Neck

What is Cervical Spondylosis?

Cervical spondylosis, also known as cervical osteoarthritis or neck arthritis, is a common age-related condition affecting the joints and discs in the cervical spine (neck). It is caused by wear and tear of the cartilage and bones, leading to changes like bone spurs and disc degeneration.

Causes:

• Age: The most common cause is simply the natural aging process, as the discs in the spine dehydrate and shrink, and the cartilage wears down.
• Genetics: A family history of spondylosis may increase your risk.
• Occupation: Jobs that involve repetitive neck motions or heavy lifting can contribute to spondylosis.
• Injuries: Past neck injuries can make you more prone to developing the condition.

Symptoms:

Many people with cervical spondylosis do not have any symptoms. When symptoms do occur, they may include:

• Neck pain and stiffness: This is the most common symptom and may worsen with certain activities or prolonged postures.
• Headaches: Often starting at the base of the skull and radiating to the forehead.
• Limited range of motion: Difficulty turning or tilting the head.
• Grating or popping sensation: A grinding or clicking feeling when you move your neck.
• Muscle weakness or spasms: In the shoulders, arms, or hands.
• Neurological symptoms: Numbness, tingling, or weakness in the arms or hands (if the spinal cord or nerve roots are compressed).

Treatment:

Treatment for cervical spondylosis focuses on relieving pain and improving function. It usually starts with conservative measures, such as:

• Rest: Avoiding activities that worsen the pain.
• Physical therapy: Exercises to strengthen the neck muscles and improve flexibility.
• Pain medication: Over-the-counter pain relievers like ibuprofen or naproxen, or prescription medications if necessary.
• Heat or cold therapy: Applying heat or cold packs to the neck can help relieve pain and stiffness.
• Soft collar: A soft collar may be recommended to limit neck movement and allow for healing.
• Steroid injections: Injections of corticosteroids around the affected nerves can reduce inflammation and pain.

Important Note:

In more severe cases or if conservative treatments are ineffective, surgery may be considered. There are various surgical options depending on the specific cause and severity of the spondylosis.

If you are experiencing any of the symptoms of cervical spondylosis, it is important to see a doctor for a proper diagnosis and to discuss the most appropriate treatment plan for you.

What is Cervical Spinal Stenosis?

Cervical spinal stenosis is a narrowing of the spinal canal in the neck region, which can compress the spinal cord and/or nerve roots. This compression leads to a variety of symptoms depending on the severity and location of the stenosis.

Causes:

• Degenerative changes: The most common cause is wear and tear of the spine due to aging.

  This can lead to:

  • Disc degeneration: The discs that cushion the vertebrae lose water and height, putting pressure on the spinal cord.
  • Osteoarthritis: The cartilage that protects the joints wears down, leading to bone spurs that can narrow the spinal canal.
  • Thickening of ligaments: The ligaments that hold the vertebrae together can thicken and bulge into the spinal canal.
• Herniated disc: A disc that ruptures or bulges out can compress the spinal cord or nerve roots.
• Injury: Trauma to the neck can cause fractures or dislocations that narrow the spinal canal.
• Congenital stenosis: Some people are born with a narrow spinal canal.
• Tumors: In rare cases, tumors can grow within the spinal canal.
• Other conditions: Rheumatoid arthritis and Pagets disease of bone can also contribute to stenosis.

Symptoms:

The symptoms of cervical spinal stenosis can vary widely depending on the severity and location of the narrowing. Common symptoms include:

• Neck pain: This can range from a dull ache to sharp, shooting pain.
• Numbness or tingling: This can occur in the arms, hands, legs, or feet.
• Weakness: This can affect the arms, hands, legs, or feet, making it difficult to grip objects, walk, or maintain balance.
• Difficulty walking: This can manifest as an unsteady gait or a feeling of heaviness in the legs.
• Loss of balance: This can increase the risk of falls.
• Bowel or bladder dysfunction: In severe cases, compression of the spinal cord can affect bowel and bladder control.

Important Note:

It is important to note that not everyone with cervical spinal stenosis will experience symptoms. In some cases, the condition may be discovered incidentally during imaging tests for other reasons. If you are experiencing any of these symptoms, it is important to see a doctor for diagnosis and treatment.

What is Cervical Spondylotic Myelopathy (Spinal Cord Compression)?

Cervical spondylotic myelopathy (CSM) is a neck condition that arises when the spinal cord becomes compressed—or squeezed—due to the wear-and-tear changes that occur in the spine as we age. The condition commonly occurs in patients over the age of 50. Because the spinal cord carries nerve impulses to many regions in the body, patients with CSM can experience a wide variety of symptoms. Weakness and numbness in the hands and arms, loss of balance and coordination, and neck pain can all result when the normal flow of nerve impulses through the spinal cord is interrupted.

