc disease throughout the entire spine. Bivariate analysis demonstrates a correlation between diabetes mellitus and DDD, yet the management of diabetes does not seem to impact the severity of DDD in the cervical spine. Notably, the connections observed between declining median household income, self-pay insurance, and cervical spine disc degeneration might be influenced by vocations involving manual labor, which present elevated risks of DDD across the spine.

Cervical spine degenerative disc disease (DDD) is influenced by patient-related factors that affect its severity and cumulative grade, similar to lumbar spine DDD. Older age, insurance status, and higher ASA classification are strongly associated with increased grade of cervical spine DDD. Diabetes is linked to higher grade and severity of cervical spine DDD as an independent risk factor, but this association diminishes when considering other medical comorbidities. This highlights the importance of patient demographics and medical conditions in influencing cervical spine disc degeneration, providing valuable insights for patient education and treatment.

 
 

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Do you have more questions? 

What are the earliest signs of Cervical Degenerative Disc Disease?

The earliest signs often include mild neck pain and stiffness, which may be more noticeable after activities that strain the neck. Some people may experience a slight decrease in neck flexibility.

How does cervical disc degeneration differ from other types of arthritis in the spine?

Cervical disc degeneration primarily involves the breakdown of the intervertebral discs, while other types of arthritis, like osteoarthritis, affect the joints and bone surfaces. Both conditions can coexist, contributing to neck pain and stiffness.

Are there specific activities I should avoid to prevent worsening of CDDD?

Avoid activities that involve heavy lifting, repetitive neck movements, and prolonged periods of poor posture, such as looking down at your phone or computer screen for extended times.

How effective are non-surgical treatments for managing CDDD?

Non-surgical treatments like physical therapy, medications, and lifestyle changes are effective for many people in managing pain and improving function. They can significantly reduce symptoms and delay the need for surgery.

Can physical therapy completely cure CDDD?

Physical therapy cannot cure CDDD but can effectively manage symptoms, improve neck strength and flexibility, and enhance overall function, thus improving quality of life.

Are there any alternative therapies that might help with CDDD?

Alternative therapies such as acupuncture, chiropractic care, and massage therapy can provide symptom relief for some individuals. Always consult with a healthcare provider before starting any alternative treatments.

How do I know if my CDDD is severe enough to consider surgery?

Surgery is considered if conservative treatments fail, symptoms significantly impact your daily life, or if there is evidence of nerve compression causing severe pain, weakness, or loss of function.

What are the risks associated with cervical spine surgery?

Risks include infection, bleeding, nerve damage, spinal cord injury, persistent pain, and complications from anesthesia. Discuss these risks thoroughly with your surgeon.

How long is the recovery period after cervical spine surgery?

Recovery time varies but typically ranges from several weeks to a few months, depending on the type of surgery and individual factors like overall health and adherence to rehabilitation protocols.

Can cervical disc degeneration lead to permanent disability?

While rare, severe cases of CDDD can lead to significant nerve damage and permanent disability if left untreated. Early intervention and appropriate management are crucial.

Is cervical disc replacement surgery better than spinal fusion?

Cervical disc replacement preserves more natural neck motion and may reduce the risk of adjacent segment disease. However, suitability depends on individual factors, and both procedures have their own benefits and risks.

Can wearing a neck brace help with CDDD?

A neck brace can provide short-term relief by limiting motion and allowing the neck muscles to rest. However, long-term use is not recommended as it can weaken neck muscles.

How can I differentiate between neck pain from CDDD and other conditions like a muscle strain?

CDDD-related pain often includes stiffness and radiating pain to the shoulders, arms, or hands. Muscle strain pain is usually localized and may improve with rest and simple treatments.

Is it safe to exercise with CDDD?

Yes, exercise is generally safe and beneficial. Low-impact activities like walking, swimming, and specific stretching and strengthening exercises recommended by a physical therapist can help manage symptoms.

How does smoking affect cervical disc health?

Smoking reduces blood flow to the discs, accelerating degeneration and impairing healing. Quitting smoking can improve overall spine health and reduce pain.

Can cervical degenerative disc disease cause headaches?

Yes, CDDD can cause cervicogenic headaches, which originate from neck issues and can radiate to the back of the head and temples.

Are there specific sleeping positions recommended for those with CDDD?

Sleeping on your back or side with a supportive pillow that keeps your neck in a neutral position is recommended. Avoid sleeping on your stomach as it can strain the neck.

What is the prognosis for someone diagnosed with CDDD?

The prognosis varies. Many individuals manage symptoms well with conservative treatments, while some may require surgical intervention. Early diagnosis and proper management can lead to a good quality of life.

Can stress worsen the symptoms of CDDD?

Yes, stress can increase muscle tension and pain perception, exacerbating symptoms. Stress management techniques like mindfulness and relaxation exercises can be beneficial.

How often should I have follow-up appointments if diagnosed with CDDD?

Follow-up frequency depends on symptom severity and treatment response. Initially, more frequent visits may be necessary, tapering off as symptoms are managed effectively.

Can I use a heating pad or ice pack for pain relief?

Both can be effective. Use a heating pad to relax muscles and improve blood flow or an ice pack to reduce inflammation and numb the area. Use for 15-20 minutes several times a day.

Are there any specific ergonomic adjustments for workstations to help with CDDD?

Ensure your monitor is at eye level, use an ergonomic chair that supports your lower back, keep your feet flat on the floor, and take regular breaks to avoid prolonged neck strain.

Is it normal to feel tired or fatigued with CDDD?

Chronic pain can lead to fatigue. Managing pain effectively, getting adequate rest, and maintaining a healthy lifestyle can help reduce fatigue.

Can CDDD affect my ability to drive?

Severe CDDD can impair neck movement and reaction times, affecting driving ability. If you experience significant symptoms, it’s advisable to consult your doctor about driving safety.

Dr Vedant Vaksha

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.