The decision to have surgery for cervical degenerative disc disease is ultimately up to the patient after carefully weighing the procedure’s potential benefits and risks. Numerous factors go into this decision-making process, and the goals and expectations vary from patient to patient.
This article is an in-depth look at what to consider before deciding on surgery for cervical degenerative disc disease, including treatments to try beforehand and various surgical options. Before any decision is made on surgery, it is important to have a good understanding of what specifically is causing the symptoms and whether it can be surgically corrected.
How Cervical Degenerative Disc Disease Causes Symptoms
Cervical degenerative disc disease typically results from natural wear and tear of the neck’s cervical discs over many decades of life, but it can also be accelerated by other factors, such as injury or genetics. As a cervical disc degenerates, it starts to lose hydration, which hampers its ability to cushion the spine’s vertebral bones and facilitate smooth neck movements.
Cervical degenerative disc disease can cause pain and other symptoms in various ways, including one or more of the following:
- Herniated disc. When a disc’s tough outer layer (annulus fibrosus) gets small cracks or tears, the soft inner layer (nucleus pulposus) can leak out with inflammatory proteins that may cause pain and stiffness in nearby structures, such as muscles, ligaments, joints, and nerves.
- Cervical foraminal stenosis. Sometimes the small bony hole (foramen) where a nerve root exits the spinal canal (on either side) can become crowded and compress a nerve root. Cervical foraminal stenosis typically involves some combination of degeneration from the nearby disc, uncovertebral joint, and/or facet joint. Increased inflammation, bone grinding against bone, and the formation of bony overgrowths (osteophytes) can all play a role in compressing and/or inflaming the nerve root within the foramen. This process can result in cervical radiculopathy symptoms, such as pain, tingling, numbness, and/or weakness that radiates down into the shoulder, arm, and/or hand.
- Cervical stenosis with myelopathy. Cervical disc degeneration and the associated inflammation and bony overgrowths that accompany it may lead to the narrowing of the spinal canal. Myelopathy occurs when the spinal cord becomes compressed and/or inflamed to the point of causing symptoms, such as neck pain that may be achy or sharp, or neurological problems with coordination, bowel or bladder control, and/or walking.
When cervical degenerative disc disease causes neck pain and stiffness, arm pain, or tingling, the symptoms tend to either go away on their own or are managed effectively with nonsurgical treatments. In a relatively small percentage of cases, cervical degenerative disc disease symptoms continue to worsen and interfere with quality of life, such as the ability to regularly work or enjoy hobbies.
How Surgery Can Help Cervical Degenerative Disc Disease
As cervical degenerative disc disease progresses, the breakdown of discs and facet joints causes the spine to become less stable. This instability can contribute to a nerve root and/or the spinal cord becoming compressed and symptomatic. As such, the two primary goals of surgery for cervical degenerative disc disease are to:
- Relieve any nerve compression. If a disc or other structure is pressing against a nerve root or the spinal cord and causing symptoms, any surgery to relieve those symptoms must remove the cause of the compression.
- Stabilize the spine. After the removal of the disc or other structure causing nerve or spinal cord compression, an instability in the spine must typically be addressed.
Two of the more common surgeries to address degenerative discs are anterior cervical discectomy with fusion (ACDF) and artificial disc replacement (ADR). These surgeries have relatively high success rates for relieving symptoms related to a compressed nerve root, such as pain, tingling, numbness, and/or weakness that radiates into the arm or hand. However, these surgeries are less likely to relieve neck pain that is unrelated to nerve or spinal cord compression.
When Cervical Degenerative Disc Disease Is Serious
If cervical degenerative disc disease progresses to the point of compressing a nerve root or the spinal cord for an extended period of time, such as months or years, permanent damage can occur. Any symptoms of pins-and-needles tingling, weakness, and/or numbness that goes into the arm, or neurological problems such as trouble with coordination, walking, or bodily functions should immediately be checked by a doctor.
When to Consider Surgery for Cervical Degenerative Disc Disease
If cervical degenerative disc disease symptoms last for 6 months despite trying multiple treatment options, surgery may become an option. In cases where tingling, numbness, weakness, and/or problems with coordination are worsening or severe, surgery may be scheduled much sooner rather than waiting months.