I have significant degeneration in my neck at C56. The discs are almost gone. There are bone spurs everywhere. The surgeon I saw gave me some treatment options from doing nothing to a disc replacement. What do you recommend?
Many people start to develop disc degeneration in the cervical spine (neck) as a result of the degenerative and inflammatory processes associated with aging. These kind of changes are often the source of neck and/or arm pain.
Treatment usually starts with conservative (nonoperative) care to address motion, weakness, alignment, posture, and of course, the pain. Besides antiinflammatory medications, physical therapy is often a main feature of treatment at this stage.
The "do nothing" plan is referred to as "benign neglect" and may just result in spontaneous bony fusion. Studies show that removing the disc without doing anything else (or letting the disc degenerate to nothing) leads to the body taking care of itself by fusing the bones together. This occurs in up to 80 per cent of cases treated with benign neglect.
If conservative therapy fails or if painful symptoms get worse, then surgery may be advised. The surgeon may just go in and do some "clean up" work -- shaving off osteophytes (bone spurs) or removing the disc (discectomy). Spinal fusion is another option. In this procedure, the surgeon joins two or more neck vertebrae into one solid section of bone. The medical term for fusion is arthrodesis.
There are many ways to perform a fusion of the cervical spine. The surgeon usually removes the degenerated, diseased disc from between two vertebrae. Bone chips (graft) are inserted into the space left by the removed disc. Sometimes a special metal cage is inserted in between the two vertebrae instead. The cage is then filled with bone chips. Hardware such as a metal plate held by screws may be placed along the front (anterior) portion of the spine to help stabilize and hold everything in place until fusion takes place.
But if you are a good candidate, disc replacement may be possible. With a disc replacement, motion is preserved. The artificial disc is inserted in the space between two vertebrae. The goal is to replace the diseased or damaged disc while keeping your normal neck motion. The hope is that your spine will be protected from similar problems above and below the affected spinal level.
We think it's great there are so many options to choose from. Each case is individual and the patient and surgeon must work together to find the right "best" choice for each person. There are many choices and many reasons to choose one treatment option over another. Hopefully knowing what some of the options are will help you ask the questions for yourself that will guide you through this process.