This is pain that starts in the neck, sometimes associated with pain that radiates down one or both of the arms. Neck pain can come from a number of disorders or diseases involving tissues in the nerves, neck, ligaments, bones, joints, or muscles. The neck region of the spinal column (the cervical spine) consists of seven bones (C1-C7 vertebrae) that stay separated from each other through intervertebral discs, which help the spine to move freely and as a shock absorber for activity.
Each vertebral bone contains an opening, which forms a continuous, hollow longitudinal space. This space (the spinal canal) travels across the back’s entire length, forming the area through which nerve bundles and the spinal cord pass. The spinal cord is bathed in cerebrospinal fluid (CSF) and surrounded by a protective layer called the dura, a leathery sac.
At each vertebral level, a pair of spinal nerves exit through small openings, known as foramina (one to the left and one to the right). These nerves supply the tissues, muscles, and skin of the body. Thus, they provide movement and sensation to all parts of the body. The nerves and spinal cord are protected by the suspension provided by the spinal fluid in the dural sac, along with the bony vertebrae. The bony vertebrae are also supported by strong ligaments and muscles that bind them, allowing for safe movement.
CAUSES
Neck pain may be caused by muscle inflammation, arthritis, narrowing of the spinal canal, strain, disc degeneration, or trauma. Rarely, neck pain may be a sign of meningitis or cancer. For patients who suffer from serious neck problems, a primary care physician and often a specialist like a neurosurgeon should be consulted in order to make an accurate diagnosis and prescribe treatment.
Poor posture, age, injury, or diseases like arthritis may lead to degeneration of the joints or bones in the cervical spine, causing bone spurs or disc herniation to form. Additionally, sudden, severe neck injury may lead to blood vessel destruction, disc herniation, whiplash, vertebral injury, and, in extreme cases, permanent paralysis. Bone spurs or herniated discs may cause a narrowing of the spinal canal or the small openings through which spinal nerve roots exit, placing pressure on the nerves or spinal cord.
Pressure on the spinal cord’s cervical region may be a serious problem, for virtually all of the nerves that run through the rest of the body pass through the neck on the way to their final destination (arms, legs, chest, abdomen). This pressure can possibly compromise the function of numerous essential organs. Pressure on a nerve can result in pain, numbness, or weakness to the area in the arm the nerve supplies.
CERVICAL STENOSIS
Cervical stenosis occurs when one’s spinal canal narrows, compressing the spinal cord in the process. This condition is often caused by degeneration, which occurs with aging. The discs in the spine that cushion and separate vertebrae may dry out as one ages. As a result, the space between individual vertebrae diminishes, and the discs lose their shock-absorbing ability. Concurrently, the ligaments and bones that comprise the spine become thicken, growing less pliable. These changes cause the narrowing of one’s spinal canal. Additionally, the degenerative changes connected to cervical stenosis may affect the vertebrae by contributing to the growth of bone spurs that compress nerve roots. Conservative treatment for extended periods of time can be provided for mild stenosis, as long as the symptoms are restricted to neck pain. Severe stenosis, however, may impinge the spinal cord, resulting in injury and requiring referral to a neurosurgeon.’
NECK INJURIES
Neck injuries can occur during motor vehicle accidents, sports, or other traumatic events. Some symptoms of these injuries are headache, neck stiffness, shoulder or arm pain, facial pain and dizziness. Pain from a motor vehicle injury may be caused by tears in muscles or injuries to the joints between vertebrae. Other causes of pain are damage to a disc or ligament rupture Conservative treatment of these injuries includes pain medication, reduction of physical activity, and physical therapy.
In addition to neck pain, pressure on a nerve root or the spinal cord by a herniated disc or a bone spur may result in any of the following symptoms:
- Pain in the arm
- Weakness or numbness in the arm or forearm
- Tingling in the hand or fingers
- Difficulty with balance and walking
- Weakness in the arms or legs
WHEN AND HOW TO SEEK MEDICAL CARE
Those with neck pain may be referred to a neurosurgeon if pain in the neck and/or shoulder is present, or if tingling, numbness, and/or weakness in the arms is present.
