Cervical Degenerative Disc Disease ICD-9
Cervical Degenerative Disc Disease Etiology / Epidemiology / Natural History
- 90% of people >60y/o have disc degeneration, most are asymptomatic (Boden SD, JBJS 1990;72A:1178).
- There is no set definition of DDD, with aging degenerative disc disease begins with disc loss of phroteoglycans and dehdration, tear formation within the annulus fibrosis and progressive fraying and dehydration of the nucleus pulposes with eventual loss of disc height etc. As degeneration advances load transmission is shifted to the posterior elements causing facet overload/arthritis/osteophytes. Disk degeneration is a noatural part of aging with the majority of people being asymptomatic.
- Risk Factors: age, family history, smoking, chronic vibration (prolonged driving), heavy repetitive loading of the spine, diabetes.
Cervical Degenerative Disc Disease Anatomy
- Anulus fibrosus = type 1 collagen oriented at 30 angles from the long axis of the spine.
- Nucleus pulposus = proteoglycan rich matrix with randomly oriented primarily type II collagen.
- Lumbar spinal canal is divided into 3 regions:
-Central Zone: region between the lateral margins of the dura.
-Lateral Recess: between the lateral magin of the dura and the medial border of the pedicle.
-Foraminal Zone:between the medial and lateral margins of the pedicle. Contains the intervertbral foramen.
Cervical Degenerative Disc Disease Clinical Evaluation
- Midline / paraspinal neck pain +/- extention into the trapezius or periscapular muscles.
- Increased pain at extremes of ROM.
- Radiation into the occiput, cervicogenic/tension headaches.
- Typically no radicular symptoms.ait, upper and lower extreity neurovascular exam.
- Rule out radicular and myelophathic findings.
Cervical Degenerative Disc Disease Xray / Diagnositc Tests
- Xray Indications: trauma, systemic disease(RA), cancer, pain for >6weeks, night pain, neuroligc findings. Xrays are oftern not indicated initially.
- A/P, Lateral, Odontoid, flexion / extention lateral views. Evaluated for instability, pseudarthrosis, atlantoaxial arthrosis.
- CT: useful for fracture, foraminal stenosis, facet arthropathy.
- MRI: demonstrates disc degeneration, neruologic compression, infection, tumor.
- Facet injections: helpful to diagnosis facet mediated pain.
Cervical Degenerative Disc Disease Classification / Treatment
- Nonusrgical: physical therapy, traction, chiropractic manipulation, NSAIDs, electrical stimulation.
- Surgical: generally not indicated. Options= discectomy and fusion (Garvey TA, Spine 2002;27:1887).
Cervical Degenerative Disc Disease Associated Injuries / Differential Diagnosis
Cervical Degenerative Disc Disease Complications
Cervical Degenerative Disc Disease Follow-up Care
Cervical Degenerative Disc Disease Review References