Anatomy

Your spine is made up of 24 bones, called vertebrae, that are stacked on top of one another.

The seven small vertebrae that begin at the base of the skull and form the neck comprise the cervical spine.

Cervical spondylotic myelopathy occurs in the cervical spine—the seven small vertebrae that form the neck.

Other parts of your spine include:

Spinal cord and nerves. The spinal cord extends from the skull to your lower back and travels through the middle part of each stacked vertebra, called the central canal. Nerves branch out from the spinal cord through openings in the vertebrae (foramen) and carry messages between the brain and muscles.

Spinal nerve root.

Intervertebral disks. In between your vertebrae are flexible intervertebral disks. They act as shock absorbers when you walk or run.
Intervertebral disks are flat and round and about a half inch thick. They are made up of two components:

• Annulus fibrosus: This is the tough, flexible outer ring of the disk.
• Nucleus pulposus: This is the soft, jelly-like center of the disk.

A healthy intervertebral disk (cross-section view).
Animation courtesy Visual Health Solutions, Inc.

Causes:

Cervical spondylotic myelopathy (CSM) arises from degenerative changes that occur in the spine as we age. These degenerative changes in the disks are often called arthritis or spondylosis.
These changes are normal and they occur in everyone. In fact, nearly half of all people middle-aged and older have worn disks that do not cause painful symptoms. It is not known why some patients develop symptoms and others do not.

Cervical Disk Degeneration

Bone spurs. As the disks in the spine age, they lose height and begin to bulge. They also lose water content, begin to dry out, and become stiffer. This problem causes settling, or collapse, of the disk spaces and loss of disk space height.

As the disks lose height, the vertebrae move closer together. The body responds to the collapsed disk by forming more bone—called bone spurs—around the disk to strengthen it. These bone spurs contribute to the stiffening of the spine. They may also make the spinal canal narrow—compressing or squeezing the spinal cord.

(Left) Side view of a healthy cervical vertebra and disk. (Right) A disk that has degenerated and collapsed.

Herniated disk. A disk herniates when its jelly-like center (nucleus pulposus) pushes against its outer ring (annulus fibrosus). If the disk is very worn or injured, the nucleus may squeeze all the way through. When a herniated disk bulges out toward the spinal canal, it can put pressure on the spinal cord or nerve roots.

As disks deteriorate with age, they become more prone to herniation. A herniated disk often occurs with lifting, pulling, bending, or twisting movements.

Herniated disk (side view and cross section).

Other Causes of Myelopathy:

Myelopathy can arise from other conditions that cause spinal cord compression, as well. Although these conditions are not related to disk degeneration, they may result in the same symptoms as CSM.

Rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In rheumatoid arthritis, immune cells attack the synovium, the thin membrane that lines the joints.

As the synovium swells, it may lead to pain and stiffness and, in severe cases, destruction of the facet joints in the cervical spine. When this occurs, the upper vertebra may slide forward on top of the lower vertebra, reducing the amount of space available for the spinal cord.

Injury:

An injury to the neck—such as from a car accident, sports, or a fall—may also lead to myelopathy.

For example, a "rear end" car collision may result in hyperextension, a backward motion of the neck beyond its normal limits, or hyperflexion, a forward motion of the neck beyond its normal limits. Because these types of injuries often affect the muscles and ligaments that support the vertebrae, they may lead to spinal cord compression.

Symptoms:

Typically, the symptoms of CSM develop slowly and progress steadily over several years. In some patients, however, the condition may worsen more rapidly.
Patients with CSM may experience a combination of the following symptoms:

• Tingling or numbness in the arms, fingers, or hands.
• Weakness in the muscles of the arms, shoulders, or hands. You may have trouble grasping and holding on to items.
• Imbalance and other coordination problems. You may have trouble walking or you may fall down. With myelopathy, there is no sensation of spinning, or "vertigo." Rather, your head and eyes feel steady, but your body feels unable to follow through with what you are trying to do.
• Loss of fine motor skills. You may have difficulty with handwriting, buttoning your clothes, picking up coins, or feeding yourself.
• Pain or stiffness in the neck.

Doctor Physical Examination

After discussing your medical history and general health, your doctor will ask you about your symptoms. He or she will conduct a thorough examination of your neck, shoulders, arms, hands, and legs, looking for:

• Changes in reflexes—including the presence of hyper-reflexia, a condition in which reflexes are exaggerated or overactive.
• Numbness and weakness in the arms, hands, and fingers.
• Trouble walking, loss of balance, or weakness in the legs.
• Atrophy—a condition in which muscles deteriorate and shrink in size.

