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What Is Neck Pain (Cervical Pain)? The cervical spine is a marvelous and complex structure. It is capable of supporting a head weighing 15 or more pounds while moving in several directions. No other region of the spine has such freedom of movement. This combination however, complexity and mobility, make the neck susceptible to pain and injury.
This complex structure includes 7 small vertebrae, intervertebral discs to absorb shock, joints, the spinal cord, 8 nerve roots, vascular elements, 32 muscles, and ligaments.
The nerve roots stem from the spinal cord like tree branches through foramen in the vertebrae. Each nerve root transmits signals (nerve impulses) to and from the brain, shoulders, arms, and chest. A vascular system of 4 arteries and veins run through the neck to circulate blood between the brain and the heart. Joints, muscles, and ligaments facilitate movement and serve to stabilize the structure.
Neck mobility is matchless. It is capable of moving the head in many directions: 90° of flexion (forward motion), 90° of extension (backward motion), 180° of rotation (side to side), and almost 120° of tilt to either shoulder.
The causes of neck pain are as varied as the list is long. Consider a few examples:
Osteoarthritis is a common joint disorder causing progressive deterioration of cartilage. The body reacts by forming new bone termed osteophytes (bone spurs) that impact joint motion.
Spinal stenosis causes the foramen, small neural passageways, to narrow possibly compressing and entrapping nerve roots. Stenosis may cause neck, shoulder, and arm pain and numbness when these nerves are unable to function normally.
Degenerative disc disease (DDD) can cause the intervertebral discs to become less hydrated, resulting in decreased disc elasticity and height. Over time, a disc may bulge or herniate causing upper extremity pain, tingling, and numbness.
Obtaining a proper diagnosis is paramount to determine the best course of treatment for neck pain. You have to know what spinal condition is causing your neck pain before you can know how to treat it.
The physician will take the your medical history. The oral segment of the examination often includes many questions such as:
A physical examination includes observing the your posture, range of motion, and physical condition. Any movement generating pain is carefully noted. The physician will palpate or feel the curvature of the spine, vertebral alignment, and detect muscle spasm.
The neurological examination tests the patient’s reflexes, muscle strength, sensory and/or motor changes, and pain distribution.
Radiographic studies may be ordered. An x-ray can reveal narrowing of disc space, fracture, osteophyte formation, and osteoarthritis. Bulging discs and herniations, often responsible for neurologic symptoms, are detected using MRI.
If nerve damage is suspected, the physician may order a special test to measure how quickly nerves conduct impulses. These tests are termed nerve conduction studies and/or electromyography. Typically these studies are not performed immediately because it may take several weeks for nerve impairment to become apparent.
Daily life (and night life) can take its toll on your neck. You may have slept wrong last night, causing your neck muscles to tighten. The best thing to do is give your body time to heal on its own. To get through the day without letting the pain interfere with your normal activities, you have a few options.
Most patients with neck pain respond well to non-surgical treatments (such as medication), so cervical spine surgery is seldom needed to treat it. In fact, less than 5% of neck pain patients need surgery. However, there are situations when you may want to go ahead with spine surgery.
Generally, surgery is done for degenerative disc disease, trauma, or spinal instability. These conditions may put pressure on your spinal cord or on the nerves coming from the spine.
Read an article focused on cervical spine surgery.
Typically, surgeons use 2 surgical techniques for cervical spine surgery.
There are different types of decompression procedures such as discectomy, corpectomy, and TransCorporeal MicroDecompression (TCMD).
Your surgeon will determine what’s best for your condition.
Stabilization surgery is sometimes—but not always—done at the same time as a decompression surgery. In some forms of decompression surgery, the surgeon may need to remove a large portion of the vertebra or vertebrae. That results in an unstable spine, meaning that it moves in abnormal ways, and that puts you more at risk for serious neurological injury. In that case, the surgeon will restabilize the spine. Commonly, this is done with a fusion and spinal instrumentation, or implantation of an artificial disc.
Some patients are at high-risk for poor bone healing or unsuccessful fusion. Smoking and diabetes are two of several risk factors that impede bone healing and fusion. A bone growth stimulator may be recommended and prescribed for patients with certain risk factors.
Less than 5% of neck pain patients will need surgery, and there are a lot of options for you to try before surgery.
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