FAQ Category: Cervical Spine

It’s a well-known fact that the cervical spine (neck) and the scapulae (shoulder blades) are linked or connected by nothing more than muscles. Specifically, the upper trapezius and the levator scapulae muscles. These are referred to as the cervicoscapular muscles.

Anything that affects one affects the other. So the fact that you can’t turn your head as far in one direction as the other could easily be as a result of the tension in the cervicoscapular muscles. The therapist can do (and your therapist has probably done) some tests to help sort this out.

For example, neck motion is increased when the upper arms are supported or lifted up. This can be done by having the patient sit with the forearms supported on the chair’s armrests. Testing neck motion in a neutral position (arms down at the sides) and comparing it to motion with the arms supported gives the therapist a good idea of the influence of the upper arms on neck motion.

Exercise programs to help restore full neck motion will take this information into consideration. Some of your exercises will be done with the arms in neutral. The same exercises may be repeated with the arms supported. By practicing normal alignment and motion, you can retrain your neck and muscles to move normally and thereby reduce pain messages that tell you something is wrong (or at least something isn’t quite right).

Today’s therapists are trained to look for causes of neck and back pain that could be something serious requiring medical attention. They know when to refer the patient to the physician for evaluation of infection, tumors, or fracture (the most common problems requiring medical treatment).

Let your therapist know your concerns and questions. If you are not experiencing an improvement in your symptoms after two or three treatments, bring this up with your therapist. Anytime you have serious misgivings, you should always check with your physician. It’s wise to listen to your inner intuition. Patients are often encouraged to follow this advice: when in doubt, check it out.

It’s fairly routine to give a patient a cervical neck brace after neck fusion. But according to the
results of a study done in multiple U.S. centers, bracing isn’t always needed. Fusion rates and return-to-work status were the same with or without the bracing.

These findings apply to patients who had a single-level anterior cervical disc fusion (ACDF).
Surgeons involved in the study say these results makes sense because the fusion was done with a metal
plate along the front of the spine that was combined with bone graft at the same site. Bracing used to restrict motion isn’t needed because the plate and graft material have the same effect of preventing motion.

You should ask your surgeon this question. You may have had a procedure that really requires follow-up bracing. Or you may be able to discontinue wearing the support. Most often, it’s not recommended that patients get too dependent on the support the brace offers. Muscles quickly weaken, which can add to your pain. This creates an even greater dependency on a brace you may not really need in the first place.

Beliefs about whiplash and anxiety-related distress can lead to pain catastrophizing. This refers to a negative focus on pain, whether that pain is real or anticipated. A person’s pain is increased or amplified and prolonged because of the way they view every physical action as a possible source of pain. This type of thinking becomes a habit and leads to chronic pain and disability.

There is also a process called somatic illness beliefs that leads to somatoform disorders. Soma or somatic refers to the body. Psychosomatic symptoms refer to the mind-body connection.

Psychosomatic or somatoform disorders are associated with chronic pain, loss of function, and disability. There usually aren’t any organic (obvious physical) signs of muscular or skeletal damage to account for the prolonged painful symptoms.

There is evidence that believing a whiplash injury causes neck pain is a good predictor of a poor outcome. There is also some data to support the idea that severe pain at the time of the injury is another predictor of a poor prognosis.

Overcoming social beliefs and modifying patient expectations about their recovery process could possibly help prevent postwhiplash syndrome. It may be helpful to identify people who have high anxiety related to the accident and injury and offer them information to reduce wrong or dysfunctional thinking.

Whiplash is defined as a sudden extension of the cervical spine (backward movement of the neck) and flexion (forward movement of the neck). This type of trauma is also referred to as a cervical acceleration-deceleration (CAD) injury. Rear-end or side-impact motor vehicle collisions are the number one cause of whiplash with injury to the muscles, ligaments, tendons, joints, and discs of the cervical spine.

The condition can be nonspecific meaning that besides the patient’s report of symptoms, there is no visible evidence of damage. What’s most puzzling is that some people have what appears to be a minor accident and suffer a major whiplash injury while others have a major accident and walk away with a little soreness that goes away in a few days.