Tests X-rays

These provide images of dense structures, such as bone. An x-ray will show the alignment of the vertebrae in your neck.

Magnetic resonance imaging (MRI) scans. These studies create better images of the bodys soft tissues. An MRI can show spinal cord compression and help determine whether your symptoms are caused by damage to soft tissues—such as a bulging or herniated disk.

This MRI image shows herniated disks pressing on the spinal cord (red arrows).

Reproduced from Boyce R, Wang J: Evaluation of neck pain, radiculopathy and myelopathy: imaging, conservative treatment, and surgical indications. Instructional Course Lectures 52. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2003, pp.489-495.

Computed tomography (CT) scans. More detailed that a plain x-ray, a CT scan can show narrowing of the spinal canal and can help your doctor determine whether you have developed bone spurs in your cervical spine. This CT scan shows bone spurs that have led to narrowing of the spinal canal (arrows).

Myelogram. This is a special type of CT scan. In this procedure, a contrast dye is injected into the spinal column to make the spinal cord and nerve roots show up more clearly.

Treatment Nonsurgical Treatment

In milder cases, initial treatment for CSM may be nonsurgical. The goal of nonsurgical treatment is to decrease pain and improve the patients ability to perform daily activities. Nonsurgical treatment options include:
Soft cervical collar. This is a padded ring that wraps around the neck and is held in place with velcro. Your doctor may advise you to wear a soft cervical collar to allow the muscles of the neck to rest and limit neck motion. A soft collar should only be worn for a short period of time since long-term wear may decrease the strength of the muscles in your neck.

Physical therapy

Specific exercises can help relieve pain, strengthen neck muscles, and increase flexibility. Physical therapy can also help you maintain strength and endurance so that you are better able to perform your daily activities. In some cases, traction can be used to gently stretch the joints and muscles of the neck.

Medications

In some cases, medications can help improve your symptoms.

• Nonsteroidal anti-inflammatory medications (NSAIDs):Drugs like aspirin, ibuprofen, and naproxen can help relieve pain from reduce inflammation.
• Oral corticosteroids:A short course of oral corticosteroids may help relieve pain by reducing inflammation.
• Epidural steroid injection:Although not often used to treat CSM, in this procedure, steroids are injected into the space next to the covering of the spinal cord (the "epidural" space) to help reduce local inflammation. Although a steroid injection may temporarily help relieve pain and swelling, it will not relieve pressure on the spinal cord.
• Narcotics: These medications are reserve for patients with severe pain that is not relieved by other options. Narcotics are usually prescribed for a limited time only.

Although people sometimes turn to chiropractic manipulation for neck and back pain, manipulation should never be used for spinal cord compression.

Surgical Treatment

If nonsurgical treatment does not relieve your symptoms, your doctor will talk with you about whether you would benefit from surgery. The majority of patients with symptoms and tests consistent with CSM are recommended to have surgery.

There are several procedures that can be performed to help relieve pressure on the spinal cord. The procedure your doctor recommends will depend on many factors, including what symptoms you are experiencing and the levels of the spinal cord that are involved.

Important Note:

It is important to note that not everyone with cervical Cervical Spondylotic Myelopathy will experience symptoms. In some cases, the condition may be discovered incidentally during imaging tests for other reasons. If you are experiencing any of these symptoms, it is important to see a doctor for diagnosis and treatment.

What is Cervical Vertebral Tumors?

Cervical vertebral tumors are abnormal growths that develop within the bones of the neck (cervical vertebrae). These tumors can be either primary (originating in the spine) or metastatic (spreading from other parts of the body).

Causes:

• Primary tumors:
  • Benign tumors: The discs that cushion the vertebrae lose water and height, putting pressure on the spinal cord.
  • Malignant tumors: The cartilage that protects the joints wears down, leading to bone spurs that can narrow the spinal canal.
• Metastatic tumors: : Cancer that has spread to the cervical spine from other organs, such as the breast, lung, prostate, or kidney.

Symptoms:

The symptoms of cervical vertebral tumors can vary depending on the size and location of the tumor, as well as whether it is pressing on the spinal cord or nerve roots. Common symptoms include:

• Neck pain: Often the most noticeable symptom, which can be constant or worsen at night.
• Radiating pain: Pain that spreads to the shoulders, arms, or hands.
• Neurological symptoms: Numbness, tingling, weakness, or loss of coordination in the arms or legs.
• Difficulty walking: Unsteady gait, loss of balance, or falls.
• Loss of bowel or bladder control:In severe cases.

