What is Cervical Discogenic Syndrome?
Chronic neck pain is a significant health issue that ranks among the top five causes of persistent discomfort. The pain can come from different parts of the neck, such as cervical discs (the discs in the neck region of the spine) or joints in the upper neck. A common cause of neck pain is Cervical Discogenic Pain Syndrome (CDPS), experienced by 16% to 41% of people suffering from neck pain. Cervical discs, which have lots of nerve fibers, can easily get damaged or inflamed, leading to pain. The most commonly affected areas are the C5/C6 and C6/C7 areas of the spine, with C7 being the most common nerve root affected. Initially, the symptoms can be felt close to these areas, but the pain can later spread down the arm (a condition called brachialgia). The pain can often be treated with conservative treatments, but stubborn pain might need further intervention.
What Causes Cervical Discogenic Syndrome?
The syndrome known as cervical discogenic pain can be caused by wear and tear damaging the discs in the neck. Damage is often caused by mechanical strains on the neck, like sitting with your neck bent forward for a long time, sticking your head out excessively, frequently bending your neck, sudden movements, and injuries. Injuries related to sports can also make people more likely to get this neck pain syndrome.
Risk Factors and Frequency for Cervical Discogenic Syndrome
Cervical discogenic pain syndrome is a frequent cause of neck discomfort, affecting between 16% to 41% of people. It’s a major type of spinal intervertebral disc disease, second only to lumbar disc disease. This disease is the reason behind one in every five visits to an orthopedic clinic. Neck pain, including that caused by this condition, ranks among the top five chronic pain problems in terms of how common it is and how much it can disrupt a person’s life. While this syndrome affects both males and females, it is notably more prevalent in female individuals. The likelihood of experiencing cervical discogenic pain syndrome also increases with age.
Signs and Symptoms of Cervical Discogenic Syndrome
Cervical discogenic pain syndrome is a condition that can cause a variety of discomfort. Patients may feel pain that stays in one spot, spreads to other areas, or even travels across a certain skin area called a dermatome. The level of pain often gets worse with activities like sitting for a long time, bending, or keeping the head in a forward-leaning position. However, lying flat on one’s back or changing body positions can often help lessen the discomfort. Some people also experience more pain in the morning due to sleeping in uncomfortable positions.
During a physical check-up, healthcare professionals will look for signs similar to another condition called myelopathy. They will check for any neurological problems such as balance issues, changes in feeling or movement in the arms and legs, and changes in nerve function. Ability to sense may diminish across a specific skin area or dermatome. On top of these, posture imperfections and limited mobility might be noticed.
Healthcare professionals may conduct some tests to better understand the situation:
- Spurling test: The neck is extended, rotated, and bent toward the painful side. A positive test would be if this action reproduces the pain and could suggest cervical radiculopathy.
- Lhermitte test: Performed with the patient sitting and bending their neck. A positive test would be if an electric shock-like sensation travels down the spine or arms, potentially indicating cervical spondylosis or myelopathy.
- Shoulder abduction relief sign test: The patient’s shoulder is moved away from the body and they rest their hand on their head. If the pain lessens, this could suggest cervical radiculopathy.
- Arm squeeze test: The middle part of the upper arm is squeezed. If this causes pain, it may suggest that the shoulder pain is actually linked to a neck problem.
Testing for Cervical Discogenic Syndrome
For cervical discogenic pain syndrome – a condition where a disc in your neck causes pain – there’s no need for blood tests or the like. However, if you’ve had a recent injury, doctors may still conduct a radiograph (which is a type of X-ray) to make sure there isn’t any damage like a broken bone or instability. However, keep in mind that such tests could also appear normal or only show degenerative changes. These changes are part of aging and don’t always correlate with whether or not you actually feel any pain.
An MRI scan, or magnetic resonance imaging, can show more details, especially concerning degenerative discs in the neck. But, it is limited in its ability to differentiate between a painful disc and an aging disc that isn’t causing any symptoms.
If your doctor is still unsure, they may recommend a special test called a cervical provocation discography. In this procedure, they inject a contrast agent – basically, a special dye – right into the gel-like center of the disc suspected of causing trouble. This can help them not only confirm the exact location of the problem, but also illustrate the extent of the wear and tear within the disc itself.
Additionally, an MRI could help decide which disc levels to focus on during the discography. If done correctly, discography can segregate the discs inducing pain from those that aren’t causing any symptoms. Combining your symptoms, MRI results, and the findings from the cervical provocative discography could contribute substantially to diagnosing and treating cervical discogenic pain syndrome.
Treatment Options for Cervical Discogenic Syndrome
When someone has cervical discogenic pain syndrome, which is caused by damage to one or more of the discs in the neck, there are numerous ways a doctor might choose to manage it. This depends on factors like what caused the issue, how severe the pain is, and the patient’s symptoms. The first step in treatment is typically a vigorous approach that doesn’t involve surgery. Options can include over-the-counter anti-inflammatory drugs, resting, maintaining good posture, and certain techniques for moving your body. Patients may also be advised to engage in exercises at home. In many cases, these measures lead to improvements within a few weeks.
