Jatana Spine

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Sanjay Jatana, M.D.

Degenerative Disc Disease, Herniated Disc and Cervical Stenosis.

Degenerative Disc Disease

Overview

Degenerative disc disease is a weakening of one or more vertebral discs, which normally act as a cushion between the vertebrae. Discs can degenerate as a natural part of the aging process, but may also result from injury to the neck.

Symptoms

Some people with degenerative disc disease experience pain localized to the neck. This pain may radiate into the base of the skull and the back of the neck or towards the shoulder blade. This pain can be episodic and can be positional.  Typically bringing the head backwards and/or sitting with suboptimal posture can increase the extent of the neck pain.  Lying down may relieve the pain depending on the necks position.  

For most people moving the neck and not being in a fixed position is often helpful in relieving the pain.

Treatments

  • Chiropractic care
  • Massage/ acupuncture
  • Medications (NSAID’s, muscle relaxers, and short-term narcotics)
  • Epidural and/or facet injections
  • Physical Therapy
  • Spine surgery in selected patients

Herniated Disc

Overview

When a disc in the cervical spine ruptures, soft, jelly-like material from inside the disc (nucleus) can protrude outside and through the outer ring (annulus) and compress the spinal cord and nerve roots. A herniated disc can arise through the wear and tear of aging or from minor injury to the spine.

 Symptoms

A herniated  disc can cause painful burning, tingling or numbing sensations in the neck, shoulders, arms and hands. It may also cause muscle weakness. Pain due to a herniated disc may worsen with activity.

Treatments

  • Rest
  • Immobilization of the neck with a soft collar
  • Anti-inflammatory medications
  • Pain Medications
  • Muscle Relaxants
  • Physical Therapy
  • Spinal Injections
  • Spine surgery

Cervical Spinal Stenosis 

Overview

Cervical stenosis is a narrowing of the spinal canal that results from the degeneration of bones, discs, or joints in the cervical spine. This narrowing can squeeze or compress the nerve roots where they leave the spinal cord or compress and potentially damage the spinal cord itself. Cervical spinal stenosis is typically caused by age and overuse, which can lead to degeneration of the spine's discs, bones and joints. Vertebrae may slip out of their normal alignment and rub harmfully against each other.

Symptoms

Symptoms depend on the area being pinched. Pressure on a nerve root can cause pain, weakness and numbness in the shoulders, arms and hands. Balance and coordination may also become an issue for those suffering from cervical stenosis. Other problems include loss of fine motor skills, manual dexterity issues, and in late stages, loss of bowel and bladder control.

Treatments

  • Anti-inflammatory medications
  • Activity modification
  • Epidural steroid injections
  • Physical therapy
  • Spine surgery

Myelopathy

Overview

Myelopathy is a condition that describes compression of the spinal cord.  Spinal cord compression can occur in the neck as well as in the thoracic region. 

Symptoms

Symptoms associated with spinal cord compression can involve neurologic symptoms such as pain, numbness, tingling, weakness, difficulty walking and lack of coordination of the arms.  Cervical myelopathy can wax and wane over time and there can be periods of improvement as well as periods of deterioration.  It can be a slowly progressive disorder.

Quick development of cervical myelopathy can occur in younger patients due to a disc herniation or injury to the neck.  Patients may often describe an electrical sensation shooting down the arms and throughout the upper and mid to lower back often referred to Lhermitte's phenomenon. 

Diagnosis involves a physical evaluation, imaging studies which may include a MRI of the cervical spine and possibly an EMG/nerve conduction study.

Treatment

Simple treatment such as medication, activity modification and physical therapy can provide some relief but since there is spinal cord compression it is best to consider surgical decompression especially if your activity levels are moderate to high.  Surgery will give the spinal cord adequate room so it is not at high risk for injury.

Surgery for cervical myelopathy carries a greater risk than other types of cervical spine surgery since the spinal cord is compressed.  It can involve anterior and/or posterior surgery on the cervical spine.  The results of surgery over the long term are good to excellent.  Depending on the age of the patient a decompression and fusion is typically the most common type of surgery for cervical myelopathy.  There are also other procedures such as a cervical laminoplasty which can decompress the spinal cord in younger patients without having to do a fusion.