Symptoms:

The treatment of cervical vertebral tumors depends on several factors, including the type and stage of the tumor, the patients age and overall health, and whether the tumor has spread. Treatment options may include:

• Surgery: To remove the tumor, stabilize the spine, and decompress the spinal cord or nerve roots.
• Radiation therapy: To shrink the tumor and kill cancer cells.
• Chemotherapy: To kill cancer cells, especially in metastatic tumors.
• Medications: To manage pain and other symptoms.
• Observation: For slow-growing benign tumors, monitoring may be sufficient.

Important Note:

It is important to consult with a healthcare professional for an accurate diagnosis and to discuss the best treatment options for your specific situation. Early detection and treatment are crucial for the best possible outcome.

What is Degenerative Disc Disease (DDD)?

Degenerative disc disease (DDD) of the cervical spine is a condition where the intervertebral discs in the neck wear down over time. These discs act as cushions between the vertebrae, and their deterioration can cause pain and other problems.

Causes:

The main cause of DDD is the natural aging process. As we age, the discs lose water content and become less flexible, making them more prone to damage. Other factors that can contribute to DDD include:

• Genetics: Some people are genetically predisposed to developing DDD.
• Occupation: Jobs that involve repetitive neck movements or heavy lifting can accelerate disc degeneration.
• Injuries: Trauma to the neck can damage the discs and lead to DDD.
• Poor posture: Slouching or other poor posture habits can put extra stress on the discs.

Symptoms:

In the early stages, DDD may not cause any symptoms. As the condition progresses, symptoms may include:

• Chronic neck pain: This can range from a dull ache to sharp, shooting pain, and may worsen with certain movements.
• Neck stiffness: Difficulty moving the neck, especially when turning the head.
• Headaches: Pain often starting at the base of the skull and radiating to the forehead.
• Radiating pain: Pain that spreads to the shoulders, arms, or hands.
• Numbness or tingling: In the arms or hands, especially if nerve roots are compressed.
• Muscle weakness: In the arms or hands.

Treatment:

The treatment of DDD focuses on relieving pain and improving function. It typically involves a combination of:

• Non-surgical treatments:
  • Pain medication: Over-the-counter pain relievers or prescription medications to manage pain and inflammation.
  • Physical therapy: Exercises and stretches to strengthen neck muscles and improve flexibility.
  • Hot and cold therapy: Applying heat or cold packs to the neck can provide temporary pain relief.
  • Lifestyle modifications: Maintaining good posture, avoiding activities that worsen pain, and losing weight if overweight can help.
  • Injections: Steroid injections may be recommended to reduce inflammation and pain in severe cases.
• Surgery: In rare cases where conservative treatments fail to provide relief, surgery may be necessary to remove the damaged disc and fuse the vertebrae.

Important Note:

If you are experiencing any of the symptoms of DDD, it is important to see a doctor for diagnosis and treatment. Early intervention can help prevent further damage and improve your quality of life.

What is Cervical Radiculopathy?

Commonly referred to as a pinched nerve, this condition may cause pain radiating down your legs or arms. Radiculopathy can have different names (sciatica, for example), depending on where in the spine it occurs.

Causes:

• Herniated disc: This is the most common cause, where the soft inner material of a disc pushes through the outer layer and presses on the nerve.
• Bone spurs: These are bony growths that can form due to arthritis and put pressure on nerves.
• Degenerative disc disease: As discs wear down with age, they can lose height and put pressure on the nerves.
• Injury: A sudden neck injury can cause a disc to herniate or a bone spur to form.

Symptoms:

The primary symptom is pain that radiates from the neck into the shoulder, arm, and hand. Other symptoms include:

• Numbness or tingling in the arm or hand.
• Weakness in the arm or hand.
• Loss of reflexes in the arm.

Treatment:

In many cases, cervical radiculopathy resolves on its own with conservative treatment, which may include:

• Rest: Avoiding activities that worsen the pain.
• Physical therapy: Exercises and stretches to strengthen the neck and improve range of motion.
• Pain medication: Over-the-counter pain relievers like ibuprofen or naproxen can help.
• Steroid injections: These can reduce inflammation around the nerve and provide pain relief.
• Injections: Steroid injections may be recommended to reduce inflammation and pain in severe cases.
• Surgery: In rare cases where conservative treatments fail to provide relief, surgery may be necessary to remove the damaged disc and fuse the vertebrae.

Important Note:

If you are experiencing symptoms of cervical radiculopathy, it is important to see a doctor for diagnosis and treatment. Early intervention can improve the chances of a full recovery.