Neck Pain
What is cervical spondylosis?
Neck pain is something that most commonly arises as people age. This is because as we age, the joints in our neck begin to degenerate. Cervical spondylitis is the condition related to this degeneration. In other words, it is an age related condition that affects the joints and discs in our cervical spine, which is in our neck. The condition also goes by the name of cervical osteoarthritis or neck arthritis. Age related changes are most common in the C5-C6 and C6-C7 segments, so this area is more prone to neck arthritis. But what exactly are these changes?
As the disc degenerate, they lose their original biomechanical and biochemical properties. The ability of the disc to retain water is impaired, it loses moisture, the amount of keratin sulfat000e increases and chondroitin sulfate decreases. As a result, the disc loses its original height and becomes less elastic. Facet joints are progressively submitted to increased stresses and instability and the uncovertebral joints become arthritic, giving rise to pain and stiffness in the neck.
Clinical picture
Degenerative changes at the cervical spine are produced in most of the population. Nevertheless, patients usually after 40 years of age can present with-
- Axial back pain and stiffness
- Headache
- Pain in the shoulder or arms
- Signs of myelopathy
- Paraesthesia
- Weakness and clumsiness in the forearm and hand
- Exacerbations of Acute discomfort
The onset of symptoms is usually insidious and they are often worse after a period of postural steadiness. The pain may spread to different regions including-
- The occiput
- Back of the shoulder girdle
- The interscapular area
- One or both upper limbs
Imaging
- X-rays show narrowing of one or more intervertebral spaces with bony spur formation at the anterior and posterior margins of the disc. Loss of the normal lordotic curve or even inversion might be found.
- MRI is more sensitive to the whole degenerative process showing details of disc, facets, vertebrae and ligamentum flavum, changes which are not otherwise visible. It is more reliable for the neutral structures, showing the degree of compromise of the spinal cord and whether or not the clinical picture is due to nerve root compression.
Treatment
- Analgesics and anti-inflammatory medication can be prescribed to control acute and exacerbating pain.
- Heat and massage are often soothing.
- Restricting neck movements with a collar is an effective treatment during neck pain.
- Physiotherapy is a very important part of the treatment strategy, which includes exercises to optimize the range of motion.
- Prolonged use of cervical collar or brace may be detrimental.