FAQ Category: Cervical Spine

Massage therapists are starting to do some research these days to study the effects of this very pleasant and soothing modality. Does it really work? How long do the effects last? Does it work better than something else like acupuncture or laser therapy? These are the kinds of questions they are trying to answer.

There is evidence now that massage improves blood circulation and with it, creates relaxation and boosts immune function. With the right kind of massage, movement of effusion (swelling) is possible in order to reduce pain and increase motion.

There are many kinds of therapeutic massage such as friction massage, clinical gliding, Swedish gliding, traction, trigger point therapy, and kneading massage. It’s always recommended to see a licensed massage therapist so that you know the individual has the right training and credentials to practice safely.

In a recent study at the University of Washington (Seattle), patients with chronic neck pain receiving massage were compared with similar patients who were given a book to read on self-care for neck pain. The massage group used less medication and sought fewer treatments outside of massage. They reported greater improvement in pain intensity and function in the first 10 weeks compared with the self-study group.

After analyzing all the data, the authors concluded that in the short-term, massage for neck pain has merit. After six months, what you will want to assess for yourself is how much better are you now compared to when you started? Are you seeing gradual ongoing improvements? Do the changes occur after the massage? If you skipped a week or month of massage, would you notice any difference?

You may not have a clone of yourself for comparison, but with some careful observation, you may be able to answer your own questions without one.

Your wife may be suffering from a condition referred to as whiplash associated disorder or postwhiplash syndrome. This is a common problem after a rear-end collision in which the neck is strained from a fast forward-backward head movement. Muscle soreness is common for a few days after such an injury. But neck pain can persist for months to even years later.

Cognitive impairment with headache, dizziness, and difficulty concentrating is also common. And these symptoms seem to contribute the most to work-related disability. Older adults seem more likely to develop work disability after a whiplash injury. They are also more likely to experience some type of cognitive impairment.

A medical exam may be in order. The physician can test for neurologic signs and symptoms as well as order CT scans or MRIs if needed. Getting help before the problem becomes a chronic one could get your wife back on track and relieve your anxieties.

Researchers say the cost of whiplash injuries is far more than ever imagined. Just as you suspected, it turns out that long-term sick leave and disability pensions for chronic pain from whiplash associated disorder (WAD) cost much more than acute medical care. This could mean that routine medical care right after a rear-end collision could save a lot of money in medical costs later.

Studies show that as many as four out of every 10 people (40 per cent) develop chronic neck pain after a car accident. This is true whether the person is a blue-collar or white-collar worker. Work disability after whiplash is a fairly new area of study as it relates to neck pain after motor vehicle accidents (MVA).

It may be possible to predict who is most likely to be affected and get them some help early on. In a recent study from Finland, older age was a predictor of work disability in a large group of post-whiplash workers. Cognitive impairment was a second preditive factor of long-term work disability.

These findings suggest that physical treatment may not be as important after whiplash injury as interventions for mental functioning. Age is not a modifiable risk factor, but it is a tip off to watch out for problems. Older adults should be screened carefully after motor vehicle accidents to help identify problems and prevent an acute injury from becoming a chronic and costly one.

Cervical OPLL refers to ossification of the posterior longitudinal ligament. Ossification means the ligament becomes hardened from bits of bone forming within it. The posterior longitudinal ligament (PLL) is located inside the spinal canal along the back wall of the canal. It runs down the spine from top (cervical spine) to bottom (sacrum). The spinal canal is the round tube formed by the vertebrae where the spinal cord is located.

When the posterior longitudinal ligament hardens as part of the degenerative changes that occur in the spine, it takes up space in the spinal canal. With decreased space for the spinal cord, myelopathy can occur. Myelopathy refers to any condition that affects the spinal cord. In this case, pressure on the cord from the ossified ligament can cause neurologic problems. Patients may report numbness, arm weakness, clumsiness of the hands, and trouble walking. Too much pressure can lead to paralysis.

But it’s not clear yet whether or not treating this problem can prevent neurologic damage from occurring (or from getting worse). Surgeons don’t want to disturb this area by performing surgery if it’s not really necessary. But then, should everyone be treated conservatively without surgery? If surgery is done early, will it prevent worse problems from happening later?

A recent study from Japan may help shed some light on these questions. Two equal-sized groups of patients with OPLL were compared. The first group had no myelopathy or only mild myelopathy. Patients with no myelopathy came to the doctors because of neck pain and/or stiffness. Their pre-treatment range-of-motion was less than those patients in the second (surgical) group. Group one received nonoperative care.

