Published on Feb 12, 2020 - 4 min read
Almost every one of us has suffered from neck pain once in our 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 we can divide them into spinal causes and non-spinal causes. In this article, we have discussed spinal 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 will be discussed under the following headings:
Degenerative disc disease.
Facet arthritis and facet joint syndrome.
Herniated cervical disc.
1) Degenerative Disc Disease:
Also known as cervical spondylosis. In layman words, it broadly refers to normal age-related changes in a cervical spine. It is mostly seen after the fifth decade of life. Fortunately, only 5 % 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 the age and this process progress, there is a decrease in the height of disc space, which leads to herniation of disc outside its normal space. Loss of disc height also contributes to the degeneration of facet joints (explained further) 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 C5-6 followed by C6-7 and C4-5. This degeneration may present as simple neck pain or associated occipital headache, posterior neck or shoulders or radicular pain in the arm.
The risk factors include:
High-risk occupations, such as heavy manual labor, farming, dentistry, and pilot.
A prior neck injury.
Long term participation in contact sports.
Prior cervical spine surgery.
Other associated diseases, such as ankylosing spondylitis.
Mostly, the symptoms are transient in nature and 70 to 80 % 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 (discussed later).
2) Facet Arthritis and Facet Joint Syndrome:
The cervical spine has seven vertebrae. Each vertebra is connected to one another with the joints known as facet joint. There are 2 facet joints between two vertebrae - right and left.
Facet joint syndrome is an arthritis-like condition which 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 cartilage of the joint 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 usually seen between 40 to 70 years of age.
Pain is often diffuse, dull ache at the back of the skull or shoulders.
Movements such as bending backward or twisting sideways will increase the pain.
Period 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.
Your doctor will take a proper medical history with a detailed examination of your cervical spine. X-ray or CT scan or MRI, and diagnostic facet joint injection (discussed later).
Facet joint arthritis cannot be reversed. Exercise, lifestyle changes, and careful management of your neck can contribute to a better quality of life. Self-care using proper posture and keeping your spine in alignment. You need to make adjustments in your daily standing, sitting and sleeping habits.
Physical therapy - your physical therapist will guide you with neck exercises. Regular compliance will help alleviate your neck pain.
Medications - Facet joint injection - This injection is both diagnostic and therapeutic. This injection is given in operation theatre under C-arm guidance (a kind of X-ray machine). It is given with the patient 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 >75 % of relief in pain then the diagnosis is confirmed. Also, this may be therapeutic with good and prolong 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.
3) Herniated Cervical Disc:
It is commonly known as “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) known as radiculopathy. It can also compress the spinal cord, which is known as myelopathy.
Similar to degenerated disc as mentioned before.
Loss of sensation.
Difficulty in the function of upper and lower limbs.
Bladder and bowel incontinence.
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.
Different surgical options - Anterior cervical discectomy and fusion (ACDF), laminectomy, cervical disc replacement.
The specific treatments offered vary based on patient’s anatomy, symptoms, and medical history.
Together degenerative disc disease, facet joint syndrome, and herniated cervical disc constitute most of the causes of neck pain. Other causes are rare. The rest of the causes will be discussed in detail in another article. At the end of this article, I would like to discuss various lifestyle changes that a person can inculcate in his or her lifestyle to decrease the chances of developing neck pain.
Maintain Proper Posture - this is the most essential measure in this era. Most of us are working on computers and have a desk job. So, posture plays a very important role. Keep the monitor at eye level. Sit with your back supported with backrest. Do not slouch for a longer time. Change posture every 40 to 45 minutes.
Exercise Daily - this will help you to keep your back and neck muscles in strength. WHO recommends at least 45 minutes of walking at a stretch daily is essential to keep the human body functions in good shape.
Query: Hi doctor, Five months ago, my wife had a disc herniation surgery. She was fine for the next two to three months, but again she is getting the pain. Her doctor advised us to go for repeated MRI. We are yet to meet her doctor, But, I am looking forward to know what is going on. I have attached the re... Read Full »
Query: Hello doctor, I am a 32 year old female with asthma. I have cervical disc herniation for 10 years. Over the past 5 months, symptoms were back with tingling, weakness and shooting pain in arms. I tried medications like Celebrex, Lyrica and also massage, physiotherapy, chiropractor and acupuncture, b... Read Full »
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