Neck pain
Cervical spine degeneration
Cervical radiculopathy
Cervical myelopathy
NECK PAIN:
Cervical spine is the most mobile part of the spine. It also supports the weight of the skull. Hence, it can be vulnerable to degeneration and injury resulting in pain and /or stiffness. While neck pain is a common symptom that affects most people at some point in their lives, fortunately for most people it is a temporary condition that gets better with time.
As with back pain, there are multiple potential sources of neck pain (spinal and non-spinal). Causes of neck pain include:
- Degenerative disc disease and/or facet joint degeneration
- Disc herniation
- Injury / trauma
- Infection
- Tumours
- Inflammatory conditions such as rheumatoid arthritis and ankylosing spondylitis
- Pain referred from outside the spine (shoulder, head and neck or muscular)
As in the lumbar spine, some of these conditions can be serious and warrant an urgent attention. Clinicians look for the “Red Flags” to help them determine whether this pain is due to a serious underlying condition.
Red Flags:
- Age under 16 or over 50 with new onset pain
- Feeling unwell, unexplained weight loss
- Unexplained fevers
- Past history of cancer or recent serious illness
- Widespread neurological deficit e.g. weakness in the limbs, bladder/bowel dysfunction
- Pain that is non-mechanical (not related to movement, occurs at rest)
- Pain that is worse at night
- New onset spine deformity
- History of significant trauma
- Failure to improve with treatment
Red Flags necessitate urgent consultation with a spinal surgeon and an MRI scan on an urgent basis.
CERVICAL SPINE DEGENERATION:
This is wear and tear process affecting the cervical spine and is also known as cervical spondylosis. It starts by the discs losing the water content and becoming stiffer. As the disc degenerate, they lose their height. This puts more pressure on the facet joint at the back of the spine, which in turn, they also degenerate and gradually become arthritic.
Cervical spine degeneration is very common and is considered part of the natural aging process. Luckily, the majority of people with cervical spondylosis are asymptomatic. However, some would complain of neck pain and a smaller percentage would complain of symptoms of nerve entrapment.
- Peripheral nerves going down the arms, giving rise to arm pains (also known as radiculopathy)
- Spinal cord, giving rise to a condition called cervical myelopathy
CERVICAL RADICULOPATHY:
Overview: This is compression or irritation of the cervical nerve roots. This can be caused by a herniated intervertebral disc or impingement because of degenerative changes. Other causes such as trauma, infection and tumours should also be excluded. The standard investigation is an MRI scan of the cervical spine. Occasionally, nerve conduction tests are required.
Clinical Picture:
- Neck pain
- Shoulder or arm pain
- Pain that can radiate down toward the hands
- Pins and needles or numbness
- Weakness in the arm or hand
- Non-operative measures: pain killers and physiotherapy usually help. By three months, around 85% of patients would have improved. Studies have shown that the prolapsed disc reduces in size over time spontaneously.
- Nerve root injections: This is a mixture of steroids and local anaesthetic, injected around the compressed nerve root in the neck. This procedure is usually performed by the radiologist where they use an x-ray machine or a CT scan to guide the injection. This settles the inflammation and reduces the pain. However, the duration of pain relief is unpredictable.
- Surgery: This is to remove the structures impinging on the affected nerve root in the neck, and commonly fusing the level affected. This can be achieved from the front or the back of the neck, depending on the condition. Like with any surgery, there are risks associated. This can be discussed in details during the consultation.
CERVICAL MYELOPATHY:
Overview: This is a clinical condition caused by compression of the spinal cord in the cervical spine. This can lead to some damage to the spinal cord and loss of some of its function. This is usually a progressive condition and can lead to significant disability.
The pressure on the spinal cord can be caused by a variety of causes. These include a herniated intervertebral disc, cervical spine degeneration leading to spinal canal stenosis, cervical spine trauma, cervical spine infection or tumours.
MRI scan is the first investigation of choice. CT scan of the cervical spine can be helpful in identifying the cause (particularly in trauma), and can also help during planning for surgery.
Clinical picture:
- Tingling and/or numbness in the arms or hands
- Weakness in the arms or hands
- Difficulty in the fine motor function if the hands such as doing buttons, using keys or writing
- Gait and balance problems
- Loss of coordination
- Neck stiffness and pain
- Occasionally patients complain of occipital headache and scalp pain
- Loss of bladder or bowel control
- Increased reflexes on examination
Treatment: The majority of cervical myelopathy patients will require surgery. The main aim of surgery is to halt the progression of the condition to stop it from getting worse. This is by treating the underlying cause of the spinal cord compression. Surgery can be anteriorly (from the front of the neck) or posteriorly (from the back of the neck), and usually involves spinal fusion. The surgery can be discussed in details at the consultation.