The second group with moderate-to-severe myelopathy had surgery. The surgeons entered the spinal canal from the anterior (front of the) spine. The main area of hardened ligament was removed. The vertebrae were fused at that spot using bone taken from the patient’s fibula (lower leg bone) or iliac crest (pelvic bone).

Everyone was followed for three to five years. Special tests were performed before and after treatment to assess the results of treatment. The Japanese Orthopaedic Association (JOA) scale was used to measure the severity of the myelopathy. This same scale used after treatment showed changes (improvement or worsening). X-rays (also taken before and after treatment) were used to show how much of the spinal canal was occupied by the ossified ligament.

In the first group who had nonoperative care, those patients who had no myelopathy remained unchanged. Of the remaining patients with measurable myelopathy, half got better. The rest (except for one person) stayed the same. Neck range-of-motion did not change before and after conservative care.

As might be expected, the amount of residual space for the spinal cord was less in the nonoperative group compared to those who had surgery to increase the diameter of the spinal canal and take pressure off the spinal cord. This finding represents improvement in the surgical group.

In looking back over the results from before and after treatment between the two groups, the authors outline a plan for deciding who should have surgery and when to operate. Conservative care is always the first choice whenever possible. This is most likely with there is no myelopathy or only mild myelopathy. Older patients with continuous OPLL are also better candidates for nonoperative care. Continuous means the problem affects more than one vertebral segment.

Surgical treatment is advised for patients with excessive neck motion and signs of growth activity of the ossified mass (as seen on MRIs). Surgery is also indicated when the MRIs show high signal intensity indicating an increased risk of myelopathy developing or getting worse if already present. The presence of segmental OPLL (affecting multiple vertebral levels) is another indication that surgery may be the best treatment choice.

Surgeons can use these guidelines when deciding on the best timing for surgery to treat myelopathy associated with cervical OPLL. The results of this study showed that conservative care is effective even when the spinal canal is narrowed. Patients in this group did not get worse over time, so there was no theoretical advantage of early surgical treatment to avoid a worsening of the problem.

Spinal stenosis is the term used to tell us there is a narrowing of the spinal canal. The spinal canal is a tube-like opening through which the spinal cord goes from the brain down to the bottom of the spine. Usually, there’s plenty of room in the spinal canal for the cord.

But many different changes occur in the bony and soft tissue structures of the spine as we age that can contribute to stenosis. Too much narrowing and there can be pressure put on the spinal cord. The result can be neurologic symptoms. With cervical (neck) stenosis, patients report numbness, arm weakness, clumsiness, neck pain, and stiffness.

Most often the changes occur within the spinal canal. The posterior longitudinal ligament located inside the spinal canal can start to thicken. It may even ossify or harden as tiny bits of bone form inside the ligament. If the ossification gets big enough, it can take up extra space in the spinal canal.

Sometimes, bone spurs called osteophytes form. These can occur around the edges of the vertebral bodies, but also around the spinal joints. The presence of these bone growths can alter the biomechanics of the spine (the way the spine moves). Each one of these changes added together can create narrowing of the disc spaces, compression of the vertebral bodies, and ultimately lead to stenosis.

Myelopathy refers to any problem affecting the spinal cord. this problem may be caused by pressure on the spinal cord after trauma or related to degenerative processes in the spine.

Sometimes myelopathy is a symptom of an unstable cervical spine. Surgery is needed to fuse and restabilize the affected segment. Myelopathy present before surgery is a known risk factor for a greater chance of problems after surgery.

New onset of myelopathy after surgery can be caused by swelling, prolonged position during neck surgery, or many days in the hospital following fusion surgery. The symptoms of myelopathy may disappear over time if the cause of the problem is eliminated. For example, swelling can be reduced with antiinflammatory medication.

It sounds like your sister has told the surgeon about this new symptom. If anything changes to make it worse, a follow-up visit is needed. The surgeon will be able to advise your sister about the cause, treatment, and future expectations (prognosis). There’s a very good chance that the feelings of weakness and heavy sensation are transient, meaning that they are temporary and will gradually go away in time.

The accuracy of health histories after car accidents has long been under suspicion. Ever since a pilot study showed that what patients reported about their past medical history and what the medical records already on file showed were two different stories.

