Cervical Degenerative Disk Disease

Degeneration means wear and tear, usually due to aging process. This wear and tear can involve any joint of the body, which also includes a spine in the cervical spine or the neck.

This aging process can set in at a variable speed in different individuals depending on individual characteristics, genetics, modifiable factors like injuries, smoking, systemic diseases among others. The degeneration in the cervical spine can involve either of the three joints namely the two facet joint and the one disc space.

All the three are usually involved simultaneously, but it is the degeneration of the disc which is more often symptomatic and needs treatment. The degeneration of the disc can be accelerated due to injuries in the form of a single accident or exposure to microtrauma over a period of time. Systemic diseases like rheumatoid arthritis can also accelerate the process of degeneration.

Cervical CT scan showing axial section.

Cervical CT scan showing axial section.

The degenerative disc disease of the cervical spine usually involves the most mobile segment that is the C5-C6 followed by C6-C7 and C4-C5 disc levels. The degeneration causes decreased water content of the disc or desiccation which leads to tears in the outer ring or the annulus fibrosus.

These tear allow the herniation of the central nucleus pulposus to the periphery. When these herniations are along the back of the disc, they can compress over the spinal cord or the nerve root leading to variable symptoms and presentation


Vast majority of patients who have degenerative cervical disc disease are asymptomatic and remain asymptomatic throughout their life. A small percentage of patients present with symptoms of neck pain or that of compression of the nerve root on one side presenting with symptoms of radicular pain going down the specific dermatome in the arm, tingling, numbness, and rarely weakness of the muscles innervated by that specific nerve root.

These radicular symptoms are caused by the disc herniation onto the side of the back of the disc thus compressing the nerve root. Rarely patients may have disc herniation to the back in midline, which can compress the spinal cord leading to symptoms in one or all four extremities along with tingling, numbness, radicular pain, electric shock-like sensations, involvement of bowel or bladder and gait abnormalities.

These patients may also have hand dexterity problems in the form of dropping things, weakness of the grip strength, change in handwriting among others. Patients may have disc degenerative disease of multiple levels causing multilevel cervical stenosis. There may also be hypertrophy and calcification of the ligament on the back of the spinal cord contributing to the stenosis.

Patients with congenital cervical stenosis may be predisposed to such disease. These patients may present with acute deterioration of their neurological symptoms following trivial trauma or whiplash type injury in the neck.

Examination of patients with radicular pain may show weakness of specific muscles and dulling of reflexes while in patients with compression of the spinal cord may show increased tone of the muscles, weakness, decreased sensation as well as hyperreflexia.


The patients who have back or neck pain with any of these following conditions should seek medical attention as soon as possible.
1. Cancer, neoplasia or malignancy.
2. Unexplained weight loss of more than 10 pounds in the last 6 months.
3. Immunocompromised comorbidities like on chemo or radiotherapy or having disease like HIV or AIDS or being on prolonged corticosteroid therapy.
4. IV drug users.
5. Urinary tract infection.
6. Fever of more than 100 degrees centigrade.
7. Significant trauma from a fall or accident.
8. Bowel or bladder involvement in the form of incontinence or retention.
9. Weakness in the major joint of arm or leg.


Most people with cervical degenerative disc disease are asymptomatic and remain asymptomatic for their life.

These patients may never visit a physician for the complaints with regard to the cervical degenerative disc disease. Some of these patients may have neck x-rays for unrelated reasons and may be found to have degenerative disc disease.

Such patients do not need any active treatment. Patients who present with occasional neck pain can also be treated with exercises and occasional medications.

Patients with symptoms of radiculopathy are usually treated conservatively for 4 to 6 weeks with excellent chances of resolution of symptoms. These patients are usually treated with physical therapy and medications. Neck collar may be used for a short period. If the patient fails conservative treatment, an MRI is usually performed to confirm the level of disease and collaborate with clinical findings.

These patients are offered surgical management to relieve them of the pain. Surgical management for cervical degenerative disc disease with compression of the nerve root or the cord from the front is usually in the form of cervical fusion or disc replacement done from the front. Another option include microscopic posterior foraminotomy, done from the back, which is a motion sparring (non-fusion) minimal invasive surgery.

Patients who have compression of the spinal cord from the back may need surgery from the back to relieve the pressure. Surgery from the back may involve removing of the bony elements from the back, relieving of the pressure and cervical fusion over multiple levels (Laminectomy and Fusion) or opening of the bony elements of the back using many plates to increase the space available for the spina (Laminoplasty).

A decision between varied surgical procedure is usually made on patient characteristics and presentation. Patients with spinal cord compression may need an emergent treatment plan especially in presence of deteriorating neurological status or acute onset to contain the neurological damage as well as allow possible recovery.

Instruments used in ACDF

ACDF Plate (3 level fusion)

The images above show ACDF (anterior cervical decompression and fusion) plate and instruments used to fuse the cervical vertebrae from the front of the neck. The surgery helps to decompress the spinal nerves/spinal cord and prevent movement between the segments to alleviate the symptoms and achieve stability.


Patients who undergo conservative treatment usually have excellent chance of complete recovery of their symptoms over a span of 4 to 6 weeks. Patients who fail conservative treatment may need surgical management for resolution of symptoms.

