The neck, also referred to as the cervical spine, is comprised of 7 bones, known as vertebrae, which stack on top of each other and connect the head to the rest of the body. They protect the spinal cord, which runs through the vertebra. There are pairs of nerves which come out from the spinal cord and run between the vertebra. Also between the vertebra, there are discs which cushion each bone and provide some shock absorption. There are several conditions that can cause neck pain that involve many of the above named structures. While this list is not exhaustive, it includes the more common, treatable causes of neck pain.
Have you ever woken up from sleep with neck pain or turned your head to the side which resulted with pain? Have you ever been involved in an accident or injury where your head was suddenly thrown forward, backward or to the side? These are all very common causes of neck strains. This causes pain because a movement or sustained position of the neck causes damage to the tendons and musculature. Since there are several muscles that surround the neck, this pain can present in several ways. It can be present in the front, back or sides of the neck with pain sometimes down the back or into the shoulders. It is usually described as an aching pain and may or may not have localized swelling and stiffness. Often, these types of injury will resolve with rest, over the counter anti-inflammatory medications and time to allow for the damaged tissues to heal. This may take 6-12 weeks or more. Other modalities, such as massage or physical therapy can be used to help with the pain and discomfort. These injuries are benign and do not require surgical intervention.
Cervical Disc Herniation
Sometimes, when an injury occurs from a fall, hyperextension or lifting, this can put abnormal pressure on the discs that cushion the neck. The abnormal pressure can cause damage to the discs, causing the outer coating to tear and the inner material of the disc to come out. This is what is known as a herniation. Unlike a disc bulge where the inner disc material stays within the disc, a hernation causes the material to place pressure against the spinal cord or nerves which causes pain. A herniation can present as neck pain with or without pain radiating down one or both arms, arm weakness, arm numbness, headaches, and, if severe enough, lower body weakness as well. A disc herniation is often found on MRI after a physical exam determines that there are findings suggestive of a disc problem. Disc herniations may get better on their own given activity modification and time, but sometimes more aggressive intervention is necessary. This could include physical therapy, cervical injections as administered by a pain management physician, or surgical intervention. The surgery to correct this would include removing the herniated disc material from the nerve or spinal canal and replacing the damaged disc with a prosthetic device. By doing this, it allows for the vertebrae above and below the damaged disc to fuse together. This is known as an ACDF (anterior cervical discectomy and fusion). It is performed through the front of the neck, allowing access to the cervical discs. This requires an overnight stay in the hospital, the use of a soft cervical collar (or hard if there are more than one herniation) to limit neck motion and limited lifting and overhead reaching for a period of time. Serial x-rays are employed to insure healing of the fusion.
There are some instances when neck pain develops and there was no injury to explain what happened. In this case, a condition known as spinal stenosis may be involved. Cervical spinal stenosis is when the canal in which the spinal cord passes becomes narrowed, causing pressure on the spinal cord and nerves. When this compression occurs, it often causes pain in the neck, but can also transmit pain down the arms (one or both). It can cause numbness, arm weakness and in extreme cases leg weakness too. Stenosis is most often caused by degeneration of the vertebra in the discs and joints, known as the facets. This is often a slow developing, progressive condition which becomes worse with time. In order to diagnose spinal stenosis, a thorough exam needs to be done and testing, such as an MRI should be ordered. The MRI will help determine the region where the narrowing is occurring and if it is affecting the spinal cord, nerves or both. Once spinal stenosis is diagnosed, there are a variety of treatments that can be employed. For early spinal stenosis, physical therapy may be useful to help lessen symptoms and maintain neck mobility. As the condition progresses, options that can be considered include cervical injections, as performed by a pain management physician, and surgical intervention. Surgery most often entails an ACDF (anterior cervical discectomy and fusion). In this case, this would involve decompression of the spinal canal and nerves not from a herniated disc, but instead from the bony overgrowth of the vertebra. It still involves removing the disc so the spinal canal can be accessed, and is done through the front portion of the neck. A prosthetic will be placed to replace the disc (or discs if this involves several levels). It requires an overnight stay in the hospital, use of a cervical collar (hard or soft) to limit neck motion, and a period of limited lifting and overhead reaching. If the stenosis is very severe and involves several levels, a posterior approach fusion may need to be utilized to decompress the spinal cord and nerves. This is done through the back of the neck and instead involves rods and screws to fuse the neck. This is a more extensive surgery which will require possibly 1-2 days in the hospital and use of a hard cervical collar. This type of fusion is not often required, but is occasionally necessary for an acceptable decompression.
Cervical Degenerative Disc Disease
Cervical Degenerative Disc Disease is another term used for arthritis of the neck. This is where the cushioning discs between the vertebrae become less effective at doing their job as cushions. This causes them to decrease in height and allows for the vertebra in some cases to rub together and develop bone spurs. This often occurs as the result of age, use and injury. It can also occur in the discs above and below areas of prior surgeries due to the alteration of force placed on these discs. Unfortunately, disc degeneration often worsens over time instead of getting better. The typical symptoms include pain and stiffness of the neck, but can in some instances cause pain and numbness in the arms. Diagnosis is made using thorough examination and x-rays of the neck. Occasionally, MRI and CT are used, but are not necessary in all cases. Often medication, physical therapy and injections with a pain management physician can help ease the pain. In more extreme cases, surgery can be utilized. This would involve an ACDF (anterior cervical discectomy and fusion) to remove bone spurs and heighten the discs that have collapsed. This can be recommended if there is disease at one or two levels, but is less advised if the degeneration is throughout the entire neck. Surgery requires an overnight stay in the hospital, use of a cervical collar (hard or soft) to limit neck motion, and a period of limited lifting and overhead reaching while the fusion heals. It is still possible for arthritis to form above and below the surgery, however, so the risks and benefits have to be carefully weighed before proceeding.
This information, while extensive, is not an all inclusive list of all issues that can cause neck pain. It is simply a guide to give you an idea of some more common neck problems. If you have pain in your neck, it is best to seek medical attention to properly diagnose your issue. This will include a comprehensive review of history and examination as well as appropriate imaging studies to help us determine the diagnosis and best treatment options in your case.