Your neck is part of a long flexible column, known as the spinal column or backbone, which extends through most of your body. The cervical spine (neck region) consists of seven bones (C1-C7 vertebrae), which are separated from one another by intervertebral discs. These discs allow the spine to move freely and act as shock absorbers during activity.
Attached to the back of each vertebral body is an arch of bone that forms a continuous hollow longitudinal space, which runs the whole length of your back. This space, called the spinal canal, is the area through which the spinal cord and nerve bundles pass. The spinal cord is bathed in cerebrospinal fluid (CSF) and surrounded by three protective layers called the meninges (dura, arachnoid, and pia mater).
At each vertebral level, a pair of spinal nerves exit through small openings called foramina (one to the left and one to the right). These nerves serve the muscles, skin and tissues of the body, and provide sensation and movement to all parts of the body. The delicate spinal cord and nerves are further supported by strong muscles and ligaments that are attached to the vertebrae.
Neck pain may be caused by disc degeneration, narrowing of the spinal canal, arthritis, and in rare cases, cancer or meningitis. For serious neck problems, a neurosurgeon should be consulted to make an accurate diagnosis and prescribe treatment.
You should consult a neurosurgeon for neck pain if:
- It occurs after an injury or blow to the head
- Fever or headache accompanies the neck pain
- Stiff neck prevents you from touching your chin to your chest
- Pain shoots down one arm
- There is tingling, numbness or weakness in our arms or hands
- Neck symptoms are associated with leg weakness or loss of coordination in arms or legs
- Your pain does not respond to over-the-counter pain medication
- Pain does not improve after a week
Age, injury, poor posture or diseases such as arthritis can lead to degeneration of the bones or joints of the cervical spine, causing disc herniation or bone spurs to form. Sudden severe injury to the neck may also contribute to disc herniation, whiplash, blood vessel destruction, vertebral injury and, in extreme cases, permanent paralysis. Herniated discs or bone spurs may cause a narrowing of the spinal canal or the small openings through which spinal nerve roots exit.
Pressure on a nerve root by a herniated disc or a bone spur may result in:
- Pain in the arm and neck
- Numbness or weakness in the arm or forearm
- Tingling in the fingers or hand
Pressure on the spinal cord in the cervical region can be a very serious problem because virtually all of the nerves to the rest of the body have to pass through the neck to reach their final destination (arms, chest, abdomen, legs). This can potentially compromise the function of many important organs.
Diagnosis is made by a neurosurgeon based on your history, symptoms, a physical examination and results of diagnostic studies, if necessary. Some patients may be treated conservatively and then undergo imaging studies if medication and physical therapy are ineffective. Tests may include:
- CT scan
- Electromyography (EMG)
- Nerve conduction studies (NCS)
- Selective nerve root block
Determining a treatment strategy depends mainly on identifying the location and cause of the irritated nerve root. Although neck pain can be quite debilitating and painful, nonsurgical management can alleviate many symptoms. Your doctor may prescribe medications to reduce the pain or inflammation, and muscle relaxants to allow time for healing to occur. Reducing physical activities or wearing a cervical collar may help provide support for the spine, reduce mobility and decrease pain and irritation. Trigger point injections, including corticosteroids, can temporarily relieve pain. Occasionally, epidural steroids may be recommended. Conservative treatment options may continue for up to six or eight weeks.
There are several surgical treatments available to treat cervical spine disorders. Factors that help determine the type of surgical treatment include the specifics of your disc disease, and the presence or absence of pressure on the spinal cord or spinal nerve roots. Other factors include your age, how long you have had the disorder, other medical conditions you have and whether you have had previous cervical spine surgery.
When conservative treatment for low back pain does not provide relief, surgery may be needed. You may be a candidate for surgery if:
- Conservative therapy is not helping
- You experience progressive neurological symptoms involving your arms and legs
- You experience difficulty with balance or walking
- You are otherwise in good health
We offer several different surgical procedures, the choice of which is influenced by the severity of your condition. In a small percentage of patients, spinal instability may require spinal fusion, which creates a solid union between two or more vertebrae. Screws or plates may be used to enhance fusion and support unstable areas of the cervical spine. This procedure may assist in strengthening and stabilizing the spine and may thereby help to alleviate severe and chronic neck pain.
The benefits of surgery should always be weighed carefully against its risks. Although a large percentage of neck pain patients report significant pain relief after surgery, there is no guarantee that surgery will help every individual.
Source: American Association of Neurological Surgeons