By Dr. Melissa Macias, MD PhD, South Texas Brain and Spine Center
There are many causes of neck pain, from simple muscle tension or spasm to more complex degenerative cervical spine disease. The cervical spine is the spine component of the neck and consists of 7 bones or vertebrae. The first two have unique anatomy and are called the axis and the atlas; together they comprise the axial cervical spine that articulates with the base of the skull to support the head. The remaining 5 vertebrae are collectively called the sub-axial cervical spine and they all have similar anatomy; articulating together to protect the spinal cord and the spinal nerves and to provide structure and support in the neck area.
Muscle tension or strain may occur with poor posture habits, work, prolonged sitting or inactivity or a plethora of reasons in day to day living. Though quite uncomfortable, this is usually not serious and may be effectively treated with stretching, massage therapy or over the counter pain relief medications such as acetaminophen or ibuprofen.
More serious is neck pain due to degenerative changes in the spinal column. Degenerative conditions are changes that occur to the bone, disc , facet (joint) and ligamentous structures. As the discs wear down and loose water and collagen content, strain is put on surrounding structures which in turn begin to alter as well. Common changes include loss of disc height, disc bulging, osteophyte growth also called bone spurs, facet (joint) arthropathy, and thickening of the ligaments. As these changes occur they may cause narrowing around the spinal cord or spinal nerves causing neurological symptoms and pain.
When the center canal is narrowed this is a condition called central cervical stenosis and often leads to compression of the spinal cord resulting in neurological changes called myelopathy. Symptoms of myelopathy include:
- Difficulty with fine motor movements of the hands, ie clumsiness
- Changes in writing abilities
- Heaviness or stiffness in the arms with weakness
- Gait imbalance
- Bowel or urinary changes
- May or may not have neck and/or upper extremity pain or numbness
This condition is quite serious and if not treated may lead to permanent neurological deficit or functional loss. Surgical treatment to decompress and relieve the pressure from the spinal cord is usually required.
When the narrowing occurs laterally rather than centrally, impingement of the spinal nerve may result in shooting pain down the arm. This type is pain is called radiculopathy as it “radiates” away from the neck into the arms. Two spinal nerves exit at each level from both sides of the spinal cord to go into the left and right arm, therefore symptoms may be uni- or bilateral depending on whether the lateral narrowing is uni- or bilateral. Symptoms of lateral nerve impingement include:
- Neck pain, stiffness
- Radicular pain –often described as shooting electric type pain down the arm or hand
- Numbness of the afflicted arm/hand
- Tingling or hypersensitivity
- Weakness, clumsiness
- Pain elicited with certain neck movements
This condition may also lead to permanent neurological damage resulting in deficit if not treated, but if caught early can often be treated with nonsurgical care. However, if weakness is present then surgical decompression may be required to prevent further loss of strength.
Neck pain from degenerative changes in the spine, commonly thought of as arthritis of the spine, may occur alone or accompanied by the above symptoms. Neck pain due to these changes can also alter the curvature of the cervical spine leading to more strain on the supportive anatomical areas such as muscles and tendons. In this fashion it can become a vicious cycle until identified and treated.
Non-surgical treatment options consist primarily of :
- Physical Therapy—which may include stretching, traction, electrical stimulation, ultrasound treatment.
- Pain management with non-steroidal anti-inflammatory medications/muscle relaxants
- Massage therapy
- Correcting ergonomics of work/home environment
- Steroid or analgesic Injections
Often, the treatments above either alone or in some combination may effectively treat neck pain. It is important to identify the cause and source of the pain if it is present for greater than 6 weeks, progressively worsening, or associated with radicular or myelopathic symptoms as described above.
As always, talk with your doctor if you experience neck pain issues so that the appropriate studies such as Xrays, CT scan or MRI can be ordered to best evaluate your condition.
Wishing you good spine health!
For more information on Dr. Melissa Macias’ practice please call 361.356.4683 or visit drmelissamacias.com.