What is the medical treatment for a new posterior herniated disc (HA) with a history of cervical degenerative disc disease (DDD)?

From the Guidelines

For a patient with new posterior headaches and a history of cervical degenerative disc disease, I recommend starting with conservative management. Begin with acetaminophen 650-1000mg every 6 hours or NSAIDs such as ibuprofen 400-600mg every 6-8 hours for pain relief, not exceeding maximum daily doses 1. Muscle relaxants like cyclobenzaprine 5-10mg at bedtime may help if muscle spasm is present. Physical therapy focusing on cervical strengthening and posture correction is essential, along with application of heat or cold packs for 15-20 minutes several times daily. Encourage proper ergonomics, especially during computer use and sleeping.

Key Considerations

• The patient's history of cervical degenerative disc disease suggests that the headaches may be cervicogenic in nature, originating from irritated cervical nerve roots or facet joints due to the degenerative changes 1.
• Cervical DDD can cause referred pain to the occipital region through the greater occipital nerve, creating posterior headaches.
• Addressing the underlying cervical pathology rather than treating this as a primary headache disorder will yield better results.
• Imaging is not typically warranted in the initial management of acute low back pain or cervicogenic headaches, as it is unlikely to change the treatment plan or improve outcomes 1.

Treatment Approach

• Conservative management should be the initial approach, with a focus on pain relief, physical therapy, and lifestyle modifications.
• If these measures fail after 2-3 weeks, consider referral for cervical facet blocks or trigger point injections.
• It is essential to inform patients about the generally favorable prognosis of acute headaches and the importance of remaining active, as well as providing information about effective self-care options 1.

From the Research

Medical Treatment for New Posterior HA with Cervical DDD Hx

• The treatment for new posterior HA (herniated disc) with a history of cervical degenerative disc disease (DDD) may involve medical management, including oral steroids or epidural steroid injections 2, 3.
• A study published in JAMA found that oral steroids can improve function and reduce pain in patients with acute radiculopathy due to a herniated lumbar disk 2.
• Another study published in Spine found that epidural steroid injections can reduce neurological impairment and enhance recovery after discectomy for herniated lumbar disc 3.
• However, it's essential to note that these studies focused on lumbar disc herniation, and the evidence for cervical DDD is limited.
• A review article published in World Neurosurgery discussed the fundamentals of intervertebral disc degeneration, highlighting the importance of understanding the pathophysiology of degenerative disc disease in developing innovative treatments 4.
• A study published in the European Spine Journal found that patients with lumbar disc herniation have a higher prevalence of asymptomatic cervical disc degeneration compared to healthy volunteers, suggesting that disc degeneration may be a systemic phenomenon 5.

Treatment Options

• Medical treatment for new posterior HA with cervical DDD hx may include:
  • Oral steroids to reduce inflammation and improve function 2
  • Epidural steroid injections to reduce neurological impairment and enhance recovery 3
  • Conservative management, such as physical therapy and pain management 4
• However, the most appropriate treatment option should be determined by a healthcare professional based on individual patient needs and medical history.