And despite many studies on whiplash injuries, we still don’t know why some people get better quickly while others suffer head and neck pain for months to years after the injury or accident. It’s likely there are central mechanisms (at the brain and spinal cord level) that make pain receptors called nociceptors super sensitive.

It has even been suggested that something was going on even before the injury. Patients with chronic whiplash may have a hypersensitivity response early on after the injury. Scientists are trying to explain this phenomenon. Does it mean these patients already had altered pain functions before the accident? Did the accident bring about an even greater sensitivity and response to pain stimulus?

There are no answers to these questions yet. And because there’s no way to know for sure, insurance companies take as much time as they need to investigate the accident before making a response and settling the case.

When the head and neck are suddenly and forcefully whipped forward and back (or side to side), mechanical forces place great strain on the cervical spine (neck). Traumatic disc rupture and soft tissue damage can occur after such a whiplash injury. The cartilage between the disc and the vertebral bone can get cracked. This is known as a rim lesion.

Soft tissue around the facet joint can be injured. Many of the pain-sensing nerves of the spine are in the facet joints. The normally smooth surfaces on which these joints glide can become rough, irritated, and inflamed. Studies show that neck pain often comes from the damaged facet joints.

More than anyplace else in the body, the muscles of the neck sense sudden changes in tension and respond quickly. Tiny spindles in the muscles signal the need for more muscle tension to hold against the sudden shift in position.

The result is often muscle spasm as a self-protective measure. The increased muscle tone prevents motion of the inflamed joint. You may experience neck stiffness as a result. Other common symptoms associated with this type of injury include dizziness; shoulder pain; numbness or tingling in the arms, hands, legs or feet; and facial pain. Fatigue, confusion, poor concentration, irritability, difficulty sleeping, forgetfulness, visual problems, and mood disorders are also reported by many people after this type of accident.

If you have not had any treatment for this problem, there are nonsurgical treatments to help ease your pain and other symptoms. Medications, rest, short-term immobilization in a soft collar, or injections may be prescribed. You may want to see a physical therapist or chiropractor. Your health care providers will work with you to improve your neck movement and strength. They will also encourage healthy body alignment and posture. These steps are designed to enable you to get back to your normal activities.

Conservative care may take some time to bring about change. If one treatment approach doesn’t work, try another. You should expect full recovery to take up to three months. Integration of rehabilitation and manipulative therapy is central in getting back to your pre-injury status.

There is a strong emphasis on keeping as active as possible, which includes incorporating manual treatments and exercise. Before your rehab program ends, your healthcare team will teach you how to maintain any improvements you’ve made and ways to avoid future problems.

For a very long time, spinal fusion was done with bone graft material. The donor bone came from a donor bank or from the patient’s own hip. This is still a common surgical approach — especially when only one segment is being fused. No metal or hardware called instrumentation was used.

But using bone grafts as the only fusion material has some distinct disadvantages. Donor bone from a bank is expensive. And it isn’t always available. Harvesting bone from the patient works well, but there can be problems with pain at the donor site.

More recently, new fixation methods have been developed and tested. These include titanium cages, plates, pedicular screws, and laminar hooks. Hardware of this type is used most often when the surgeon is fusing multiple vertebral bodies together.

Titanium cages are inserted between the two vertebrae (after the remaining disc material has been removed). If the body of the vertebral bone is removed, then it can be crushed up and put inside the cage. This will help foster new bone growth at the fusion site.

Your surgeon will direct the surgery based on how many segments are to be fused, your general health, and his or her expertise with the various procedures. Don’t hesitate to bring this question up at your next pre-op session. Let your surgeon know if you have any specific preferences. Find out how much of the decision is yours to make. It’s always a good idea to be informed and prepared.

You can always call your surgeon and ask for an exam. Imaging such as an X-ray or MRI may be ordered. But the surgeon may also be able to tell what’s going on by comparing the results of your last tests with your current clinical presentation.

He or she will carefully assess your motion, muscles, and joints. Specific clinical signs of fusion disruption are not real obvious right away. Pain (neck and head) pain are the usualy first signal to watch out for.