Patients who undergo surgical management for radicular pain in the form of cervical discectomy and fusion, disc arthroplasty or posterior foraminotomy usually have near complete recovery along with resolution of symptoms.

Patients who have spinal cord compression may have guarded prognosis. The recovery is inversely proportional to the deterioration of neurological deficit prior to surgery. Though the surgery may optimize and allow good environment for spinal cord to recover, it may take many months to years for a partial or a near complete recovery.

Occasionally despite all measures, patient may not get any recovery. Patients with spinal cord compression have a prolonged rehabilitation period and are at risk for multiple other problems including urinary tract infection, lung infection, deep vein thrombosis, pulmonary embolism, aspiration pneumonia, respiratory depression, death among others.


As for all surgeries there are certain but rare risks for anesthesia including cardiac arrest, stroke, paralysis, and rarely death.

Risks of Cervical spine surgery may include though not limited to:
• Hematoma or hemorrhage
• Damage to the carotid or vertebral artery which may result in a stroke or excessive bleeding, even death
• Blindness
• Damage to the nerve in the neck resulting in hoarseness or swallowing difficulties
• Damage to the food or wind pipe
• Damage to the dura, resulting in a cerebrospinal fluid leak
• Failure, loosening or pull out of the graft, cage, implant or plate
• Wound infection
• Failure of fusion to happen
• Damage to the spinal cord or nerve root(s) resulting in new onset or deterioration of preexisting pain, weakness, paralysis, loss of sensation, loss of bowel or bladder function, impaired sexual function, etc., which may or may not recover.
• A few of these conditions may warrant repeat surgery

Certain patient population is at a higher risk for complication which include but are not limited to:
• Smoking
• Seizures
• Obstructive sleep apnea
• Obesity
• High blood pressure
• Diabetes
• Other medical conditions involving your heart, lungs or kidneys
• Medications, such as aspirin, that can increase bleeding
• History of heavy alcohol use
• Drug allergies
• History of adverse reactions to anesthesia


Patients with radicular pain involving one or more than one nerve roots who have failed conservative treatment are good candidate for surgical management.

The surgical treatment stops the progression of the symptoms and allows optimum environment for the nerve root to heal and recover and resolve the symptoms as well as restore muscle power.

Patients who develop acute deterioration of neurological symptoms or acute onset of symptoms have a good chance of halting the progression as well as allowing recovery of the spinal cord nerve root and neurological function.

Patients who have had neurological deterioration for a long time may not be benefitted with the surgery especially if the symptoms have been stable.

Though a surgery may provide an environment for the spinal cord to heal and recover, but any recovery may not be complete. Patients with pain usually have good relief, those with numbness and tingling may take some time.


The surgeries for cervical degenerative disc disease include anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), or hybrid procedure including ACDF and ACCF, posterior microscopic foraminotomy, total cervical disc replacement, posterior laminectomy and fusion, and laminoplasty.


Exercises involving strengthening of the core muscles of the neck that is the front and the back muscles of the neck help in stabilization of the cervical spine.

These should usually be performed under the supervision of a physician or a physical therapist especially in patients with cervical degenerative disc disease.

Any injury, sudden movement, loading of the head and neck as well as excessive movement of the neck should be avoided especially in patients with degenerative disc disease of the neck.


Cervical disc degenerative diseases are common phenomena in aging population. Patients are asymptomatic in vast majority of population and do not need any treatment.

Patients who are symptomatic can usually be treated with conservative means with a successful outcome. Patients who have failed conservative measures and patients with sudden or rapid onset or deterioration of neurological symptoms can be treated with surgery with good results.

Patients who have profound neurological involvement may have guarded recovery even after surgical management.

Call Us Now!

Based on 116 reviews
I had an extremely friendly and personalized medical consult with Dr Karkare. Dr Karkare was very knowledgeable and very professional. His communication skills was extremely good and explained my medical condition in very simple words. The office visit was very helpful in understanding my medical condition. Thank you Dr Karkare
Padmanabhan Nagaraj
20:49 25 Sep 23
Dr. Karlkare and his staff were excellent. Dr. Karkare explained everything clearly and took his time getting to know my Dad.
Anna Acker
22:46 07 Sep 23
Dr Vedant Vaksha had done emergency surgery in 2020 after a traumatic injury.His office at Complete Orthopedics handled the continued care thereafter.Dr V and his staff had been Professional and friendly throughout the process, taking the time to explain all the questions on how to proceed and what to expect.Whenever I needed to speak with Dr V or the office they were a phone call away, without waiting or calling several numbers like in so many other medical offices.The office was accommodating to scheduling to my needs at all times. Dr Vedant Vaksha earned the following5 out of 5 stars, highly recommended.
John Kuey
20:58 05 Sep 23
Dr. Vaksha helped me recover from an injury. I am very thankful that he took the time to explain the best treatment for my injury. Also thankful for the wonderful office staff!
Joseph Castelli
22:30 02 Aug 23
The office is wonderful!… Dr Paresh was very helpful and attentive and made my sister in laws recovery so much better.. Thank you for everything
Jazz Lorenzo
17:48 14 Jul 23
The ladies are very welcoming, the service is great, the doctor is very professional and caring and the building is super clean. I really like to come here, the atmosphere is very friendly... Come and you will love it too.
Joan Carasco
14:41 30 Jun 23
Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.