What is the management for cervical degenerative disc disease?

From the Guidelines

Surgical intervention, specifically an anterior approach, is the most appropriate management for cervical degenerative disease when conservative measures fail, as it poses less morbidity to the patient and allows for the removal of the entire disc and surrounding bones, providing a durable support system. When considering surgical options, the anterior surgical approach is preferred, especially when the infection is confined to the disc space or vertebral body, as noted in the 2016 IDSA clinical practice guideline for the treatment of coccidioidomycosis 1. This approach is familiar to most spine surgeons and results in less muscle manipulation and better wound healing for the patient. Key considerations in the surgical management include:

• The removal of the entire disc and surrounding bones, even if complete corpectomy is required, to ensure the removal of the diseased tissue and to facilitate a stable fusion.
• The use of autologous bone, harvested from the iliac crest or the ribs, as graft material, as it is probably the best option whenever possible, providing a durable and physiologically dynamic support system that protects neural structures and decreases mechanical pain, as highlighted in the study 1.
• The patient's general medical condition and any collateral medical illness can impact the quality of the bone and the duration of the fusion maturation process, emphasizing the need for a thorough preoperative evaluation.
• A mature bony fusion is crucial for providing long-term stability and reducing the risk of further complications, underscoring the importance of careful patient selection and surgical technique.

From the Research

Management for Cervical Degenerative Disc Disease

• The management of cervical degenerative disc disease can involve various approaches, including surgical and non-surgical methods 2.
• Non-surgical methods may include physical therapy, massage therapy, and other conservative treatments 3, 4, 5.
• Massage therapy has been shown to be effective in alleviating symptoms of cervical degenerative disc disease, including chronic neck pain and limited cervical range of motion 3.
• Physical therapy management, including cervical manipulation and mobilization, cervico-scapular strengthening, and self-applied cervical mobilization, has also been found to be effective in reducing pain and disability in patients with cervicogenic headache, a condition related to cervical degenerative disc disease 4.
• The American Physical Therapy Association recommends cervical manipulation as an intervention to address acute, subacute, and chronic symptoms in patients with neck pain, including those with cervical disc degeneration 6.
• It is important to consider the mechanical, neurological, and vascular consequences of cervical disc degeneration when developing a treatment plan, and to select techniques that prioritize patient safety 6.

Treatment Options

• Anterior cervical discectomy and fusion (ACDF) is considered the "gold standard" for the treatment of cervical disc disease, but other approaches, including motion-preserving technologies and minimally invasive dorsal techniques, are also being used 2.
• Physical therapy should be implemented during both the acute and chronic phases of cervical disk disease, and should include active modalities, such as exercise and stretching, as well as passive modalities, such as heat and cold therapy 5.
• Behavioral modification techniques and lifestyle modifications, such as workplace modifications and stress management, may also be necessary to address psychosocial dysfunction and promote recovery 5.