Cervical discopathy: symptoms, how to treat it?

What is the definition of cervical disc disease?

Cervical disc disease is a condition that affects the discs located between the cervical vertebrae of the spine. “The cervical discs are flexible and shock-absorbing structures which serve as cushions between the vertebrae, allowing the spine to move, explains Dr. Mayalen Lamerain, orthopedic spine surgeon. When these discs suffer wear and tear or degenerationthis can cause cervical disc disease or cervical hernia”. This condition can be caused by age, injury, repetitive strain, or underlying medical conditions.

What is degenerative cervical disc disease?

“A discopathy is due to a degeneration of the disc so by definition, she is degenerative, says Dr. Maëva Masson, rheumatologist. Degenerative cervical disc disease is a common form of cervical disc disease which is caused by the progressive wear of the discs located between the cervical vertebrae of the spine“.”This condition is part of cervical discarthrosis, completes Dr. Lamerain. Osteoarthritis is wear and tear on the joints of the vertebrae, there are two joints and a disc between two vertebrae”. The disc is a shock absorber between two vertebrae. “Like cartilage, it is healthy at the end of growth, but it does not have the capacity to regenerate. Over time, the discs between the cervical vertebrae lose their elasticity and ability to absorb shock, which can lead to cracks or breaks in the disc structure.” As a result, the cervical vertebrae can push together causing pain, stiffness and tension in the neck and shoulders. “Everyone will have cervical disc disease in their lifetime. as she will have wrinkles or white hair, assures Dr. Lamerain. It is an inescapable and often asymptomatic physiological process“.

What is C5-C6 cervical disc disease?

Cervical disc disease C5-C6 refers to a condition affecting the disc located between the fifth and sixth cervical vertebrae of the spine. This part of the spine is found in the neck. “The C5-C6 disc is often the first to be damaged and to wear out because of its position in the middle of the cervical spine, it is most exposed to mechanical stress”, confirms Dr. Lamerain. C5-C6 cervical disc disease can be caused by the natural wear of the disc due to age, injury or trauma, or even repetitive activities involving the neck. “The most common cause of trauma is “whiplash”, such as a car accident or the practice of certain sports such as rugby”.

What are the symptoms of cervical disc disease?

Symptoms of cervical disc disease may vary depending on the severity of the disease and the vertebrae affected. Some patients with cervical disc disease may have no symptoms. However, common symptoms include:

• Cervical pain
• muscle tension in the neck area, which may be aggravated by movement or position of the head,
• A sore spot, such as a stab at the edge of the shoulder blade or between the shoulder blades
• Cervicobrachial neuralgia: pain that may radiate to the arms, shoulders, hands, or fingers if the nerve is compressed
• Tingling or numbness in the arms, shoulders, hands or fingers.
• Muscle weakness in the arms or hands that results in a change in handwriting or object “dropping”
• Headaches, especially in the region of the occiput (back part of the head).
• In severe cases, the disc can compress the spinal cord and cause gait and balance problems in addition to the symptoms described above. We will then speak of cervical myelopathy.

It is also important to emphasize that the presence of cervical disc disease is not synonymous with pain. “A study in more than 1200 people without any symptoms showed that one or more cervical discopathies were present in more than 87% of the subjects“, reports a study published in the National Library of Medicine.

► Cervical imaging is the first line radiography. It is to be discussed:

• In case of persistent pain more than 4 to 6 weeks.
• In the event of warning signs (insidious onset, progressively increasing progression, insomnia pain, rebelliousness to symptomatic treatments, multiple or atypical localizations, history of cancer, etc.), a cause other than cervical discopathy should be sought.

► “Cervical imaging is not indicated if neck pain has been evolving for less than 4 to 6 weeks, because the pain generally improves with symptomatic treatment within this time without any imaging examination being performed. necessary“, emphasizes Dr. Masson. There is no indication to repeat the same imaging examination in the absence of a change in symptoms.

► “MRI is indicated as a second line (or CT scan if MRI is contraindicated or not available) if there are suspicious or poorly visualized areas on x-rays or if pain persists or worsens. In the event of cervical pain radiating into the arm, an MRI is indicated as a first-line treatment to find the cause or if an invasive procedure is discussed”. It may be associated with an X-ray assessment for optimal interpretation.