Most neck fusions have a good start after six months, but complete fusion isn’t likely for another six months. Since you only had one level fused, it’s likely that you did not have plates and screws to hold the fusion together.

Bone graft and/or stand-alone titanium cages are used most often for a single level fusion. This approach tends to be less stable than the locking or dynamic plate used with multiple level fusions. No matter what type of fusion you had, it’s more than likely the surgeon will adopt a wait-and-see attitude. Unless there are obvious signs of instability, the chances are good that nothing happened to disrupt the fusion site.

Without a closer look at your front desk and staff, we can only offer some general suggestions. First, be aware that neck pain is a very common problem in the adult population. In fact, studies show that on any given day, 20 per cent of adults in the United States report similar symptoms. And two-thirds of all adults will experience neck pain at some point their lives.

Age may be a factor, but usually it’s older adults with arthritis who make up the larger group of affected individuals. In younger adults, it may be necessary to take a look at the way they hold the phone.

For example, are they wearing hands-free headsets? Or are they cradling the phone between the shoulder and ear while using their hands to access the computer or write information down? If that’s the case, then the amount of time spent on the phone may be a problem.

Changing the work space, providing hands-free head sets, and chairs that adjust up and down may be very helpful in reducing and even eliminating neck and/or low back pain. Take some time to just observe employees work habits, posture, and fit between various body types and the front desk counter, chairs, or other workspace.

It may be helpful to have a physical therapist or other ergonomics expert assess your workplace and employees for ways to reduce neck, shoulder, back or other musculoskeletal pain. Ergonomics is the study of designing work place settings and job to match the people. The goal of a good fit between people and their work is to reduce, minimize, or eliminate physical stress and prevent injury. A little attention to the ergonomics of your work place may be all that’s needed.

Neck pain is a common reason people visit their doctor. Neck pain typically doesn’t start from a single injury. Instead, the problem usually develops over time from the stress and strain of daily activities. Eventually, the parts of the spine begin to degenerate. The degeneration can become a source of neck pain.

Knowing how your neck normally works and why you feel pain are important in helping you care for your neck problem. Patients are often less anxious and more satisfied with their care when they have the information they need to make the best decisions about their condition.

There are many possible causes of neck pain. A medical diagnosis is needed before a specific program can be prescribed. Your doctor will make every effort to ensure that your symptoms are not from a serious medical cause. Once it’s clear that you have a mechanical problem, you may be advised to use over-the-counter pain relievers and to keep active.

Mechanical neck pain tells us the problem is within the joints and/or soft tissue structures. It is not caused by tumor, infection, or fracture. But if patient education and motion exercises don’t help, you may need to see a physical therapist. In a recent study of patients with mechanical neck pain (with and without accompanying arm pain), manual therapy and exercise had much better results than advice and range-of-motion exercises.

Manual therapy and exercise includes joint mobilization or manipulation, muscle energy techniques, and stretching. Home exercise programs are prescribed based on impairments identified during the exam. Impairment areas identified often include dysfunction of the cervical spine, thoracic spine, and ribs.

Physical therapists are working hard to narrow down what treatment works best with subgroup of patients. In the past 10 years, the results of research studies in physical therapy have changed the ways low back pain patients are treated. Additional studies may do the same for patients with neck pain.

Many studies have been done to identify what it is about some people who have a whiplash injury from a car accident that causes them to develop chronic neck pain. Is it the severity of the injury or the way they view the experience? A recent study from the Netherlands may help answer the question. The researchers looked at the role of catastrophizing and causal beliefs as possible predictive factors in postwhiplash syndrome.

Pain catastrophizing refers to a negative focus on pain, whether that pain is real or anticipated. A person’s pain is increased or amplified and prolonged because of the way they view every physical action as a possible source of pain. This type of thinking becomes a habit and leads to chronic pain and disability.

Causal illness beliefs describe the patient’s ideas about what originally caused the problem in the first place. In the case of a whiplash injury, the patient may have been given the wrong impression about their prognosis.

