FAQ Category: Cervical Spine

Patients who have had cervical spine fusions experience a wide range of problems after surgery. Infection, hardware failure, bone graft rejection, and even failure of the fusion are all reported. Difficulty swallowing called dysphagia or painful swallowing called odynophagia occur in about 10 to 13 percent of all cases.

Some patients report that symptoms are go away within a month’s time. For others it takes up to six months for swallowing to return to normal.

Long-term results of this problem aren’t reported but individual patients say minor problems exist. In some cases of anterior fusion, scar tissue forms pressing on the esophagus. Food going down expands the esophagus and comes in contact with the scar tissue. Patients report an odd sensation of pressure and discomfort.

Pressing with the fingers alongside the esophagus can reproduce these same symptoms. Most of the time it’s a minor annoyance and doesn’t cause any real problems.

Mountain bike riders aren’t legally required to wear a protective helmet. But if you talk to anyone who has ever had a bike injury while wearing a helmet, you’ll hear enough to convince you to wear a helmet. It just makes good, common sense.

There’s no guarantee that taking a spill from a bike will result in a quick death. A helmetless rider can sustain serious injury and damage to any part of the body but especially to the face, head, neck, and shoulders.

Helmets protect against permanent brain damage in those who survive a fall head first. Most mountain biking accidents do involve falling forward over the handlebars. Often the rider is going downhill at high speed.

The helmet doesn’t protect the very mobile cervical spine. There are numerous cases of neck fracture and permanent paralysis reported. Most of these accidents could have been prevented with proper gear, paying attention, and reducing speed on uneven or unfamiliar terrain.

A helmet is a small price to pay for a large amount of protection. It just makes good sense.

In recent years studies have shown an increasing number of patients with rheumatoid arthritis (RA) who have neck instability. Joint and capsular erosion from the same disease process can lead to significant neurologic problems later.

A doctor who suggests or orders cervical spine X-rays is forward thinking and up to date on this issue. Finding the problem early can prevent future disability. Treatment will take into consideration this extra problem if it’s present.

Even if no changes are present, a baseline X-ray is good to have. Future X-rays can show if there’s been any progression or worsening of the disease. Type and degree of changes can be seen, once again directing treatment.

Your son is doing well according to the statistics. Surviving the first year is the biggest hurdle. Many patients don’t make it past the first month. Once they’ve passed the first year anniversary they are probably more stable. Urinary tract or upper respiratory infections are the main cause of death for many spinal cord patients at any stage.

There aren’t very many studies long-term results after diving accidents. Recently doctors in Athens, Greece reviewed 20 patients who had diving accidents over the past 34 years. They looked at neurologic status and improvements over a 10-year follow-up period.

About half of the patients available for study made some gains in the first five years after the accident. The other half was unchanged. Ten years later one patient had improved neurologically. One was worse.

More and more scientists are finding out how changeable the nervous system is. They call this idea neural plasticity. In the past there wasn’t much hope for recovery after the first year. Today there is greater hope than ever for gains in recovery. Improved treatment early on and new discoveries about the nervous system may offer some breakthroughs for your son.

Diving is the number one cause of paralysis from recreational activities. Over 800 new cases are reported in the United States every year. Diving head first into a shallow pool of water can cause neck fracture and spinal cord damage. Twenty percent of all spinal cord injuries are diving related. More than 90 percent result in paralysis from the neck down.

The real trend is the use of alcohol by our young adults today. There’s a direct link between alcohol use and the increase in diving accidents nationwide. It is estimated that alcohol is involved in almost half of all diving-related spinal cord injuries.

The typical patient is a young, athletic male less than 25 years old. Reckless behavior and misjudging the depth of water are common factors in many cases. Doctors are calling for greater education and awareness of this devastating but potentially preventable injury.

Studies show varied results with facet joint blocks, especially in the neck. The idea is to inject a numbing agent or local anesthetic around the nerve root to the joint. Since one joint can have two or three different nerve branches, finding the right one can be a problem.

Sometimes the patient gets immediate and long-lasting relief. In other cases there may be no relief at all. There are patients all along the continuum between those two extremes.

One good thing about selective nerve blocks in the cervical area is that the doctor can use imaging technology to make direct application. The anti-inflammatory and anesthetic go right to the target nerve root.

The idea isn’t to give the patient a cure necessarily. The goal is to interfere with pain signals long enough for healing to take place. Research shows that therapeutic nerve block works well in patients who don’t have neurologic damage.

Studies comparing autograft bone fusion with cages continue to be published. Researchers agree more studies are needed before the advantages are clear for one choice over the other.

In a recent study from Germany two groups of patients were compared. All had cervical spine disc degeneration. The first group was treated by removing the disc and using bone graft from their own pelvis to fuse the two vertebrae together. In the second group a titanium cage was inserted where the disc used to be located between the two bones.

The results were measured by patient pain, function, and satisfaction. X-rays with the spine flexed and extended were also done. Everyone was followed for at least one year.