The treatment of cervical disc disease depends on the severity of the disease and the symptoms presented.

► In mild to moderate casesthere are several non-surgical treatment options.

• Re-education is the cornerstone of care, “with, in addition to analgesic methods (massage, heat), work on proprioception, strengthening the spinal muscles, postures“, suggests Dr. Masson. In addition, rest can help relieve pain and allow faster recovery.
• Patients should also avoid activities that aggravate symptoms, such as repetitive neck flexion/extension movements.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids may be prescribed – over a short period and in the absence of contraindications – to relieve pain and reduce inflammation, says Dr. Masson.
• Pain relievers and muscle relaxants may also be prescribed to relieve symptoms.
• Steroid injections can also be administered into affected spinal joints to relieve inflammation and pain
• Psychosocial care may sometimes be necessary, especially in the presence of work-related risk factors, observes Dr. Masson.

► In more serious cases, surgery may be required. Surgical procedures may include replacement of the damaged disc or surgical removal of the damaged disc.

What does cervical disc disease surgery involve?

The operation for cervical disc disease can vary depending on the severity of the disease and the symptoms presented. It is necessary to understand the risks and benefits of each surgical procedure and to follow the postoperative instructions for a successful recovery. There are several surgical options for cervical disc disease.

► Vertebral arthrodesis is a surgical procedure”which consists of removing the damaged disc in order to remove the cervical hernia at its posterior part and fusing two neighboring vertebrae using an implant containing a bone graft, explains the surgeon. Unlike lumbar hernias which can be removed directly by retracting the nerve, treating a cervical hernia requires bypassing the spinal cord to avoid damaging it. The approach is through the throat and this requires systematically removing the entire disc to damage the hernia, osteoarthritis and release the compressed nerve.

► Arthroplasty is a surgical procedure that involves replacing the damaged disc with an artificial implant that performs the same functions as the disc. “This procedure is proposed when there is a cervical hernia without associated osteoarthritis. It also goes through a total removal of the disc“. The advantage of a disc prosthesis is the economy of the adjacent discs to avoid their degeneration. ” In the event of arthrodesis, the loss of mobility of the removed disc is compensated by the adjacent discs which can lead to faster these discs.

► Cervical laminectomy is an operation that involves removing the posterior part of the vertebra. “It is indicated when there are several cervical discopathies resulting in compression of the spinal cord at the level of several vertebrae. This intervention is proposed in case of serious neurological risks in the absence of treatment.

Can you work with cervical disc disease?

The sitting station and the position in front of a computer does not aggravate the discopathies.

Maintaining employment with cervical disc disease depends on the severity of the disease and the symptoms presented and the profession. “In mild to moderate casesit is possible to continue working with appropriate adjustments to minimize pain and discomfort”, recognizes Dr. Lamerain. However, in more serious cases, a temporary or permanent absence from work may be necessary. Workers with cervical disc disease can benefit workstation layouts, such as ergonomic workstations, or the ability to change working position to reduce strain on the neck. “The seated station and the position in front of a computer does not aggravate the discopathies. Physical professions with carrying loads are more exposed“.

The course of cervical disc disease can vary greatly from person to person depending on the severity of the disease, the person’s age, general health and lifestyle. In many cases, cervical disc disease may progress slowly and cause intermittent symptoms which can get worse over time. “Over time, cervical disc disease can cause cervical discs to lose height, which can cause nerve and nerve root compression. Symptoms may gradually worsen over time, including chronic pain, numbness, tingling, and weakness in the arms and hands.” emphasizes Dr. Lamerain. In some cases, cervical disc disease can lead to the formation of herniated cervical discs, which can cause more severe compression of nerves and nerve roots. “This can lead to more serious symptoms, such as severe pain, difficulty performing daily tasks, and coordination problemsadds Dr. Masson. It is important to diagnose and treat cervical disc disease as soon as possible to prevent the disease from getting worse and leading to more serious complications. It is also important to be able to put in place preventive measures, especially in the professional context.

Thanks to doctors Maëva Masson, rheumatologist at the Toulouse University Hospital, and Mayalen Lamerain, orthopedic spine surgeon, from the Clinique de la Montagne (Ramsay Santé group) in Courbevoie (92)