Cervical Degenerative Disc Disease Treatment Options

Cervical Degenerative Disc Disease Treatment Options

The general treatment for cervical degenerative disc disease is largely the same as for degenerative disc disease in the lumbar spine (Read more about Degenerative Disc Disease Treatment). That is, conservative care (non-surgical) is recommended as the primary strategy and surgery is only considered if a concerted effort at conservative care fails to provide adequate pain relief or a patient's daily activity has been significantly compromised.

  • Conservative care
    Patients may find relief by applying ice or heat, using medications to control pain and inflammation, and exercising the neck and shoulder areas (alone or with the help of a professional familiar with neck conditions) to relieve stiffness and maintain flexibility. In addition, neck appliances or traction may be prescribed.
  • Over the counter and prescription medications can provide relief. These include non-steroidal anti-inflammatories (NSAIDs) and pain relievers like acetaminophen (such as Tylenol). Prescription medications such as oral steroids, muscle relaxants or narcotic pain medications may also be used.
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  • Exercise, specifically stretching as many dimensions of the neck as possible, is essential to maintain flexibility in the neck and relieve chronic stiffness. A specific set of exercises should be developed by a physician or physical therapist. Some exercises that could be done several times a day include:
    • Chin-to-chest stretch, which stretches the back of the neck
    • Side-to-side swivel, which involves slowly turning the head to the left and right
    • Eyes-to-the-sky, where a patient lifts the chin upward to stretch the front of the neck and upper thoracic area
    • Ear-to-shoulder stretch to extend the sides of the neck as much as possible (this can be facilitated by gently placing a hand on the head but should not involve pulling or pushing the neck and head to the shoulder)
    • See more neck exercises: Neck Exercises for Neck Pain.
  • Physical therapy or chiropractic adjustment may also provide relief by helping patients extend the neck and shoulders to increase, at least temporarily, the disc space in the affected vertebral segment
  • Use of a cervical collar, cervical pillows, or neck traction may also be recommended to stabilize the neck and improve neck alignment so the disc compression is not exacerbated as a patient sleeps or relaxes at home

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  • Surgery
    If pain is not relieved adequately with six months of conservative care and daily activities become difficult, surgery may be considered. Specifically fusion may be recommended to stop the motion of the affected cervical vertebral segment. This entails removal of the disc, decompression of the nerve root, and insertion of a bone graft or a metal cage device to help maintain or reestablish the normal height of the disc space as well as neck stability and alignment. A cervical plate may be used to promote fusion between the two vertebrae.

Generally, a one-level fusion is done, and in rare circumstances a two-level fusion would be considered. However, patients should know that surgery for neck pain is much less reliable than surgery to relieve arm pain from cervical degenerative disc disease. Thus if the only or predominant symptom is neck pain, fusion surgery should be recommended only as a last resort and after all other treatment options have been exhausted. If a disc space cannot be identified as the probable pain generator, it is reasonable even in cases where conservative treatment has not worked well to avoid surgery.

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Article written by: Peter F. Ullrich, Jr., MD