MUSCLE AND SKELETAL PAIN: NECK PAIN IS NOTHING TO SHRUG ABOUT

Thousands of Americans suffer from episodes of acute or persistent neck pain each year as a result of injury, strain, overuse or aging. However, a pain in the neck should not be ignored and left undiagnosed and untreated. Problems in the cervical spine, the first seven bones (vertebrae) in the neck running from the base of the brain to just past the shoulder blades, require assessment and treatment to prevent further, more permanent, damage.

"The cervical spine is where the spinal cord lives," said Volker K.H. Sonntag, MD, a member of the American Association of Neurological Surgeons Board of Directors and a neurosurgeon practicing in Arizona. "The spinal cord is the most delicate tissue in the entire body. Even minor damage to the spinal cord cannot be repaired. Unlike low back pain, in which waiting to seek treatment may prolong the pain but usually doesn't cause any further damage, untreated spinal cord compression can lead to irreversible damage."

Two Types of Neck Pain

There are two distinct types of cervical neck pain. The first type often involves a dull pain in the neck that radiates down the shoulders and arms. Patients may also notice weakness in specific muscles in the arms.

A herniated (bulging) disc in the spine pinching a nerve root in the neck often causes this type of neck pain. Discs are found between each vertebra, or bone, in the spinal column. They serve as "shock absorbers" within the spine and have a gel-like center that makes them flexible, allowing the spine to bend and move. However, because the discs are soft they can also bulge and become misshapen. When this occurs, they can place pressure on the spinal cord or irritate one of the nerves leading from the spinal cord out to the arms and upper torso. If the bulge becomes severe, the disc may herniate and push into the spinal canal. The result can be weakness, tingling, clumsiness and numbness in the arm and hands. Bulging discs can be caused by injuries like whiplash, stress on the spine by overuse, or by arthritis/degeneration in the spine.

The second type of neck pain often isn't experienced as 'pain' by patients at all. It usually involves numbness or weakness in the arms or legs, difficulty walking, loss of pain or temperature sensation in the hands and arms, poor balance and stiffness in the neck. In this case, there is pressure directly on the spinal cord. Because this type of "pain" is not felt in the neck itself, it is easily misdiagnosed.

"We usually see patients with neck pain in one of three different scenarios," Dr. Sonntag said. "One, they've been in some sort of accident and have suffered a whiplash-type injury. Two, they have a chronic injury caused by overuse, most likely caused by working at a computer for endless hours. Or they've experienced one of the first two scenarios in the past and now have arthritis or a tissue degeneration problem."

Neck Injuries

Neck injuries, which commonly occur in automobile or sports accidents, are not to be taken lightly. "If a vertebra in the neck is broken and left untreated, injury to the spinal cord can happen hours or days after the injury," explained Edward C. Benzel, MD, a spine surgery professor and practicing neurosurgeon in Ohio. "Because of the severe consequences and irreversible nature of spinal cord injuries, extreme caution needs to be taken with anyone who has suffered a direct injury to the neck." If the spinal cord is injured or bruised the patient can be paralyzed below the site of the injury. If a vertebra in the neck is broken or cracked, neurosurgeons often will stabilize the spine by fusion and instrumentation to prevent further injury to the spinal cord.

A more common neck injury is whiplash. Symptoms include neck stiffness, shoulder or arm pain, headache, facial pain and dizziness. Aggressive physical therapy, time and medication are often the most effective treatment for whiplash injuries, unless there is a herniation of a disc in the cervical spine. If the symptoms still persist after four to six weeks, or if there is severe weakness in the arms, hands or legs, a neurosurgical consult should be considered. Over 90 percent of patients who undergo surgery for cervical disc herniation have significant pain relief.

Degenerative Conditions

The neck is also susceptible to osteoarthritis and degenerative disc disease, which can be caused by general wear and tear on the spine. The discs begin to lose their flexibility and ability to absorb stresses in the spine. Or, bone spurs develop on the vertebrae. In either case, the nerves in the cervical spine can become irritated or pinched, causing pain in the neck or the arms. If there is a great deal of degeneration in the cervical spine, the spinal cord and nerve roots may become compressed, causing irreversible damage.

Cervical stenosis is another condition that may result from degeneration in the spine. It occurs when the spinal canal narrows and compresses the spinal cord. If the pain from stenosis is restricted to the neck, conservative treatment is prescribed. However, if it extends into the arms or legs neurosurgeons can remove part of the vertebrae and ligaments to allow more room for the spinal cord and nerves. If there is significant degeneration in the cervical spine, the neurosurgeon can fuse the vertebrae by grafting bone or using metal plates to provide additional support and stability in the spine.

"The cervical spine is a delicate area and the surgeon must use an exact touch," said Dr. Benzel. "The brain and the cervical spine are the two areas of the body where there is little margin for inaccuracy and the neurosurgeon's hands and instruments must be precise and controlled. I like to compare it to a jump shot that hits 'nothing but net.'"