Doing physical therapy can also be very helpful. The focus of these sessions is typically to ensure the patient maintains good posture and moves their body in ways that are helpful, not harmful. One method that is often used for this is the McKenzie approach. This method involves creating a custom exercise program that is based on how far the patient can comfortably move their neck and repetitive movements of the neck.
Certain individuals with cervical discogenic pain syndrome may need to get shots in their neck to help relieve the pain. These can include cervical epidural injections or nerve root blocks and are usually given to make physical therapy easier to tolerate. However, these aren’t usually the only treatment given because they’re typically not effective on their own.
If the initial treatment methods described above don’t relieve the pain, and the patient continues to experience severe symptoms like radiating nerve pain, weakness in the muscles, or signs that the spinal cord is being compressed, surgical intervention may be considered. A surgery called anterior cervical discectomy and fusion can potentially be helpful for those suffering from neck pain rooted in their discs. Before this operation is done, it’s important to do a technique called cervical provocative discography. This imaging study helps doctors figure out which levels of the spine might need to be addressed in the surgery. Research has shown that this surgical intervention can be effective for relieving pain and improving functionality.
What else can Cervical Discogenic Syndrome be?
When trying to identify a condition causing neck pain, your doctor will rule out other possible conditions including neck disc injuries, neck muscle or ligament injuries, neck joint pain, facet syndrome (painful inflammation of the joints in your spine), neck muscle pain, fibromyalgia (a condition causing pain in your muscles and bones), and spondylosis (age-related wear and tear affecting the spinal disks).
If the doctor suspects your pain is due to Discogenic Pain Syndrome, a condition where a damaged spinal disc causes pain, he or she will start with a conservative treatment plan. To make sure this is the right diagnosis, they’ll need to quickly eliminate the following possible conditions:
- Cancer: Especially if you’re over 50, have a history of cancer, or have lost weight without trying.
- Infection: If you’ve recently had surgery, have a history of drug use, or are experiencing fever or chills.
- Trauma: If you were recently in a car accident, had a work-related injury, sports-related injury, or had neck surgery in the past.
- Neurological issues: If you’re experiencing weakness, loss of reflexes, or problems with your bowel or bladder.
What to expect with Cervical Discogenic Syndrome
The outcome of having Cervical Discogenic Pain Syndrome (CDPS), a neck condition causing discomfort, varies greatly; it depends on how it presents itself and what caused it. Some people start feeling better within the first few weeks of experiencing symptoms by using non-invasive treatments. It appears that starting treatment early may lead to better results. However, if the pain refuses to go away with traditional methods, further diagnosis and potentially surgery might be necessary.
Possible Complications When Diagnosed with Cervical Discogenic Syndrome
Complications from a surgical procedure can include a variety of issues, such as:
- Bleeding during the surgery
- Blood-filled swelling at the surgery site
- Injury to the major neck arteries that can result in a stroke
- Damage to the nerve related to the voice box that can lead to hoarseness or difficulty swallowing
- Persistent leakage of fluid that surrounds the brain and spinal cord
- Injury to the spinal cord or nerve roots that can lead to increased pain
- New neurological problems
- Complications related to surgical tools and implants
- A condition called Pseudarthrosis, where there is a lack of healing after a spinal fusion surgery
- A condition known as Adjacent Segment Disease, where the segments next to a fusion surgery start to degenerate
Recovery from Cervical Discogenic Syndrome
Patients typically head home on the same day they have anterior cervical discectomy and fusion surgery, which is a procedure for relieving neck or arm pain due to spinal disc issues. Early walking and movement is incredibly important for healing and preventing complications. Initially, painkillers called opioids might be used to manage discomfort, but after about a week, they should ideally be replaced with another type of painkiller, NSAIDs. Some patients might have trouble swallowing, but this usually improves over time. How long it takes for a patient to recover can change depending on the severity of their symptoms before surgery.
During the recovery phase of post-surgery rehabilitation, the focus is on managing any abnormal strain or dysfunction in the body’s tissues and structures. The goal is to reduce pain, improve the spine’s normal movement, and enhance muscle control of the neck. Therapists guide patients to recover the usual length of their resting muscle and to gradually improve to the full range of neck movements with minimal pain. Rehabilitation exercises start with simple movements and gradually progress to complex muscle movements.
In the final stage of rehabilitation, the patient should have a full range of neck movement with the correct spinal posture and stabilization. At this point, patients move to function-focused exercises tailored to the tasks they perform at work or in sports. Patients also gradually begin weight training as their body tolerates it.
Preventing Cervical Discogenic Syndrome
Educating patients is crucial in managing cervical discogenic pain syndrome, which is pain caused by a problem in one of the neck’s discs. It’s important for people experiencing this to incorporate conservative strategies, like maintaining good posture and making sure they move their bodies correctly. Home-based exercise treatments can also be beneficial.