Neck Pain Symptoms, Causes and Treatment
Neck pain can be a symptom of a variety of disorders or diseases of any structure of the neck.
What is Your Cervical Spine?
Your neck is part of a long flexible column of bone and other tissue, often referred to as the spinal column or backbone, which extends through most of your body. The neck region of the spinal column, called the cervical spine, consists of seven bones called vertebrae that are shaped like building blocks. The spine has three main functions: (1) it supports the body, (2) it protects the spinal cord and nerve roots, and (3) it allows flexible movements.
Soft pads called intervertebral disks separate the vertebrae from one another. These disks allow the spine to move freely and act as shock absorbers when you move around. Attached to the back of each vertebral body is an arch of bone that creates a continuous, hollow space. The hollow space is much like a tube that runs the whole length of your back. This space is the spinal canal, through which run the spinal cord and several bundles of nerve roots. The spinal cord is surrounded by cerebrospinal fluid and three layers of protective membrane: the pia, the arachnoid, and the dura.
At each level of vertebrae a pair of spinal nerve roots exit through small openings called foramina (one to the left and one to the right). These nerve roots serve the muscles, skin, and tissues of the body. Together they provide sensation and movement to all parts of the body. The delicate spinal cord and nerve roots are further supported by strong muscles and ligaments that are attached to the vertebrae. The cervical spine needs to be strong because it also holds up your head, which can weigh 10 pounds or more.
Common Disorders of the Cervical Spine
Cervical Disk Herniation
With age, injury, poor posture, or diseases such as arthritis, damage can occur to the bones or joints of the cervical spine. The disks may become worn out, and bony growths (bone spurs) may form on them as a result of repetitive stresses on the disk and vertebra. Sudden severe injury to the neck may also cause disk and vertebral injury. The herniated disk or bone spurs may narrow the canal through which the spinal cord runs or narrow the small openings (foramina) through which spinal nerve roots exit. Occasionally, significant trauma may cause a disk herniation. Disk material degenerates, or wears out, naturally with age. Bone spurs can form, resulting in neck, shoulder, and arm pain, or weakness and numbness of the arm.
Pressure on a nerve root by a herniated disk or a bone spur may result in:
- Pain in the arm and neck.
- Numbness or weakness in the arm or forearm.
- Tingling in the fingers or hand.
Pressure on the spinal cord in the neck can be a very serious problem. It may cause symptoms and neurological problems involving the arms and legs, and may also affect bowel and bladder function.
Initially, the symptoms of cervical disk disease may be limited to neck pain and later arm pain; weakness or numbness may also occur, along with difficulty walking. Further progression of the problem may lead to severe impairment, including significant numbness or weakness of the arms and legs. Osteoarthritis and degenerative disk disease, often caused by aging and general wear and tear on the spine, are common in the cervical spine. Common symptoms include neck pain, headache, and numbness, tingling, or weakness in the arms or legs.
Cervical stenosis occurs when the spinal canal narrows and compresses the spinal cord. This narrowing can be a result of a number of factors, but most frequently it happens as a by-product of aging. The disks in the spine that separate and cushion our vertebrae may dry out. As a result, the space between the vertebrae shrinks and the disks lose their ability to act as shock absorbers. At the same time, the bones and ligaments that make up the spine become less pliable and thicken. These changes result in a narrowing of the spinal canal. In addition, the degenerative changes in the vertebrae associated with cervical stenosis can lead to the growth of bone spurs that compress the nerve roots. Symptoms include neck pain, numbness and weakness in both hands, unsteady gait when walking, and muscle spasms in the legs. Mild stenosis can be treated conservatively for extended periods of time as long as the symptoms are restricted to neck pain. Severe stenosis requires referral to a neurosurgeon.
Neck injuries can occur during motor vehicle accidents or other traumatic events. Symptoms of these injuries include neck stiffness, shoulder or arm pain, headache, facial pain, and dizziness. Pain from a motor vehicle injury may be caused by tears in muscles or injuries to the joints between the vertebrae (facet joints). Other causes of pain are ligament rupture or damage to a disk. Treatment of these injuries consists of analgesics, nonsteroidal anti-inflammatory drugs, muscle relaxants, and physical therapy.
Diagnosing Your Cervical Spine Problem
Before your doctor can recommend a course of treatment, your cervical spine needs to be thoroughly evaluated. Your evaluation will include a medical history, physical exam, and diagnostic tests.
Your doctor will document your symptoms and find out the extent to which these symptoms affect your daily living. The physical examination will include an assessment of sensation, strength, and reflexes in various parts of your body to help pinpoint which nerve roots or parts of the spinal cord are affected.
If conservative treatment such as medication or physical therapy does not provide sufficient relief, your doctor may perform diagnostic studies. These diagnostic studies may include:
An x-ray will show the bones of the neck and determine if there is significant wear and tear or disease of the bone. It will also show whether the bones are lined up properly. It may show degeneration of the disk space or any abnormal movement of the spine.
The myelogram is an x-ray with a special dye that highlights the spinal cord and nerve roots. The dye is usually injected into the spinal fluid in the lower back with a needle, and then the x-rays are obtained. Plain x-rays and CT scans are performed after dye injection.
Computed Tomography (CT)
A CT (also known as a CAT scan) produces a computerized map of the neck. The CT will show the anatomy of the neck in more detail and from different angles. It will also better define the relationship of the disk or bone spurs to the spinal cord and nerve roots. The CT may be done in conjunction with a myelogram of the neck to provide additional information. CT scans are ideal for showing bone detail (stenosis).