After 12 months, the bone graft group had more pain than the cage group because of the donor site hurting so much. They were surprised at this outcome because it wasn’t expected. The authors say all things considered the two methods are equal. The cages reduce overall pain and seem to be the best choice right now.

Laryngeal nerve palsy or paralysis of the nerve to your vocal cords is usually a temporary problem after this type of surgery. You should regain the full use of your voice in the first few days. In some cases the temporary paralysis lasts much longer from days to weeks.

In a very small number of people permanent paralysis occurs. When the surgeon fuses the spine anteriorly the trachea and soft tissues of the neck must be moved gently out of the way. The doctor finds the laryngeal nerve and carefully moves it to the side to avoid cutting it when opening the neck.

In some people the nerve is hard to find and gets nicked during the incision. In another small group there is an extra branch of the nerve that is too small to see easily. If this gets cut but the main branch remains intact, then some partial paralysis occurs. In most cases the condition is usually temporary.

With nerve damage there’s no quick and easy way to know what the long-term picture will be. It’s usually a wait-and-see affair. First you wait and see if you are in the group that recovers in a day or two. If not, then you may expect recovery to occur in the first two weeks to two months after the operation. Permanent nerve damage can occur.

When you use donated bone from someone else it’s called an allograft. Using your own donor bone is referred to as an autograft. Problems with allograft surfaced over the years. Often the fusion site didn’t hold up. The bone collapsed in up to 30 percent of the patients.

Surgeons started using metal plates to reinforce the graft. There were fewer problems using the hardware but they cost more and increased the amount of time in the operating room. Still problems with the plates and screws did occur in as many as 20 percent of the cases. The fusion rates with plate-assisted fusion were good (94 percent).

As more studies were done it became clear that some way to fuse the spine without bone graft was needed. Titanium cages were designed and tried. At first they were filled with bone graft material but now they are left empty by some surgeons. Fusion rates are good and complications are low. The next step? Finding the best type of fusion cage.

As a matter of fact researchers at various labs around the United States are working on this. Scientists from three separate places recently studied the use of resorbable polylactide polymers for a single level fusion.

A polymer is a natural or synthetic (man-made) material. Polymer means many parts. Millions of units are used in a regular pattern to make polymers. Plastic is a polymer. Starch made from sugar is a polymer. Polylactide (PLA) polymers used to form a bioabsorbable fusion implant are made from corn sugars.

They are biocompatible meaning the body accepts it as a natural substance and doesn’t try to reject it. PLA polymers are also biodegradable. They break down easily and leave the body without problems.

These devices aren’t ready yet. The work is being done on cadavers before testing it in animals and then humans.

Many studies have been done in this area of research. Scientists want to know if bone graft alone is enough? Does adding plates and screws called instrumentation make a difference? How much of a difference — enough to make it worth using both methods of fixation?

Some researchers are looking at the fusion rate of a single-level spinal fusion with and without instrumentation. They are comparing the risk-to-benefit of adding a cervical plate. So far it looks like there is a fairly high fusion rate (90 percent) with a single-level fusion using only bone graft.

Adding an anterior cervical plate (ACP) bumps this up to 96 percent. They also noted there are fewer pseudoarthrosis rates in patients with plate fixation. Pseudoarthrosis means the fused area is moving enough to act like a joint. This is considered a fusion failure.

They are also looking at the results of fusion at several levels. Success without instrumentation is much lower in this group. All in all it looks like bone graft with instrumentation is a good idea, especially if you are having more than one level fused.

You are. Whiplash injuries still account for a large part of the costs associated with road traffic accidents. The exact mechanism for whiplash injury is unclear. The head restraints added to all passenger vehicles in 1969 were meant to reduce how far back the head could extend. At that time it was thought that hyperextension was the cause of whiplash.

The head restraints were not found to reduce whiplash-related injuries after all. Then it was proposed that muscle contraction and the forceful motion forward might be the problem. Air bags may help with this but many times the air bags don’t deploy.

Today’s advanced technology is helping researchers examine neck motion under different conditions. Comparing changes in the neck under normal motion versus under the load of an accident may bring some new answers.

The exact mechanism for whiplash injury remains unknown. As you said, scientists have shown that muscle damage might be part of the acute symptoms, but muscles heal and recover during those first few weeks. Nerve root pain doesn’t really cause the kind of symptoms whiplash sufferers report.

A more recent study looked at the impact of whiplash injury on the joints of the lower cervical spine. Facet joints at C4-5 were stressed under normal conditions. Then they were examined under whiplash conditions. The amount of extension was the same in both cases. The speed and shear motion were much greater in the cases of whiplash.

It looks like the stress on the joints and joint capsule may be the source of the problem. This type of information will help doctors, therapists, and chiropractors rethink treatment for symptoms from chronic whiplash injuries. More studies are needed to find out what kind of treatment works best for this problem.

It’s possible. Candace Pert, a scientist at the National Institutes for Health discovered chemical messengers in the body called neuropeptides. These messengers are chemicals that carry emotions throughout the body in a biologic form. The theory is that cells damaged from an accident or injury have neuropeptides that “remember” what happened.