Since that time, another, larger study was conducted at Stanford University. They compared the information given by patients experiencing chronic neck or back pain following a car accident with data in their medical records on the same patients. They were expecting that the information would match up.

But what they actually found was that patients frequently (half the group) underreported previous bouts of neck and back pain. And they denied ever having treatment for these problems even when the medical records clearly showed they did have treatment at some time in the past.

Not only that, but the patients who were not at fault (the accident was caused by someone else) were much more likely to fail to report previous back and neck pain problems. Patients with a history of psychologic problems were seven times more likely to underreport information on those problems. These patients didn’t just leave out a small portion of their history. Often, they omitted the entire history.

To make sure this wasn’t just a general underreporting of all problems (including health conditions unrelated to an accident), the authors also included two control conditions: hypertension and diabetes. Consistent with the idea that the underreporting was conscious or deliberate, no one failed to tell the examiner about other health concerns of this type.

It is extremely important to obtain an accurate history after a motor accident. Patients with a previous history of treatment for neck or back pain are much more likely to have a poor prognosis. Management of the problem may be approached quite differently under these circumstances. Not knowing this information could compromise quality of care.

Luck may have something to do with it, but certainly, your surgeon’s skill and expertise had a large part in the results. Most likely you had an anterior (from the front) fusion. The risk of hoarseness, loss of voice, and dysphagia (difficulty swallowing) are greater with the anterior approach.

That’s because the anesthesiologist places a tube down your throat to keep your trachea (airway) open during the surgery. There can also be laryngeal (vocal cords and voice box) spasm or swelling that contribute to the problem.

There are delicate nerves in the throat that control the voice and swallowing. During lower cervical spine fusions, such as at the C6 level or lower, the surgeon must watch out for the recurrent layngeal nerve (RLN). The RLN is located along the right side of the neck. It splits into two parts and loops and travels in several directions. The surgeon must find this nerve and carefully avoid cutting into it by mistake.

All things considered, it’s good news that you’ve been spared this particular complication of anterior cervical spine fusion.

The spine is where the nerves go down throughout your body. At each disc level in the spine, some nerves branch out to reach different parts of the body. The higher up the nerves branch off, the higher part of the body they control.

The neck is like a hub, where most of the nerves have to pass through on their way down. If the neck is compressed and is pressing on the nerves, then all the nerves running through are affected, including the ones for the arms and the legs. For this reason, many parts of the body, including urinating can be affected by this one problem.

There’s plenty of evidence from research that joint manipulation is an effective treatment for positional neck pain. But there is more than one way to perform a thrust manipulation of the involved spine.

It’s possible that another technique would yield even better results than the one used on you. At the same time, there are other ways to treat mechanical neck pain. For example, sometimes applying heat and/or use electrical stimulation is quite effective. And there are other modalities able to achieve improved pain control and increased function.

As you have discovered, having a positive short-term benefit of treatment is good, but it’s not too helpful if the results don’t last and you end up in therapy again later. Studies are needed using other treatment strategies and longer time frames to help find optimal ways to manage mechanical neck pain.

Sometimes it just takes a while for the vertebral alignment to settle into a more healthy, normal pattern. In other cases, there are some soft tissue problems that must be addressed. Tight muscles, poor flexibility, nerve impingement or entrapment can add to the problem. The factors contributing to these problems must be identified and eliminated before the pain will go away or the joint manipulation has a long-term favorable result.

Talk with your therapist about your concerns and expectations. Ask if there’s anything else you can do personally to improve your situation. Don’t be afraid to ask the therapist if there is anything else he or she can do as well to manage the problem.

Cervical collars have been used for a long time for neck problems, such as whiplash or torticollis. They’re also used for people whose discs in the neck, the cervical discs, are too weak to support their head or if they have fractures, and they’re used after certain types of neck surgeries.

If you were wearing a neck collar and you found that you could turn your head, it could have been a sign that the collar didn’t fit you properly, although only your doctor or the person who fits the collars would have been able to tell you for sure.

This is a question that can only be answered by your mother’s surgeon. There are some types of neck surgery that don’t require bracing and others that leave it up to the doctor. However, there are also neck surgeries that absolutely require a neck brace or collar for a specific amount of time afterwards.

If your mother won’t go see her doctor, you may try to call the office to see what you can find out on your own, but this is really something that needs to be seen about by a healthcare professional, in person.