Neurosurgeons should be consulted for neck pain if:
- It occurs after a blow or injury to the head
- Headache or fever that accompanies the neck pain
- Stiff neck, which prevents the patient from touching their chin to chest
- Pain shoots down one arm
- There is tingling, weakness, or numbness in the arms or hands
- Neck symptoms associated with loss of coordination in arms or legs or leg weakness
- The pain does not respond to over-the-counter pain medication
- Pain fails to improve after a week
TESTING AND DIAGNOSIS
A neurosurgeon completes the diagnosis, basing it on symptoms, patient history, a physical examination, and results of diagnostic studies, if necessary. Certain patients may be treated conservatively, later undergoing imaging studies if physical therapy and medication do not improve symptoms.
These tests may include:
- Nerve Conduction Studies (NCS)
- Computed Tomography Scan (CT or CAT scan)
- Electromyography (EMG)
- Magnetic Resonance Imaging (MRI)
- Myelogram
- Discography
- Selective Nerve Root Block
- X-rays
TREATMENT
Non-Surgical Treatment
Most causes of neck pain are not life threatening situations, often resolving with conservative medical treatment and time. Creating a treatment strategy predominantly depends on identifying the cause and location of one’s pain. Although neck pain can be quite painful and debilitating, nonsurgical management can alleviate numerous symptoms. Medications to reduce the pain or inflammation, along with muscle relaxants that allow time for healing to occur, may be prescribed. Wearing a cervical collar or reducing physical activities can provide support for the spine, reduce mobility, and decrease both pain and irritation. Trigger point injection, such as corticosteroids, can also temporarily relieve pain. Occasionally, doctors may suggest epidural steroids. These conservative treatment options may continue for up to six or eight weeks.
If the patient is experiencing any numbness or weakness in the arms or legs, seek medical advice more urgently. If the patient has had any trauma and is now experiencing neck pain with these two sensations, urgent consultation with a neurosurgeon is recommended.
Surgery
If conservative treatment for neck pain fails to provide relief, surgery may be needed.
Patients may be a candidate for surgery if:
- Conservative therapy is not helping
- Persistent pain causes the patient to experience a decrease in function
- They experiences progressive neurological symptoms, involving the legs and arms
- The patient experiences difficulty with balance or walking
- The patient is in otherwise good health
Several different surgical procedures can be utilized, the choice of which beijing influenced by each case’s specifics, both from the front of the neck or the back of the neck. Often, a surgeon performs spinal fusion, but artificial disc replacement simple decompression may be employed in other cases. During spinal fusion, a surgeon creates a solid union between two or more vertebrae. Various devices, such as screws or plates, may support the cervical spine’s unstable areas, enhancing fusion. This operation may assist in strengthening and stabilizing the spine, thereby assisting to relieve severe and chronic neck pain. The specifics of the disc disease, along with the absence or presence of pressure on the spinal nerve roots or spinal cord help determine what type of surgical treatment should be used. Some other helpful factors are how long the patient has had this disorder, their age, other medical conditions, and if there has been previous cervical spine surgery.
If the patient smokes, he or she should attempt to quit for safety reasons. Smoking damages the architecture and structures of the spine, slowing down one’s healing process. An overweight patient should attempt to lose weight. Both smoking and obesity have a negative impact on the outcome of spinal fusion surgery.
The benefits of every surgery should always be weighed carefully against the surgery’s risks. Although a large percentage of neck pain patients report significant pain relief after surgery, no guarantee can be provided that surgery will help every individual.
FOLLOW-UP
If neck pain resolves with just non-surgical, conservative treatment, follow-up will most likely occur only when needed or if with the return of symptoms. The follow-up to patients who undergo surgery varies for each procedure.
