FAQ Category: Cervical Spine

You may be referring to a tool called an inclinometer. This device sits over the head like a baseball cap. It has a special nose piece to hold it in place for accurate measurements. Velcro straps adjust it to your head size and help hold it in place.

The cervical spine inclinometer measures neck range of motion. There are six possible motions. These include forward flexion (chin to chest), extension, rotation to the right and left, and side bending to the right and left.

The therapists hands are free to guide your movements and record the results. These advantages of the inclinometer reduce the chances of error. Usually you are sitting when the measurements are taken.

It’s likely that your motion has improved but there seems to be a lag in your perception of the change(s). Ask your therapist about this. He or she can use some of your treatment time to help you regain this lost sense of joint position called proprioception. There may be other reasons why you don’t feel better. Bring this to your therapist’s attention for further testing and discussion.

X-rays can be helpful when looking at bones and joints, but don’t show problems with the soft tissue structures. Joint spaces are seen on X-ray and can show the thickness or thinning of the cartilage.

Doctors and therapists don’t rely on X-ray findings. Studies show patients can have severe symptoms without any changes seen on X-rays. And the opposite is also true: many patients with severe changes on X-rays have no symptoms at all.

During the patient exam, a history of what happened and information about the current symptoms are taken. Tests of motion, strength, and flexibility give the physical therapist (PT much of the information needed to start treatment. A postural assessment can also be very helpful.

Experts agree that even if the exact problem (pathology) can be found, it may not change the treatment. Efforts are being made to classify or group patients based on who is likely to get better with each type of treatment. X-rays may be of limited value in this decision.

Many studies have shown that spinal fusion puts increased stress on the adjacent level (above or below). It’s not uncommon for problems to occur later at the next level.

About two to three per cent of the patients who have cervical (neck) fusion develop new symptoms of neck and/or arm pain each year. Disc degeneration is the most common cause of the symptoms. Spinal joint arthritis and joint instability can also lead to similar problems.

If there were changes at the C56 level at the time of your first operation, the X-rays would have shown them. Usually it’s the case that X-rays appear normal before surgery but changes occur after the fusion.

About 175,000 cervical (neck) spine fusions are done every year in the United States. And that only accounts for anterior fusions performed from the front of the neck. Many people have a posterior (from the back) fusion as well.

Most of these operations are done because of neck and arm pain and instability that occurs from degenerative disc disease. Just about half of these fusions are done at one single level. Some of these numbers may be patients who had a previous fusion and are back for a second one.

Whenever spinal fusion is done, stress and load are increased on the segments above and below the fusion. Increased motion at these levels causes accelerated degeneration. Areas affected include the disc between the vertebrae, the vertebral bones, and the joints between the fused and nonfused vertebrae.

Many studies are being done to find ways to help patients recover from disc problems without fusion. Preserving or maintaining motion is a key goal. But for now, surgical fusion is a widely accepted way to treat this problem.

When cancer spreads to the cervical spine (neck), it starts to destroy the bone. The process of bone destruction is called osteolysis. If enough of the bone is affected, fracture can occur. The bones may start to collapse. The result of either of these events can be pain, instability, and deformity.

Treatment may depend on the patient’s prognosis. Treatment is advised if the patient is expected to recover or possibly live longer by having treatment. Sometimes quality of life is improved enough that the treatment (with its possible side effects) is still more beneficial than not having treatment.

Radiation has been shown to help stop the destruction of bone in the cervical spine from multiple myeloma metastases. In fact, there are case reports of reversal of the bone destruction. X-rays show fractures heal and bone remodeling can occur with radiation alone.

In some cases, surgery may be needed to stabilize the spine. Spinal fusion may be needed. But since radiation alone has been so effective, this is the first step. The next step (if any is needed) is based on the patient’s response to the treatment and results at the bony level as seen on X-ray.

Doctors at the M. D. Anderson Cancer Clinic in Houston, Texas have reported on the results of patients receiving radiation in similar circumstances. There were 35 patients treated with external beam radiation and/or surgery. The main symptoms were pain and neck instability.

The results showed that everyone got good pain relief. Some of the patients who had surgery didn’t have as good a result as those who had radiation alone. It appears from that study that radiation may be all that is needed. Patients may be able to avoid surgery and still get relief from pain and increased stability of the neck.