If someone has cervical myelopathy, the compression of the neck that causes pain and disability, surgery is often done to help relieve that pressure. It is a successful surgery for many patients, although it isn’t guaranteed.

As to whether the compression can happen again – this is a possibility. When surgeons prepare surgery for a patient, they weigh the pros and cons and look into what the prognosis, or outlook, is for each individual patient. If it looks like the surgery might not be successful, the surgeon may propose some alternative treatment, rather than doing the surgery for not much gain.

Currently, arthroplasty – replacement of discs – is only approved for the mid to lower back. The United States FDA has not yet approved it for the cervical, or upper spine, yet. That being said, there are ongoing studies that are examining the usefulness and the efficacy of cervical spine arthroplasty and the medical community believes that it shouldn’t be too long now that the FDA will approve it within the next few years.

Severe pain in the neck or upper back, or immobility, can make it tough to live life normally. The pain can interrupt sleep, making you feel fatigued and subject to becoming ill. Fatigue can leave to sleepiness, which can cause fatal accidents. Pain also makes it so people can’t work, go out, or even take care of themselves. If pain is having such an effect on a life, it may be that surgery – despite risks – is the only option.

All surgery has risks. Back and neck surgery have the added risk of there being potential problems with the nerves in the spinal column. However, it’s very important to understand that the risks of developing a complication are very low, mostly less than 1 percent of patients will experience them.

It sounds like the injury is a fracture of the odontoid process (sometimes called the dens). The odontoid is a bony knob or upward projection of bone on top of the second cervical vertebra (C2). C2 is also known as the axis. The dens points up and fits through a hole in the first cervical vertebra (called the atlas). The joints of the axis give the neck most of its ability to turn to the left and right.

A fracture in the upper part of the dens is a Type I odontoid fracture. This type of injury is usually stable and will heal nicely. A break right where the odontoid process attaches to the C2 vertebral body is a Type II odontoid fracture. Without this piece of bone in place, the first two vertebral bones (the atlas and the axis) can slide apart. This puts a tremendous compressive or stretching force on the spinal cord as it goes down through the spinal canal. The spinal canal is a round opening or hollow tube formed by the vertebrae stacked on top of each other.

Type III odontoid fractures occur through the vertebral body. This type of fracture is also usually stable and heals well without surgery. It’s the Type II odontoid fractures that require the most thought in planning the best treatment.

There are pros and cons with both types of treatments (surgical versus nonsurgical) for a type II odontoid fracture. Nonoperative treatment to allow the bone to knit back together can be successful. If the atlas and axis have not been displaced (moved), then immobilizing the neck for a period of time is an option. The two most common forms of immobilizers used include a rigid cervical collar or a halothoracic brace.

The halo brace is a titanium ring (the halo) that goes around the head. This portion of the brace is secured to the skull by metal screws (pins). Four metal bars attach the halo ring to a vest worn on the chest. This vest offers the weight to anchor the ring and immobilize the neck. Sometimes the halo brace is referred to as a halo vest.

Complications can occur with either conservative or surgical care. The loss of movement and immobility is often a risk factor for all kinds of problems in older adults. There’s the risk of pneumonia or other respiratory problems. With bracing, pressure ulcers (skin sores) can develop. Infection at the pin sites used with the halo vest is another potential problem. Most of these can be prevented with proper follow-up home care.

Bracing may be preferred because of known complications that occur when surgery is done for this problem in older adults. If conservative care fails, then surgery to fuse the spine can still be done. Surgery is indicated in cases of nonunion instability such as recurrent dislocation or when there is serious neurologic involvement (e.g., paralysis).

You may want to seek a third opinion and then weigh all the factors when making the final decision. Your decision will be based on the exact type of fracture your mother has, whether or not it is stable, her overall health, and the kind of postoperative care that is available.

The odontoid is a bony knob or upward projection of bone on top of the second cervical vertebra (C2). C2 is also known as the axis. The odontoid process is also called the dens. The dens points up and fits through a hole in the first cervical vertebra (called the atlas). The joints of the axis give the neck most of its ability to turn to the left and right.

A Type II odontoid fracture occurs right where the odontoid process attaches to the C2 vertebral body. This type of fracture is most common in older adults who fall or who have a motor vehicle accident and break off the odontoid in the cervical spine (neck).