In the case of whiplash pain neuropeptides seem to be involved. These pain-related neuropeptides have been found in the nerve fibers and joints of people after whiplash injury. Each time the joint moves past a certain point the pain messengers are released. In this way the spine may “re-live” the injury over and over.

This is only a theory at this time. Discovering neuropeptides was like finding the first piece of a large puzzle. Scientists have many other pieces of the puzzle now. They are still trying to put the pieces together for the full picture.

You are seeing the difference between passive and active range of motion (ROM). Passive motion is the true physical amount of motion in the neck joints or spine. Full passive motion is available when you’re asleep, relaxed, or under anesthesia.

Active ROM describes movement under your own power. This is how far you can turn side to side or up and down on your own. There are many factors that can decrease your active motion. The first is muscle tension or spasm. The second most common reason patients with whiplash can’t turn fully is the fear of pain or reinjury. Dizziness can also stop neck motion.

Sometimes something as simple as eye movement or breathing can make a difference in active cervical ROM. When you turn your face to one side and reach the end of motion, try two things. First turn your eyes as far to that side as possible. See if you can turn your head just a little further. Now take a deep breath. As you exhale try to turn your head a little more.

You can repeat this exercise or return your face to the midline if you’re uncomfortable. Try doing this once or twice a day for a few days. If you have increased pain or dizziness, see a doctor or physical therapist. You may need a more specific treatment or exercise program.

Yes — you’ve pointed out two truths. The first is that all people have reduced joint motion as we age, including motion in the spine. With each passing decade we seem to lose a little more. Secondly, men seem to be affected by this more than women.

This change is accompanied by reduced peripheral vision (seeing out the side or corner of the eye). Scientists aren’t sure all the reasons why this happens yet. Vision, hearing, balance, and neck motion all seem to be connected. Change in any one of these can affect the others.

Chronic whiplash injury is not well understood at this time. Most doctors agree that at least six months of conservative care is needed before trying something else. Surgery is one option. A neurosurgeon can at least evaluate you and let you know what might work.

A recent study found that some patients have atypical motion after whiplash. This is defined by less than 10 degrees of motion in each of six neck motions. Adding up all degrees of motion for the six directions would be less than 60 degrees. The patients in this study with less than 60 degrees total motion had some differences in personality that could explain their results.

If you fall into this group, behavioral therapy may work best. Try to find a behavioral counselor who has training in chronic pain after injury or accident.

You may be describing a sign of neck instability. The top two vertebrae in the spine make up a unit called the atlantoaxial joint. One vertebra is slipping forward of the other one. This occurs with weakening of the capsules and ligaments around the facet joints.

Trauma and/or deterioration can occur on one side or both. The weight of the head during neck flexion moves the bones into the subluxed position. Extending the head and neck when you look up causes a clunk as the bones shift back to their normal places.

Many patients with this sign also report stiffness and “crunching” or crepitus in the neck during neck movements. There may be neck pain and even sleep apnea (breath stops) from pressure on the spinal cord and traction on the brainstem.

Until you know for sure what’s causing this problem, it may be best to avoid neck flexion. Call your doctor today and report this symptom. Get a follow-up appointment for a re-evaluation. Pay attention to any other symptoms that might be present. Report these to the doctor no matter how small or insignificant you may think they are.

Researchers are working very hard to identify patients with RA who need surgery and who would have a good result after an operation. Doctors from Tufts University in Boston been able to come up with a list of at least eight signs that a patient needs surgery.

Most of these are from findings on X-rays. The most common are: 1) neurologic signs and symptoms that are getting worse instead of better, 2) severe, constant pain, and 3) neck instability. The others are based on measurements made from the X-rays showing location of bones and joints and any changes in their spacing.

Once a patient is advised to have an operation it’s best to follow through. Patients with the best preoperative function seem to have the best results from this type of surgery.

You may want to try a conservative approach with nonsurgical treatment first. If you do and your symptoms don’t improve, it may be best not to wait more than six months before rethinking the surgical options.

Compared with contact sports like football or ice hockey, cheerleading is fairly safe and low in injury counts. Even so the newer, more complex cheering style of the last 10 years requires a lot of skill, strength, and coordination among the group.

The basket toss is performed by throwing the cheerleader into the air by three or four tossers. She may go anywhere from six to 20 feet high. This stunt is perfectly safe if the group catches the girl. Landing on a hard gym floor can lead to head and neck injuries.

Because of accidents there are now safety limits on the basket toss. Only four throwers are allowed. No flips are allowed. Safety guidelines include using a landing mat, requiring special training for the spotter, and placing one of the throwers behind the flyer during the toss. Mini-tramps and spring boards are not allowed.

Your concerns are well-founded. In the year 2000 there were an estimated 1,258 serious head injuries and 1,814 neck injuries in cheerleaders around the U.S. Talk to the cheerleading coach and find out what safety and practice guidelines they are following.