The neck (or cervical spine) performs a very important function of supporting the head and allowing full motion of the head and allowing full motion of the head and neck; therefore, the delicate spinal cord must be protected from external trauma.
The neck consists of seven pieces of bone (vertebra) with a soft cushion (disc) between each of them. Every time you move the neck, these vertebral and disc work in sync to allow movement. Muscles of your upper back as well as your shoulders are attached to these bones.
There are many common causes to neck ache and pain, and if serious, there are several treatment options that one can consider.
Causes to Neck Pain
Degeneration (or Spondylosis)
This refers to the wearing out of the intervertebral disc that acts as cushions between the individual neck bones. When the disc wears out, it cannot support the neck as well as it used to. The body then tries to repair this by forming extra bone to act as supports and these are known as bone spurs (osteophytes). It is these bone spurs that cause compression on the nerves and spinal cord resulting in some of the more severe symptoms such as difficulty in walking or loss of control of the bladder or bowel.
Disc Prolapse
When the disc wears out, it can also protrude outwards and it is this herniated disc that results in the sharp arm pain sometimes experienced by sufferers of acute disc prolapse. This may also cause tingling in the arms and hands. In more severe cases, there is weakness in the arms and fingers.
Inflammation
This refers to conditions like rheumatoid arthritis. This inflammatory condition affects the fingers as well as other big joints like the knee joint. In the neck, it usually affects the upper cervical spine resulting in loss of stability and pain.
Postural Causes
This is the most common cause of neck pain. Prolonged bent postures of the neck in an unnatural position such as falling asleep on the sofa or prolonged working on computer (especially on laptops) with the neck bent forward.
Traumatic Injuries
This can range from minor sprains to severe injuries as in whiplash injuries in car accidents.
Other Rare Causes
This can include infection, tumours and congenital abnormalities.
When it becomes serious
So when do you see a doctor? For most of the time, the pain is self-limiting, meaning it will reduce over time with simple medications like paracetamol or NSAIDs (non-steroidal anti-inflammatory drugs), and simple stretching exercises.
However, it can become serious if you have one or more of these symptoms:
Weakness
When there is nerve compression with damage to the nerve fibres, and if left untreated, paralysis may occur and can be permanent.
Numbness or Tingling
Occasional numbness that lasts for a short period may be a sign of early nerve pressure. If the numbness is persistent, it means nerve damage has taken place and muscle weakness will soon follow.
Loss of Bladder and Bowel Control
This is very serious and this warrants immediate admission to hospital and surgery. The presence of sudden incontinence means severe spinal cord or root compression that if left untreated, will result in total and permanent paralysis.
Persistent Pain on Neck Movement
The pain from neck sprains usually lasts from several days to one week. If the pain persists in severity and worsens over time, especially if it is associated with a fall or accident, there may be an undiagnosed neck fracture.
The Next Step
The doctor would need to exclude serious conditions that can cause permanent damage. He would go through the patient’s history and perform an examination to determine the state of the spinal cord and nerves.
X-rays
This is simple and cheap, but yields limited information. It is used to look for the presence of fractures and misalignment of the spine.
CT Scans
This is a good tool for looking at bony details but does not give sufficient information on the disc and spinal cord. This is usually reserved for those with metallic implants like pacemakers who can’t have MRIs.
MRI (Magnetic Resonance Imaging)
This is the preferred imaging modality as it provides a good view of the nerve roots and spinal cord, together with any prolapsed disc or tumours.
Conservative Treatment Options Include:
Rest
Use of a collar for a few days to reduce motion.
Simple Analgesia
Like paracetamol, NSAIDs or the newer COX2 inhibitors.
Exercises
Stretching and strengthening.
Hot Packs
Modification of Lifestyle
Physiotherapy
Surgery Options for the Cervical Spine Include:
Surgery is sometimes needed when the above methods fail to provide relief or when there is danger or permanent nerve or spinal cord damage.
Fusion
A procedure where the damaged disc is removed and bone or a cage is inserted between the vertebras. This relieves the pressure on the nerve and spinal cord but it also increases the stress to disc above and below the operated level.
Arthroplasty (Artificial Spinal Disc)
This is a newer approach where after the disc is removed, an artificial metallic disc is inserted. This performs the same function as the disc by allowing motion at the operated level and reduces the damage to the adjacent discs.
Laminectomy / Laminoplasty
This is a time-tested way to reduce pressure on the spinal cord over a large area by removing part of the bone. This surgery is performed from the back of the neck.
Facet Blocks and Radio Frequency (RF) Neurotomy
This is a minimally-invasive technique to reduce neck pain where a fine needle is inserted from the side of the neck. Then using RF, it reduces the pain signals coming from the facet joints. These joints are the small joints at the back of the neck and they will undergo increased stress when the disc starts to wear out. With this increased stress, muscle spasms and persistent aching pain the neck will start.
Disc Nucleoplasty
This is one of the latest minimally-invasive methods to treat mild prolapsed disc and neck pain caused by disc degeneration. It involves using coblation (controlled ablation using RF waves) technology to remove disc material. This removes a part of the disc and reduces the pressure inside the disc, It also encourages the formation of new collagen to repair the disc.
In Conclusion
It is important to take good care of the neck by having proper posture in the way we sit, work and play. Once degeneration starts, it is not reversible. The good news is if we start taking proper care, the degeneration can be slowed down and it may be years before any intervention may be needed.
Prevention Tips
When working on a computer or laptop, the screen should be as close to eye level as possible. There are notebooks stands you can use to elevate the screen of the laptop computer. If your work requires you to sit at a desk and stare at the monitor for long hours, you can reduce the neck problems by moving your neck (side to side, forwards and backwards in gentle movement) as well as rotating your shoulders will help loosen your neck and shoulder blade muscles and prevent muscle spasms.
With the increased use of iPad and other handheld devices, it is important to bring these devices up the face rather than to keep the head bent forwards. Resting the elbows on the table will allow you to hold the devices up for longer periods.