Everyone wore a neck collar after treatment with radiation and/or surgery for at least three months. It’s not clear how long an external cervical orthosis of this type is really needed. Some patients wore it for many months. Others stopped wearing it when they were pain free and the X-rays showed the fractures were healed.

A recent study by physical therapists showed that using total cervical (neck) spine motions is a good way to measure change as a result of treatment. The same range of motion measurements can probably answer your question of who’s worse.

The therapists compared two groups of patients in the same age range (19 to 55 years). One group had whiplash injuries at least six months ago. The second group had degenerative changes as a result of disc problems or arthritic bone spurs.

Findings showed patients in both groups had a 25 to 35 per cent decrease in total neck range of motion. This represents a moderate-to-severe degree of neck disability.

A closer look at the data did show that the group with degenerative changes had a slightly higher severity of disability. Whiplash patients tend to have greater loss of motion in extension whereas patients with degenerative changes had a more global loss of motion in all directions.

Pain more than structure or anatomy appeared to be the real factor limiting function in these two groups. So you ladies can compare pain levels, function, and range of motion and get a pretty good idea of which condition is more limiting.

Residual pain and loss of motion from cervical spine (neck) injuries associated with car accidents are often called whiplash disorders. You didn’t mention how long ago the accident occurred. If it’s been more than three months, your condition may be considered a chronic whiplash disorder (CWD).

Whiplash disorders or CWD are often accompanied by significant muscle guarding and splinting. The muscles around the neck contract to hold and protect against motion that could cause pain. Sometimes changing this movement pattern can cause an initial increase in pain such as you are having.

Neck range of motion (ROM) may be a better measure of treatment success than pain relief — although pain relief is still an important treatment goal. Relying on only one neck motion can be misleading because there is a greater chance of test/retest error in measuring motion. Using a combination of all six neck motions is a more accurate gauge of success.

Let your therapist know of your concerns and questions. Ask about goals and measures of success to help you better understand your treatment process and progress.

Cervical spine (neck) injuries can be hard to classify and describe. Damage can occur to the bones, joints, ligaments, and discs. In addition the injury can affect the nerves and/or spinal cord causing a neurologic problem.

Anything that can change the alignment and function of these various parts can result in an unstable spine. According to spine experts, stability is the ability of the spine to hold up under loads keeping each segment in place. The vertebra stay lined up in their normal positions at rest and during neck movement. There should be no damage or irritation to the nerves or spinal cord due to structural changes.

Today’s technology has made it possible to take X-rays while the spine is moving. Any obvious loss of form or structure will show up as an unstable segment. In your daughter’s case, swelling from an injury, fracture(s), or damage to the ligaments can make for an unstable spine until healing occurs. Then the spine can be re-evaluated under conditions of normal motion. If all goes well, everything will move as it should under normal loads. In other words, she will have a stable cervical spine.

Apnea or cessation of breathing isn’t normal at any age but it can affect people of all ages from babies to older adults.

A medical exam is needed to find out the cause of the problem. It could be a form of sleep apnea that only occurs when the person is asleep. Or it could be positional from the forward bent position of the head on the neck.

There have been some reports of bone spurs in the anterior cervical spine (front of the neck) pressing on nearby soft tissues causing problems. If the bone spur gets large enough it can press on the windpipe (pharynx) or voice box (larynx). Bending the head forward would push the bony protrusion even further into the soft tissues making the problem worse.

Usually the person reports difficulty breathing, talking, or swallowing when awake. It’s impossible to know what’s going on without an MRI or some other form of imaging. A medical evaluation is advised as soon as possible.

Osteophytes or bone spurs are a common finding in X-rays of the spine in the aging adult. They are especially common after the age of 50 and can be seen most often in the cervical spine (neck) or lumbar spine (low back).

Osteophytes don’t always cause problems. Many people don’t even know they have them until they have an X-ray for something else. If the bony growth gets large enough it can press on soft tissues in the area.

The symptoms depend on where the osteophyte is located. If the bone spurs are in the anterior (front) of the spinal column then in the C3-5 area, the pharynx (throat) or larynx (voice box) can be compressed. The patient would report difficulty swallowing, talking, or even breathing.

With an anterior cervical osteophyte symptoms would get worse with forward flexion (forward bend) of the head and neck. Posterior osteophytes are more likely to press on the spinal cord or spinal nerve roots as they leave the spinal canal. Symptoms of posterior pressure include neck, shoulder, and/or arm pain, numbness, and tingling. Prolonged pressure can cause muscle weakness and atrophy.

