Cervical degenerative disc disease [Neurosurgery Wiki]

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====== Cervical degenerative disc disease ======

{{ ::ossification_of_the_posterior_longitudinal_ligament.png?400|}}

Cervical [[degenerative disc disease]] is generally discussed in terms of [[cervical spondylosis]], a term which is sometimes used synonymously with [[cervical spinal stenosis]].

[[Spondylosis]] usually implies a more widespread age-related degenerative condition of the cervical spine including various combinations of the following:
 
1. Congenital cervical spinal stenosis (the shallow cervical canal
((Miller CA . Shallow Cervical Canal: Recognition, Clinical Symptoms, and Treatment Contemp. Neurosurg. 1985; 7: 1-5)))

2. Degeneration of the cervical [[intervertebral disc]] producing a focal stenosis due to a cervical bar which is usually a combination of: 

a. Osteophytic spurs ([[hard disc]] in neurosurgical jargon)

b. And/or protusion of the intervertebral disc material ([[soft disc]])

3. Hypertrophy of any of the following (which also contribute to canal stenosis):

a. Lamina

b. Dura

c. Articular facets

d. Ligaments, including

Increased stenosis in extension is more common than flexion (based on MRI studies 
((Muhle C, Weinert D, Falliner A, Wiskirchen J, Metzner J, Baumer M, Brinkmann
G, Heller M. Dynamic changes of the spinal canal in patients with cervical
spondylosis at flexion and extension using magnetic resonance imaging. Invest
Radiol. 1998 Aug;33(8):444-9. PubMed PMID: 9704283.
))
and cadaver studies), largely due to posterior inbuckling of [[ligamentum flavum]]
((Shedid D, Benzel EC. Cervical spondylosis anatomy: pathophysiology and
biomechanics. Neurosurgery. 2007 Jan;60(1 Supp1 1):S7-13. Review. PubMed PMID:
17204889.
)).

[[Posterior longitudinal ligament]]: may include [[ossification of the posterior longitudinal ligament]]
((Nagashima C. Cervical myelopathy due to ossification of the posterior
longitudinal ligament. J Neurosurg. 1972 Dec;37(6):653-60. PubMed PMID: 4631923.
)).
May be segmental or diffuse. Often adherent to dura.

[[Ossification of the ligamentum flavum]]
((Miyazawa N, Akiyama I. Ossification of the ligamentum flavum of the cervical
spine. J Neurosurg Sci. 2007 Sep;51(3):139-44. PubMed PMID: 17641578.
))
([[yellow ligament]]).

4. Cervical [[subluxation]]: due to disc and facet joint degeneration.

5. Altered mobility: severely spondylotic levels may be fused and are usually stable, however there is often hypermobility at adjacent or other segments.

6. Telescoping of the spine due to loss of height of vertebral bodys.Shingling of laminae.

7. Alteration of the normal lordotic curvature
((Batzdorf U, Batzdorff A. Analysis of cervical spine curvature in patients with
cervical spondylosis. Neurosurgery. 1988 May;22(5):827-36. PubMed PMID: 3380271.
))
(NB: the amount of abnormal curvature did not correlate with the degree of myelopathy)

a. reduction of lordosis including:

Straightening

Reversal of the curvature (kyphosis): may cause bowstringing of the spinal cord across ostophytes

b. exaggerated lordosis (hyperlordosis): the least common variant (may also cause bowstringing).

Although the majority of individuals > 50 yrs old have radiologic evidence of significant degenerative disease of the cervical spine, only a small percentage will experience neurologic symptoms
((Cusick JF. Neurosurgical considerations of cervical myelopathy. Semin Neurol. 
1989 Sep;9(3):193-9. Review. PubMed PMID: 2700507.
)).

===== Cervical disc herniation =====

see [[Cervical disc herniation]].

===== Cervical spinal stenosis =====

see [[Cervical spinal stenosis]].

===== Pathophysiology =====

see [[Cervical degenerative disc disease pathophysiology]].

===== Clinical Features =====

see [[Cervical Degenerative Disc Disease Clinical Features]]

{{http://upload.wikimedia.org/wikipedia/commons/9/91/Cervical_Spine_MRI_showing_degenerative_changes_closeup.jpg?200}}

Degenerated disc, C5-C6 with [[osteophyte]]s

===== Outcome =====

see [[Cervical degenerative disc disease outcome]].

===== Case series =====

[[Cervical degenerative disc disease case series]].