Spinal Causes of Neck Pain

Introduction:

Almost everyone must have suffered from neck pain once in their lifetime. The lifestyle of people in this competitive world exposes them to many mechanical problems like low back pain and neck pain. There are various reasons for neck pain. Broadly it can be divided into spinal causes and non-spinal causes. This article discusses the spinal causes of neck pain.

What Are the Causes of Neck Pain?

Neck pain is thought to result from poor posture, faulty ergonomics, or muscle fatigue. The various spinal causes of neck pain include:

1. Degenerative disc disease.

2. Facet arthritis and facet joint syndrome.

3. Herniated cervical disc.

4. Spinal fractures.

5. Spinal deformity.

6. Spinal stenosis.

7. Spinal infection.

Some of the spinal causes are discussed below in detail.

How Does Facet Arthritis and Facet Joint Syndrome Cause Neck Pain?

The cervical spine has seven vertebrae. Each vertebra is connected to one another with the joints known as facet joints. There are two facet joints between two vertebrae - right and left.

Facet joint syndrome is an arthritis-like condition that can cause significant neck pain. It is caused by degenerative changes to the joints. The disease process is the same as “knee osteoarthritis.” There is damage to the joint's cartilage, leading to reduced smoothness during movements. As a result, the joint becomes inflamed and irritated, leading to pain. It is seen equally in both men and women and is usually seen between 40 to 70 years of age.

Symptoms:

• Pain is often diffuse and dull at the back of the skull or shoulders.

• Movements such as bending backward or twisting sideways will increase the pain.

• Periods of inactivity may worsen the pain.

• Changing positions may ease the pain.

• In rare cases, it may mimic disc herniation, and pain may travel down the arm.

Diagnosis:

The doctor will take a proper medical history with a detailed examination of the cervical spine. X-ray, CT (computed tomography) scan or MRI (magnetic resonance imaging), and diagnostic facet joint injection is usually suggested for proper diagnosis and management.

Treatment:

Facet joint arthritis cannot be reversed. Exercise, lifestyle changes, and careful management of the neck can contribute to a better quality of life. Self-care using proper posture and keeping the spine in alignment. Patients need to make adjustments in their daily standing, sitting, and sleeping habits.

• Physical Therapy - The physical therapist will guide with neck exercises. Regular compliance will help alleviate neck pain.

• Medications - Facet joint injection: This injection is both diagnostic and therapeutic. This injection is given in the operation theater under C-arm guidance (a kind of X-ray machine). It is given while the patient is awake and under local anesthesia. It is a daycare procedure, and the patient can walk home within a few hours. A mixture of local anesthesia and steroid is given in and around the joint. Pain is assessed before and after the injection. If there is more than 75 percent of relief in pain, then the diagnosis is confirmed. Also, this may be therapeutic with good and prolonged relief to the patient. It needs to be remembered that injection may help reduce pain but does not change the underlying degeneration of the spine.

How Does Degenerative Disc Disease Cause Neck Pain?

It is also known as cervical spondylosis. It refers to normal age-related changes in the cervical spine. It is mostly seen after the fifth decade of life. Fortunately, only five percent of people are symptomatic.

The disc is a gel-like substance present between two vertebrae. It has a covering around it known as annulus fibrosus. After the third decade of life, the blood supply to the disc starts reducing. Also, there is a decrease in the hydration of the disc. As a result, there is an alteration in the structural and load-bearing properties of the disc. Gradually as age and this process progress, there is a decrease in the height of disc space, which leads to herniation of the disc outside its normal space. Loss of disc height also contributes to the degeneration of facet joints and other structures in the cervical spine, contributing to neck pain.

Degenerative changes can be present at all levels of the cervical spine, but the most common is at the C5-6 level, followed by C6-7 and C4-5. This degeneration may present as simple neck pain or associated occipital headache, posterior neck or shoulder, or radicular pain in the arm.

The Risk Factors Include:

• Genetic predisposition.

• High-risk occupations, such as heavy manual labor, farming, dentistry, and pilot.

• Nicotine abuse.

• A prior neck injury.

• Long-term participation in contact sports.

• Prior cervical spine surgery.

• Other associated diseases, such as ankylosing spondylitis.

Treatment:

Mostly, the symptoms are transient in nature, and 70 to 80 percent of patients respond to conservative management with pain medications, anti-inflammatory drugs, and physiotherapy. Patients not responding to conservative management may require other invasive forms of treatment.

How Does Herniated Cervical Disc Cause Neck Pain?

It is commonly known as a “bulging disc” or “ruptured disc.” It is a common cause of neck pain or arm pain. The herniated disc can compress the nerve (arising from the spinal cord), which is known as radiculopathy. It can also compress the spinal cord, which is known as myelopathy.

Symptoms:

Symptoms include:

• Loss of sensation.

• Weakness in upper or lower limbs.

• Difficulty in the function of upper and lower limbs.

• Bladder and bowel incontinence.

Treatment:

Most patients respond to conservative management, which includes medications and physiotherapy. In cases of intractable pain not responding to conservative management or if there is a motor weakness, then surgery is essential. Neck pain due to spinal causes can be treated with various surgical options, such as anterior cervical discectomy and fusion (a surgical procedure involving the removal of the damaged disc), laminectomy (a surgical procedure that involves removing a part of the vertebra called the lamina), and cervical disc replacement.

What Lifestyle Changes Can Help Reduce Neck Pain?

There are various lifestyle changes that a person can inculcate in his lifestyle to decrease the chances of developing neck pain.

• Maintain Proper Posture - This is an essential measure in this era. Most people work on computers and have desk jobs. So, posture plays a very important role. Keep the monitor at eye level. Sit with the back supported with a backrest. Do not slouch for a longer time. Change posture every 40 to 45 minutes.

• Exercise Daily - This will help people to keep their back and neck muscles in strength. WHO (World Health Organization) recommends at least 45 minutes of walking at a stretch daily is essential to keep the human body functioning in a good shape.

Conclusion:

Neck pain is one of the common types of body pain, but sometimes the cause can be serious conditions that may require surgical treatments. Degenerative disc disease, facet joint syndrome, and herniated cervical disc together constitute most of the causes of neck pain. Other causes are rare. The specific treatments offered vary based on the patient’s anatomy, symptoms, and medical history.