There have never been any reports of sudden death from cervical spine osteophytes. Most patients start to have symptoms early on. Surgery to remove the extra bone is usually done before serious problems develop. Unless your doctor thinks your case is an emergency you can probably wait until you start to have symptoms. Don’t let it go too long after symptoms begin or you may be facing permanent nerve damage.

In general the Halo effect refers to a positive view of something without merit. For example when movie stars endorse products, the consumer thinks the product is good or worth buying because the celebrity said so. The celebrity may not really know anything about the value of the product.

In another example people who are physically attractive are often judged as smarter or more capable than someone of average appearance.

In the medical world, sometimes patients rate the benefit of a treatment method higher than the actual results show. For example, patients with chronic neck pain from a whiplash injury may say they are very pleased with the final results even though they still don’t have full neck motion and pain remains. If they get enough pain relief to relax the muscles and move the neck more freely they may say they are 100 percent satisfied.

When motion is only 50 percent improved and pain remains rated a five out of 10 then that satisfaction level doesn’t match the results. This is one example of the halo effect. Medical researchers attribute a feeling of well-being in patients who have some but not total improvement as the halo effect.

Sometimes it is difficult to separate out psychologic response to pain from the pain itself. A recent study of patients with whiplash associated disorders (WAD) offers some insight into this dilemma.

Patients were given a psychologic exam then treated and tested again. The treatment consisted of cervical (neck) radiofrequency neurotomy (CRFN). Radio waves are used to generate enough heat to cut the nerve that carries pain messages. Patients got pain relief, muscle relaxation, and increased range of motion with CRFN.

Psychologic tests given again after treatment showed that all psychologic distress present before CRFN was completely gone after pain relief from CRFN. This is proof that at least for some patients, the psychologic changes occur as a result of chronic pain not the other way around.

When there’s no treatment that can offer pain relief, then behavioral counseling has a role in helping patients learn to cope with their pain. If your sister has already tried various conservative measures, then CRFN may be the next best option before giving up hope for recovery.

Acute whiplash injury is always a cause of concern for patients. Predicting who will develop long-term, chronic symptoms isn’t easy. Recent research from the Whiplash Research Unit at the University of Queensland in Australia may shed some light on this topic.

They followed a group of whiplash patients for two to three years. Subjects were tested immediately after injury, one month later, and six months after the accident. Results were compared to similar measures taken two to three years later.

They found a cluster of physical and psychologic factors that may predict long-term outcomes. It seems that older age combined with cold insensitivity and psychologic distress are important predictors. Most of the patients who had these symptoms still had moderate-to-severe neck and/or arm pain six months up to three years later.

But this doesn’t mean that if you have neck and arm pain now that you won’t have a complete recovery. Early treatment and pain management may make a difference. Talk to your doctor about what steps you can take now. If you still have symptoms at the end of one month, consider adding physical therapy and counseling. There’s some evidence that a multidisciplinary approach can make a difference.

You may be describing a condition called cold hyperalgesia. Some studies suggest this reduced tolerance to cold may actually help predict who will get better and who won’t. Patients who have had an acute whiplash and suffer from increased sensitivity to cold are more likely to still have symptoms six months up to two years later.

There is actually a group of symptoms that predict the future result of whiplash injury. Besides cold intolerance, there’s loss of neck motion, high pain and disability at the time of the accident, and older age.

How and why this all happens remains unclear. It’s possible that damage to the receptors that sense temperature and movement occur with the trauma of the neck injury. Many scientists are actively studying the problem to find a way to prevent it from happening.

Pain in the cervical spine (neck) after car accidents is often some type of whiplash injury. The formal term given this problem is whiplash-associated disorder (WAD).

Based on insurance claims, WAD is very common. More than half of all car accident victims file with some type of neck injury. Up to one-third of these people end up with chronic neck pain.

Many studies have been done trying to find the cause of persistent pain after WAD. The mechanisms of low back pain have been compared with neck pain linked to WAD. It appears that the facet joints in both areas of the spine may be the source of the pain.

Animal studies show there may be a difference in how pain signals are interpreted and transmitted between these two areas. It may be that the joints in the cervical spine have more units ready to send the pain message. It’s also possible that these units called nociceptors have a lower threshold. This means they fire sooner than later.

