Spinal: Cervical

The cervical spine area is the portion of the spine that allows the neck its great mobility. It consists of 7 vertebrae composed of one disc in front and paired facet joints in the back to provide a stable base for extension. The first cervical segment is a ring that does not have a vertebral body, but is attached to the second vertebral body which acts as a post. Together, these top two segments provide the majority of the rotation in the neck.

Neck Pain
The neck is composed of 7 vertebra bones, which begin at the base of the skull and run to the upper torso. In between the bones are the shock absorbers of the spine called the discs. The bones and discs are held together with a complex series of ligaments and muscles. Because the neck is very flexible and must support the weight of the head, it is often vulnerable to injury and disorders that produce pain, decreased motion, and some times weakness or numbness or tingling in the arms. The neck is less well protected than the rest of the spine, and is vulnerable to injury from accidents, falls, lifting, or even day to day work conditions of repetitive motion.

Neck pain may result from abnormalities in the soft tissues or the bones. The most common cause of neck pain are from the soft tissues. Most often this is from the discs, or shock absorbers in the neck. These discs can degenerate or be damaged. These damaged discs can often times push against the nerves in the neck causing headaches, shoulder pain, arm pain, or weakness, and numbness.

If these symptoms persist, x-rays or MRIs (magnetic resonance imaging) may be needed to evaluate the extent of the damage of the discs or the nerve roots. X-rays will help show if there is damage or disease to the bones themselves, while a MRI is very helpful in evaluating damage to the discs and/or the nerves.

Treatment of neck pain depends on what the diagnosis reveals. Most patients are treated successfully with rest, medication, immobilization, physical therapy, exercises, activity modifications or a combination of these methods.

Sometimes these conservative treatments are not successful in treating patients with severe disease. Surgery may be required to relieve neck pain in these patients. Surgery most often is needed to reduce the pressure on the spinal cord or nerve root that is caused by herniated disc or bony narrowing of the spinal canal. Surgery my also be needed after an injury in order to stabilize the neck to minimize the possibility of paralysis such as when a fracture results in instability of the neck. Surgery usually involves removal of the disc material, which is pushing on the nerves. Once this disc material is removed, and the nerve is free, the space previously occupied by the disc, must be replaced. It is usually replaced with bone and the neck is immobilized until the bone is able to fuse together, allowing the neck to be stable once again. The results of the surgery are very good. Even so, surgery is the last option used if conservative treatments fail. Again, the majority of patients can be treated with these conservative measures successfully. The orthopedic physician can help you evaluate, diagnose and treat these conditions of neck pain successfully.

Spinal Stenosis
Spinal stenosis is a term used to describe the narrowing of the spine. This is a nature process of aging, which can be accelerated often times by damage to discs or accidents or scoliosis or other changes to the spine. The basis problem is that slowly over time, the contents of the spine are slowly compressed. This includes the spinal cord and the nerve roots, which control the legs and other organs of the body. The result is a steadily increasing back pain, which can sometimes radiate to the legs causing leg pain, or numbness or tingling. Often times, the patients notice that they develop slowly increasing weakness to the legs. The can also develop an unsteadiness with their walking. If severe enough, it can also cause bowel or bladder changes. An example of what spinal stenosis is like in the body can be compared to the plumbing in an old house. If you have ever turned on the water in an old house, you notice that it does not flow very quickly. This is because the pipes slowly become clogged over time, restricting the water flow.

The same is true for the spine and the spinal cord. Through the nature processes of aging, the spine becomes clogged, restricting the flow of the nerve roots, causing them to slowly be squeezed and thus weakening the muscles of the body and causing back pain.

The treatment of spinal stenosis begins with conservative therapy. This often will include overall exercise, activity modification, medication and some types of physical therapy. When these options fail, medicine can sometimes be injected into the back to relieve the tightness on the nerves. The results with these treatments are very good.

Sometimes, patients still become worse despite these conservative treatment measures and then surgery is necessary. Surgery involves removing the bone and soft tissue that is squeezing the nerve roots. Occasionally, the spine will also need to be stabilized because of instability that forms through the nature process of aging. The results of the surgical treatment for spinal stenosis are very good. Surgery is always used a last option.

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