Cervical Disc Degeneration – Clinical Considerations

Cervical disc degeneration (CDD) is an age-related condition occurring commonly in patients greater than 45 years of age and is characterized by its progressive nature and radicular symptoms.  Like lumbar disc degeneration, CDD can be identified on radiographs in asymptomatic patients although, in contrast to lumbar degeneration, radiographic findings in CDD are more strongly correlated with pain.  Clinical practice guidelines provide a solid basis for treatment recommendations – including cervical manipulation – but, these guidelines generally do not make recommendations on specific manipulation techniques, instead leaving those decisions to the clinician. 

Some authors suggest that identifying patients likely to respond to manual therapy is more central to treatment success than the choice of treatment itself, with ongoing research advocating for incorporation of biopsychosocial perspectives in treatment.  Despite this shifting focus, the pathophysiological, anatomical, and biomechanical considerations of CDD must not be overlooked, nor should the potential of neurological and/or vascular sequelae. 

The authors of this narrative review present a comprehensive summary of CDD, including an anatomical review, pain-generating mechanisms, instability and radicular symptoms, plus provide recommendations on manual therapy interventions in CDD.

Dr. Thistle’s comment : Cervical disc degeneration is generally a slow process. The challenge for us is that the clinical consequences of CDD – if there are any – can emerge slowly over time. Often, we see patients over many months (or even years), and this can lead to a certain degree of comfort (or, dare I say complacency) in continuing to treat them as you always have. Remember, if you’ve seen a patient for 20 years (for example), their 55-year-old neck may be significantly different than the 35-year-old neck they had when you first started seeing them! This underscores the importance of consistently monitoring our patients for new symptoms and any changes in their neurological status (especially if you haven’t seen them for a while). Remember to include relevant neurological assessments in your re-evaluations and be sure to pause and re-examine the patient, and your clinical approach, should new symptoms emerge.

RESEARCH REVIEW: Cervical Disc Degeneration – Clinical Considerations

This paper was published in the Journal of Manual & Manipulative Therapy (2022). 

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