Magnetic Resonance Imaging (MRI)
The MRI uses a powerful magnetic field instead of x-rays to produce a detailed anatomic picture of the neck and the structures within it. This test is best for soft tissue detail (disk, nerve roots, spinal cord). It can also help show abnormalities of the spinal cord itself.
Electromyogram and Nerve Conduction Studies (EMG/NCS)
Unlike the other tests – which help your doctor determine anatomy and structure – these tests primarily study how the nerve roots and muscles are actually working together. They measure the electrical impulse along the nerve roots, peripheral nerves, and muscle tissue. Small needles may be placed in the muscle or along the course of a nerve root to measure electrical activity. Slowing of the impulses may reveal which nerve roots or muscles may be functioning abnormally.
Conservative (Nonsurgical) Treatment Options
Cervical disk problems do not always mean you require surgery. In fact, for many patients with neck pain, nonsurgical management can relieve most of their symptoms. Your doctor may prescribe medications to reduce the pain or inflammation and muscle relaxants to allow time for healing to occur. Reducing physical activities or wearing a cervical collar (to provide support for the spine, reducing mobility, reducing pain and irritation) may also be prescribed. Trigger point injection, including corticosteroids, can temporarily relieve pain. Occasionally epidural steroids may be recommended.
If you are experiencing any weakness or numbness in your arms or legs, you should seek medical advice. If you have had any trauma and are now experiencing neck pain with weakness or numbness, you need to see a neurosurgeon.
Conservative treatment options may continue for up to six or eight weeks.
When Surgery is Necessary
When conservative treatments for cervical disk problems do not provide relief, surgery may be needed. There are several surgical treatments available to treat cervical spine disorders. The choice of treatment and the decision as to when to perform the operation should be determined by a neurosurgeon – the medical specialist trained in the surgical treatment of disorders of the spine, spinal cord, and peripheral nerves.
You May Be a Candidate for Surgery If
- Conservative therapy is not helping.
- You experience progressive neurological symptoms involving your arms and legs.
- You experience difficulty with balance or walking.
- It is required to prevent future neurological injury.
- You are in otherwise good health.
Factors in determining the type of surgical treatment include the type of disk disease you have (herniated disk or bone spurs) and the presence or absence of pressure on the spinal cord or spinal nerve roots.bOther factors include your age, how long you have had the disorder, other medical conditions that may be present, and previous operations on your cervical spine.
If you smoke, quit. Smoking damages the structures and architecture of the spine and slows down the healing process. Smoking will also interfere with a successful fusion, if fusion is surgically necessary. It is important to keep in mind that surgery has its limitations. It cannot reverse all the effects of overuse or aging, and it does have risks. Yet, it may be the only way to relieve your pain, numbness, and weakness. The decision whether or not to have surgery is yours. In order to make this decision, it may be helpful to understand more about the available surgical treatments. The three most commonly used procedures are:
This is one of the most common surgical procedures used to treat disorders of the cervical spine. It is performed on the neck to relieve pressure on one or more nerve roots or on the spinal cord. It involves removing the disk and enlarging the nerve root openings (foramina), as well as removing bone spurs.
The surgeon will make an incision in the front of your neck. If only one disk is to be removed, typically it will be a small horizontal incision in one of the creases of the skin. If the operation is to be more extensive, the incision may be vertical and longer.
The soft tissues within the neck are separated to allow the surgeon to reach the front of the spine, after which the disk and any bone spurs are removed. An operating microscope may be used to better visualize the area while the disk is removed. Sometimes, the space between the vertebrae is filled with a small piece of bone in a procedure called fusion. The bone may be yours or may be taken from a donor bone bank. In time, the vertebrae and bone should fuse together, creating a stable structure. In addition to the piece of bone, it may be necessary to also attach a metal plate and screws at the fusion site to strengthen it further.
Historically and statistically, there are few surgical risks associated with anterior cervical diskectomy. However, some risk is unavoidable and the unexpected may occur, resulting in complications. Although every precaution will be taken to avoid complications, potential risks include infection, excessive bleeding, difficulty swallowing, stroke, injury to the recurrent laryngeal nerve (resulting in temporary or permanent hoarseness), and injury to the involved nerve root(s) or the spinal cord, which can cause varying types and degrees of paralysis (rare).
Cervical Corpectomy with Fusion
This operation is an extension of the diskectomy procedure. Also using an anterior (frontal) approach, the surgeon removes a part of the vertebral body to relieve pressure on the spinal cord. One or more vertebral bodies may be removed, including the adjoining disks. The incision is generally longer. The space between the vertebrae is filled using a piece of bone, and a metal plate and screws may be used to help secure the fusion. Because more bone is removed, the recovery process is usually longer than with anterior cervical diskectomy alone.
This operation is performed through a vertical incision in the back of the neck, generally in the middle. Through this opening, the surgeon will retract the strong muscles of the neck and expose the arch of the bone that forms the back of the spinal canal. The bone around the spinal cord and/or the bone around the nerve opening will be removed, as will the attached ligaments exerting pressure on the spinal sac and nerve roots. Once the nerve root is identified, it is gently moved aside and an incision may be made in the fibrous outer layer of the disk, which then allowed disk material to be removed.
Content Source: American Association of Neurological Surgeons