Treatment will be needed to stabilize the bone. If the fracture is nondisplaced (hasn’t separated), then immobilization with a rigid cervical collar or brace may be all that’s needed. Treatment can get a bit more complicated if the odontoid process has broken off completely.

Without this piece of bone in place, the first two vertebral bones (the atlas and the axis) can slide apart. This puts a tremendous compressive or stretching force on the spinal cord as it goes down through the spinal canal. The spinal canal is a round opening or hollow tube formed by the vertebrae stacked on top of each other.

With a displaced fracture, surgery is needed to bring the bones back together and hold them in place until healing (fusion or union) occurs. Results of treatment vary from patient to patient. The hope is that the patient will be pain free with a stable neck and restored function. But sometimes pain and loss of function can lead to disability.

There’s no way to predict ahead of time what kind of final results will occur for each patient. Age, general health, and the condition of the bones in older adults are just a few of the key factors that can affect the overall outcomes. Stabilizing the fracture and restoring function are the first two steps in the process. Healing and recovery from this type of injury can take weeks to months in an older adult. But the results can be good-to-excellent.

Halo braces are used to help stabilize the neck. To apply a halo brace, the surgeon needs to drill holes into the skull around the head to insert pegs or screws that will hold the round, halo, part of the brace. The brace does weigh up to seven pounds.

People with halo braces have to be careful not to allow the pin areas to get infected. This means cleaning the areas regularly as instructed by the surgeon or the nurse when the person is sent home. The halo will be removed once the neck or upper back is stable enough to support the head without causing damage.

Scientists are still scratching their heads over chronic whiplash injuries. They ask the same question: why is it that some people recover just fine, while others go on to develop a chronic problem? In fact, the problem is common enough that it now has a label: whiplash associated disorder (WAD).

Some experts suggest there are risk factors that predict who might end up with WAD. One of those predictive factors is referred to as local sensitization to noxious stimuli. This describes how the nervous system seems overly sensitive and responds faster and with stronger pain signals in some people. The theory is that the nervous system is already pretty touchy either before the accident or right after the injury.

Studies have shown that when the body perceives stimulation as painful, it produces muscle fatigue and weakness. The person who becomes highly sensitive has a lower threshold for pain. Not only that, but the pain spreads to other parts of the body outside the area of injury. The affected muscles have a reduced ability to contract fully and also have reduced endurance (lasting power).

There may be pre-injury factors that set a person up for the development of chronic pain after a whiplash injury. The exact mechanism for how and why this occurs remains unknown. Clearly, there is a decreased pain threshold and increased sensitivity to pressure or other stimulus that is then perceived as pain, but why does this happen?

If patients who are at risk for WAD can be identified early enough, it may be possible to prevent persistent symptoms and preserve muscle function. The result could be a faster return to full function without loss of work capacity.

Future studies will continue to look into this question. Scientists will try to understand exactly what’s going on in the nervous system and why some patients seem more susceptible than others to WAD. Identifying predictive patient factors (personal or physiologic) can open the door to finding ways to keep pain signals from escalating in intensity, duration, and frequency. In this way, it may be possible to prevent WAD altogether.

The mechanism of injury is the same no matter which direction the force comes from. The head and neck are forced into extension and flexion with a rear-end collision or flexion and extension with a front-end impact.

The good news is that nearly 90 per cent of all people in motor vehicle accidents who develop neck, jaw, or head pain recover quickly. Most are back to full function within a matter of days to weeks. Only a small number develop persistent or chronic pain that results in what we call a whiplash associated disorder (WAD).

It’s not clear yet why some people recover just fine while others end up with all kinds of aches and pains. Is there a personality trait, emotional state, or simply bad karma that accounts for who gets better and who doesn’t?

So far, studies have identified a couple potential risk factors. Factors that can increase a person’s risk for poor recovery include female gender, decreased active neck motion (right after the accident), and pain intensity after injury. Increased muscle tenderness and pressure sensitivity right after the accident are also possible risk factors.

The question is — are these tender, touchy muscles already on high-alert before the accident? Is it possible that some people’s nervous systems are primed for poor recovery and long-term symptoms? There’s some evidence to support this idea. Not only are these folks already experiencing increased frequency, duration, and intensity of pain, they develop painful symptoms in other parts of the body (outside the injured area).

But don’t borrow trouble before it comes your way. The other person involved in your car accident could very well end up in the 90 per cent who recovery quickly and fully. Right now, it’s a wait-and-see moment for you.