What it is
Each cervical disc has a tough outer ring and a softer, water-rich center. With age the center loses water, the disc loses height, and the load shifts onto the small facet joints at the back. Bone spurs form at the margins. This is the ordinary wear of a working neck rather than a disease process.
It matters clinically only when it narrows the space for a nerve root or the spinal cord, or when a degenerating segment becomes a genuine source of pain.
Symptoms
- Aching or stiffness across the neck, often worse at the end of the day
- Pain that comes and goes over months or years rather than steadily worsening
- Grinding or clicking with movement
- Where a nerve is involved: pain, numbness or weakness into the arm
- Where the cord is involved: clumsiness in the hands, balance change
How it is diagnosed
The diagnosis is usually made on X-rays showing lost disc height and spur formation. MRI is used when the examination suggests nerve or cord involvement. Dr. Long reads the imaging against the examination rather than in isolation, because degeneration is so common that the scan alone cannot tell you what is causing the pain.
Non-surgical treatment
The mainstay, and effective for most people. Physical therapy for the deep neck flexors and the shoulder girdle, posture and workstation changes, anti-inflammatory medication, and targeted injections where a specific level has been identified.
When surgery is considered
Not for degeneration itself. Surgery is considered where degeneration has produced nerve root compression with persistent arm symptoms, or spinal cord compression. An operation offered for neck pain with no nerve involvement and no instability is one to ask careful questions about.