Cervical Problems

Neck Pain

The first 7 vertebral bones on the spinal column form the cervical spine and are located in the neck region. The neck bears the weight of the head, allows significant amount of movement, and also less protected than other parts of spine. All these factors make the neck more susceptible to injury or other painful disorders. Common neck pain may occur from muscle strain or tension in everyday activities including poor posture, prolonged use of a computer and sleeping in an uncomfortable position.

The most common cause of neck pain is injury to the soft tissues (muscles, ligaments, or nerves) or prolonged wear and tear. Traumatic accidents or falls and contact sports can cause severe neck injuries causing pain in the neck. Neck pain can also come from infections, tumors or congenital abnormalities of the vertebrae. Common conditions producing neck pain include:

Rheumatoid arthritis: It is an auto-immune disease in which the body’s immune system attacks healthy joints, tissues, and organs. The condition occurs most often in the upper neck area causing inflammation of the lining (or synovium) of joints resulting in neck pain, stiffness, swelling and loss of function.

Cervical disc herniation: Disc herniation is the bulging or rupture of the soft fibrous tissue, discs, cushioning the vertebrae. Cervical disc herniation refers to herniation of discs in cervical spine region or neck region. As a result of this the soft central portion called nucleus pulposus bulges out through the tear in the capsule. The condition can be caused by the normal aging or by traumatic injury to the spine. The condition results in painful, burning, tingling or numbing sensations in the neck.

Cervical Spondylosis: Cervical spondylosis refers to abnormal degeneration of the cartilage and bones in the neck region. The condition results in neck pain radiating to arms or shoulder and neck stiffness that gets worse over time.

Cervical Stenosis: Cervical stenosis refers to narrowing of the spinal canal that protects the spinal cord and its branching nerves. The condition causes neck pain radiating to arms and hands.

Degenerative disc disease: Degenerative disc disease refers to gradual deterioration of the disc between the vertebrae and is caused due to aging. As people age intervertebral discs lose their flexibility, elasticity and shock absorbing characteristics resulting in neck pain.

Diagnosis of neck pain is made with physical examination and other imaging techniques including electromyography (EMG), X-ray, MRI scan, CT scan, blood tests and bone density assessment.

Treatment options include rest, ice application, elevation of the injured area, use a soft neck collar and neck immobilization using a splint, cast, or sling.Medications such as anti-inflammatory drugs, analgesics and muscle relaxants may be prescribed to reduce the pain and inflammation. Certain stretching and strengthening exercises may be recommended to strengthen the neck muscles.

Surgical treatment by anterior cervical discectomy with spinal fusion is typically recommended only after non-surgical treatment methods fail to relieve the pain. An anterior cervical discectomy is a surgical procedure performed to remove a herniated or degenerative disc in the cervical (neck) spine. Spinal fusion may be performed to provide stability to the spine.

The following steps may help you prevent or improve your neck pain:

  • Practice relaxation exercise to prevent undesirable stress and tension to the neck muscles
  • Perform stretching exercises for your neck before and after exercise
  • Keep good posture if you work at a computer and adjust the monitor at your eye level. Stretch your neck frequently
  • If you use the telephone a lot, use a headset
  • Use a pillow that keeps your neck straight
  • Wear seat belts and use bike helmets to reduce injuries

Arm Pain/Numbness (Cervical Radiculopathy)

Cervical radiculopathy is a condition caused by compression of a spinal nerve that leads to arm pain, numbness, tingling or weakness. It most commonly occurs as a result of arthritis in the neck or a cervical disc herniation. Arthritis in the neck leads to development of bone spurs and enlargement of the joints, and these structures in turn begin to pinch off nerves that go down the arm.

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Cervical Disc Herniation

Cervical spine refers to neck portion of spine, and cervical spine conditions may result from overuse injuries, trauma and certain diseases.

A cervical disc herniation is a condition affecting the neck, in which the outer fibers surrounding the disc (annulus fibrosis) may cause tears or cracks. As a result of this the soft central portion called nucleus pulposus bulges out through the tear in the capsule. The condition can be caused by the normal aging, or by traumatic injury to the spine. The condition results in painful burning, tingling or numbing sensations in the neck, shoulders, arms and hands.

Diagnosis & Treatment

Diagnosis of cervical disc herniation is made with physical examination and other imaging techniques including electromyography (EMG), X-ray, MRI scan, CT scan, blood tests and bone density assessment.

Treatment options are best decided by your spine surgeon based on the disease condition and severity of disease.

Conservative Treatment

  • Medications: Anti-inflammatory drugs, analgesics and muscle relaxants may be prescribed to reduce the pain and inflammation.
  • Physical therapy: A wide range of exercises for flexibility, toning, strengthening, stability and restoration of range of motion may be recommended.

Surgical Treatment

Anterior cervical discectomy with spinal fusion and decompression combined with fusion are some of the surgical treatments recommended for cervical spine conditions; and the surgical procedures are recommended in cases where conservative treatments are a failure or if not appropriate.

Cervical Stenosis with Myelopathy

Cervical stenosis refers to narrowing of the cervical canal to the extent that there is insufficient space for the spinal cord. The most common cause of cervical stenosis is arthritis or wear and tear (called degeneneration). As arthritis advances with aging, a number of structures in the spine (such as discs, joints, ligaments, bones) become "overgrown" and begin to take up more space in the spinal canal, leading to stenosis. At first this stenosis may not cause any symptoms and most patients with cervical stenosis are not aware of its presence. Symptoms begin when the spinal cord gets pinched, and the degree of pinching can determine the severity of symptoms.

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