The Aging Spine:
Osteoarthritis and Other Degenerative Conditions of the Spine
Cervical Degenerative Disc Disease

Neck pain and stiffness frequently occur in the aging spine. This is due to arthritic changes in the joints and degenerated discs, which can often be seen on regular X-rays.

Symptoms and Diagnosis

When the neck pain is associated with pain and/or numbness or weakness in the shoulder, arm, or hand, further workup may be needed, as these symptoms indicate pressure on one or more nerve roots. Evaluation entails a thorough neurologic examination and imaging using an MRI and/or CT scan.

Treatment

Initial treatment consists of immobilization with a collar, non-steroidal anti-inflammatory medications, and physical therapy. Occasionally, halter traction is used as well. If the symptoms are significant and persistent despite these nonoperative measures and/or a significant neurological deficit is apparent, surgical treatment is often necessary. Usually, an anterior cervical discectomy and fusion is performed, with possible removal of the degenerative bony spurs that occur around the border of the discs. The fusion is performed with either bone from the pelvis (iliac crest) or from the bone bank, and the vertebrae are usually fixed together using a metal plate and screws. If multiple levels are involved, a posterior decompression and stabilization with plates and screws and a fusion may be performed as an alternative. If there is severe narrowing of the canal in the cervical spine, significant pressure on the spinal cord itself (not just the nerve roots) can occur and may lead to loss of the ability to walk and/or loss of bowel and bladder function and control. This is known as cervical myelopathy. When it occurs, it usually progresses slowly, and diagnosis is often delayed.