DEGENERATIVE DISC DISEASE describes the wear and tear of the disc. Degenerative disc disease is a misnomer for the reason that it sounds as though it’s a progressive and threatening condition. This process occurs naturally with age. However, it is not strictly degenerative and is not actually a disease. Degenerative disc disease can also be accelerated by a motor vehicle accident or labor and other repetitive activities, known as traumatic degeneration. The basic problem begins with a tear in the fibers that make up the annulus fibrosis. It is recognized that annular tears cause pain by excreting inflammatory chemicals that are caustic to nerve roots and neural elements. The break down and the collapse of the facet joints causes mechanical pain.
Classically, a patient with this condition complains of neck pain through the scapula (shoulder blade), which is exacerbated by sitting or standing. The pain is commonly reported as being deep, dull, and aching, or a boring pain, progressing distally from the neck into the arm in a nonspecific zone. This is as opposed to radiculopathy, which is an irritation of the nerve root. Pain, numbness, weakness, and +/– reflex changes of the arm might be present.
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Traditional treatments include early motion, traction, physical therapy, massage, modalities, acupuncture, osteopathic manipulation, chiropractic care, pain management, activity avoidance, and activity with job modifications. Heat in the form of long, hot showers, sauna, and heat packs can help relieve pain. Application of cold packs and gels could also offer some relief. Medications in the classes of aspirin, non-steroidal anti-inflammatories, muscle relaxants, oral steroids, antidepressants, and narcotics might be recommended. Wearing a brace for external stabilization could be helpful in the short term.
When the patient is less symptomatic, specific treatments such as cervical stabilization will often assist with the resumption of function and endurance. Yoga and Pilates may be used to strengthen core muscles, while Medx treatment might help to strengthen neck muscles.
Cervical or lumbar injections such as epidural steroid, facet blocks, or radiofrequency ablation may be recommended.
Cervical or lumbar spine surgical treatments include ACDF and posterior foraminotomy or decompression, fusion and instrumentation.
Prevention: While wear, tear, and break down of the discs is natural and unavoidable, certain factors will accelerate the process. Repetitive bending, lifting, twisting, reaching, vibration exposure, poor posture, poor body mechanics, weak abdominal and extensor muscles, smoking, and obesity can increase the rate of disc break down. An appreciation of the cervical facet joint’s anatomy could, specifically, help in the long-term preservation of neck function. Understanding the function, motion, and limitations of the facet joint can serve as a tool to help slow the process of wear and tear in the neck.
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