There’s much we still don’t know about what signals are sent to trigger pain messages or even how to stop them. Current research is focused on whether the joint is being pinched, pressed, strained, or stretched. Finding the source of pain generation will help us develop better ways to turn off the signals and thereby prevent excess pain messages from getting through.

You’ve asked a question that has many doctors and scientists scratching their heads looking for an answer. Despite many animal and human studies, we still don’t know what sets off persistent neck pain after whiplash injury. Like you, most people aren’t seeking attention or secondary gain — they just want to get better.

There’s some new information that may help guide treatment for patients with chronic neck pain after car accidents. It’s possible that the soft tissues around the joints in the neck may be strained and stretched during the accident.

Greater force or strain on the joint sets off special pain message units called nociceptors. Nerve or capsular injury around the joint leads to the release of inflammatory chemicals around the area. There is a heightened sensitivity of the pain pathways from the joint to the spinal cord and up to the brain.

As part of the increased sensitivity, there may be some “after shocks” or discharge from the nociceptors. The result is even more swelling, spontaneous firing of nociceptors, and more nerve pain.

Nothing shows up on an X-ray. Overstretch of the joint capsule isn’t visible yet with any imaging studies we have available today. It’s believed that high strain on the joint capsule damages the nerve pathways in the capsule. Persistent pain is the final result.

The future may bring better treatment for this problem. Right now pain relief can be obtained by destroying the nerves to the damaged facet joint capsule(s). Radiofrequency is used to heat up the nerves and destroy them. Sometimes the treatment has to be repeated more than once because the nerve endings try to regrow.

Nonunion after ACDF can be followed with no further treatment required. If the patient is symptom-free and stable, then a watchful attitude may be best. On the other hand, if the movement is enough to create a pseudoarthrosis or “false joint,” then a second (revision) surgery may be needed.

The surgeon will decide what’s best based on your symptoms and the results of X-rays and sometimes, additional CT scans. Anterior revision surgery is one option. The surgeon goes back through the front of the neck to the fusion site. The pseudoarthrosis is removed. Bone chips or slices of bone are taken from the patient’s pelvic area and used as a graft. A metal plate may also be inserted along the front of the spine between C5 and C6.

There’s a fairly high rate of nonunion with anterior ACDF revision. Knowing this, some doctors are using a posterior fusion instead. Wires, plates, or rod and screws are used for the posterior surgery. There’s more blood loss and a longer hospitalization but the fusion rate is excellent.

At your next appointment, ask your surgeon to explain the various options. Find out what he or she would recommend and why.

Nonunion of anterior cervical fusion are not uncommon. Studies show the rate of nonunion goes up as the number of levels fused together increases. Type of bone graft and surgery may also have an effect on the success or failure of a fusion.

A single-level fusion has a 20 percent chance of failure. A multilevel fusion without the use of plates, screws, or wires to hold it together has a 60 percent chance of nonfusion.

Repeating the fusion from the front is called an anterior revision. It has fewer problems afterwards compared to a posterior fusion to repair the problem. But there’s a high rate of failure requiring yet another surgery.

Posterior fusion may be a better option for you. It has a higher success rate and avoids cutting through the scar tissue. Posterior fusion does have more blood loss and postoperative infections. This is because the muscles are stripped off the bone causing more soft-tissue injury. The trade-off is a 98 percent fusion rate.

Cervical spine fusion is a complex operation. The discs are removed from either side of each vertebral body removed. Removal of the vertebral body is called a corpectomy. Ligaments along the spine are cut to give the surgeon access to the bones.

Bone material for the graft is taken from the patient’s corpectomy or from a donor bank. The patient’s own bone is called an autograft. The fusion rate is usually better when using autograft bone. There are fewer problems with graft rejection and infection with autografts.

Multilevel fusions are less likely to gain a solid fusion because of the number of surfaces that must fuse. The chances for movement are greater if the fusion isn’t solid in all areas. And once movement occurs in one area, increased stress on other areas can cause a breakdown of other fused sites.

Studies show that fusion rates are better for multilevel fusions when combining an anterior (from the front) and posterior (from the back) fusion of the spine. The use of expandable cylindrical cages (ECCs) may also improve results of multilevel fusions. These cages can be adjusted to fit the size and shape of the hole left after corpectomy.