Neck Pain

Cervical or neck pain as it is frequently referred to, is a common complaint of which there are a variety of different causes. Disorders affecting the cervical region of the spine may result in either localised or referred pain. Localised pain is felt at the source of the problem, whereas referred pain radiates away from the source, to other parts of the body.

Common Causes

Spondylosis

Cervical Spondylosis describes a range of symptoms that are a result of the effects of wear and tear to the neck – typically associated with the ageing process. When the balance of the body’s natural wear and repair cycle is lost, cervical spondylosis may occur.

Disc Related Problems

Intervertebral discs serve to separate the spinal vertebrae, preventing them from grinding against one another, as well as acting as shock absorbers when the body is moving.

As we age, the gel like substance in the interior of the discs begins to dry out, causing them to shrink – cracks and tears on the disc’s tough outer layer are more likely to occur, allowing the gel like substance to seep out of the disc’s interior and encroach on nearby nerve roots exiting the spinal cord. Compression of these nerves, regardless of the location in the spine, can result in severe pain.

Disc pain in the cervical region may be localised or referred pain and both types can be associated with headaches. Localised pain is present in the side of the neck and often at the back of the neck. Sometimes lower cervical discs refer pain to the scapula or shoulder blade.

Referred pain occurs when a disc is prolapsed and a nerve root is being irritated, pain radiates in the distribution of supply of the nerve root, e.g. to the shoulder, if the C5 nerve is involved, or further down the arm to the hand, with lower nerve roots.

Inflamed Facet Joints

Facet joints are small joints at each segment of the spine between the vertebrae, they allow the vertebrae to move smoothly, enabling movement and flexibility in the back. Irritation to the facet joint in the cervical region may result in pain and stiffness – causing difficulties when turning the head because of pain or restriction.

Bone Spurs

The degeneration of the joints in the cervical region can lead to the growth of bony spurs (osteophytes). The excessive bone growth in itself is not usually painful, however, if it impinges on exiting nerve roots from the spinal cord or growth is sufficient to compress the spinal cord causing spinal stenosis, painful symptoms are likely.

Whiplash

Sudden impact usually caused by a car accident, over stretches tendons and ligaments in the neck, causing reduced, painful movement and headaches.

Red Flag Indicators

Neck pain accompanied by any one of the symptoms below, may be an indicator of a more serious underlying cause such as cancer or infection

  • lack of coordination
  • problems walking
  • bladder/bowel control
  • unexplained weight loss
  • high temperature/fever

Other

Other causes of chronic neck pain may be the result of the following

  • general poor posture
  • extended periods of sitting at an office desk
  • poor ergonomics
  • driving a vehicle for extended periods of time
  • incorrect sleeping positions
  • sleeping on a soft mattress with high pillows
  • weight lifting or other exercises that are strenuous for the neck

neck pain

Diagnosis

This is made from the history and tests – MRI and SPECT CT. Sometimes an X-ray is needed, this is not however, usually a first line investigation.

Treatment

The chosen method of treatment will depend on the cause and the results of the tests, in particularly the SPECT CT scan.

If facet joints are affected then radiofrequency denervation is very effective and can abolish the pain for many years.

If discs are seen on the SPECT CT to be inflamed, or prolapsed, then transforaminal root blocks with steroid can be very effective.

Other forms of treatment include physiotherapy and pain medication.

For the risks involved in these treatments see here.

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