Neck of an individual does the job of holding an individual's head high in the society. Because neck bears the weight of head all throughout the life of an individual, one can imagine the stress over neck. Neck does this job with support of various ligaments, muscles, bones and other structures. Apart from holding the head, it also participates in various movements of the head like bending to and fro and sideward. It acts as a conduit between head and other parts of the body like chest and extremities. Various vascular and neural structures pass from great vessels and spinal cord respectively to different parts of body. The food pipe (oesophagus) and windpipe have attachments in neck. The spinal cord passes from brain to chest through a bony tunnel formed by spinal canal in the neck. The neural structures are protected from injuries by ligaments and muscles.
The cervical disc is similar to the thoracic and lumbar discs in the early decades of life; however in the third decade onwards, fissures (cracks) appear and gradually extend to become confluent across the disc by the sixth and seventh decades. The cervical spinal nerves after arising from the spinal cord pass through the intervertebral foramen before emerging in the neck to form various branches. |
 |
The nerve root can be compressed as soon as it emerges from the spinal cord before it enters the intervertebral foramen, by the intervertebral disc. This compression can occur because of either disc herniation or some other pathological process. In the cervical spine, the disc herniation occurs 60% to 75% at C6,7 and 20% to 30% at C5,6.
This herniation can happen following injury, accident or sudden abnormal movements of neck like forceful manipulation. Depending on the compressed root, the symptoms manifest accordingly as mentioned. All these patients complain of aggravation of pain by hyperextension. The lateral and rotation movements are often restricted by pain.
Unlike lumbar discs, the cervical disc herniation can lead to compression of spinal cord if the disc prolapse is a larger one. If a patient complains of vague pains in leg, it is worth keeping cervical pathology in mind.
|
Treatment - Medical Management - Interventions - Interlaminar epidural injection -Transforaminal epidural injection Surgery -Discectomy |
The degenerative changes of cervical spine secondary to aging are termed together as cervical spondylosis. The changes can be like osteophytes (bony projections) pressing on the nerve root or spinal cord, spur or bridge across the intervertebral foramen etc . The pain secondary to these kind of degenerations can radiate to back of the head, shoulders and arm on one or both sides of the thorax. Incidental nerve compression can present as sensory loss, paraesthesias, weakness or deep tendon reflex changes. There will be difficulty in differentiating cervical spondylosis with or without disc herniation from primary neurological disorders of spinal cord with an unrelated osteoarthritis of the cervical portion of the spine. Sometimes the diagnosis becomes difficult when the cervical spine with degenerative changes has traumatic injury.
Last decade has seen the additional interest about the facet joint degeneration. The facet joints are seen between two adjacent vertebral bodies of spinal column. These joints are meant to restrain excessive mobility and distribute axial loading over a broad area. They help in resisting the shearing motion produced by forward bending and the compression produced by rotation. Degenerative facet arthropathy is commonly seen in the fourth and fifth decade onwards. These joints are also injured in motor vehicle trauma.
The facet joint pathology problems present with deep and aching pain over the corresponding cervical nerve distribution area. This can be easily diagnosed by feeling these facets, which lie behind the neck muscles. Pressing firmly on them and rotating the neck can elicit this pain.
Treatment
Medical Management
Interventions
-Facet joint injections
-Medial branch blocks
-Radiofrequency denervation
The thoracic outlet refers to the tunnel between the neck and chest through which important nerves and blood vessels travel. Any of these structures can get compressed in this channel presenting as either neck or upper limb pain. This problem most often happens following trauma wherein the cervical spine is involved in flexion and extension excessive movements. One more situation is the repetitive movements of the arm, especially overhead (tennis player) can also cause similar situation. It could be this kind of injury or anatomic abnormalities which can predispose to this traction injury. The abnormalities like ligaments, bands, extra bone growths, ribs can all pose problems.
Treatment