Information provided at the emergency department or in the doctor’s office may have led him or her to believe there was severe, irreparable damage done to the neck. This impression added to the social or cultural belief that whiplash injuries are permanent could lead to a negative spiral in thoughts and actions.

The patient starts requesting more medical help. He or she constantly scans the body for any new symptoms or to check the severity of the old symptoms. Expecting pain and looking for symptoms can lead to more severe and longer lasting complaints. Intense anxiety and fear of pain are linked with a poor outcome or prognosis.

Social research has also shown that pain catastrophizing actually leads to more dysfunctional causal beliefs. In time, a vicious cycle is set up that creates a pathway from acute to chronic neck pain. The first study to prove that believing whiplash causes neck problems is actually a negative prognostic factor in chronic whiplash or postwhiplash syndrome has been published.

This information suggests that patient education is a critical feature in the management of the acute injury. If this proves true, guidelines will eventually be published to help early responders (EMTs, nurses, emergency room physicians, primary care physicians) victims of educate motor vehicle accidents what to really expect and how to prevent further problems from developing.

Whiplash, caused by a sudden jerking movement of the head forward and then backward, is usually the result of being hit from behind, as in a motor vehicle accident. There are other ways that whiplash can occur, such as on an amusement park ride or falling from a significant height.

There don’t seem to be any particular risk factors to make someone more prone to sustaining whiplash, although some do say that women and younger people may be more prone to hurting their neck. As well, if you’ve had whiplash before, it may be easier to get it again should you be in an accident.

Whiplash, which occurs if your head is jerked violently from front to back, can and does cause pain in the neck area. However, it’s not just the muscles and soft tissues that are hurt, the nerves can be affected too from the violent shake. If there is pressure on the nerves, this can cause numbness or other nerve-related symptoms.

Neck pain is a common complaint and can be quite severe. In many cases, it’s easy to see what has caused the injury, but there are also many cases where the cause is never found. These are called non-specific neck pain. The doctors aren’t saying that the pain isn’t there, just that they can’t find a cause.

If you have not been injured and the doctors can’t see anything on x-ray or imaging tests, like a mass, a fracture, or something that isn’t quite right, then it’s likely that it is non-specific neck pain that you have. Treatment for this type of pain often is a wait-and-see approach, with medications to help relieve the pain. If the pain doesn’t go away, some doctors recommend physiotherapy or even spinal manipulation.

Neck pain can be caused by many different causes from the known to the unknown. Most people have experienced a “crick in the neck,” a sharp pain on one side of the neck that makes it difficult to turn their head. This can be caused by sleeping in the wrong position or perhaps turning your head too fast and pulling on something in the neck. Many types of neck pain are considered to be non-specific neck pain, where there is no clear diagnosis.

In other cases, some people have neck pain because of arthritis or some other type of joint problem, they may have osteoporosis that is causing their spinal bones to become brittle and weak, or they may have a swelling, tumor or mass pressing on a nerve.

Neck pain should be checked to see if it is something serious. If it’s not, many times it heals with time. If it is serious, than the doctors can work on a diagnosis and treatment plan.

Cervical spondylotic myelopathy (CMS) affects the neck and can cause disabling pain and loss of function. Cervical refers to the cervical spine or neck. Spondylotic means the vertebral bones are involved. In the case of CSM, the opening of the vertebral bones that form the spinal canal (where the spinal cord goes) is too narrow. Myelopathy tells us the spinal cord is pinched or compressed by the narrowing of the canal.

One cause of CSM is a congenital decrease in the size of the spinal canal. This occurs without an equal decrease in the size of the spinal cord going through the canal. The condition is referred to as developmental stenosis since it is present at birth.

There are different ways to approach this problem. One of the more common surgical procedures performed is a bilateral open-door laminoplasty. An open-door laminoplasty refers to a single incision along the lamina bone of the vertebra with a partial incision on the other side.

The lamina is the bridge of bone that connects the spinous process (bony projection out from the vertebra felt as a bump along the back of your spine) to the main body of the vertebra. The lamina is present on both sides of the spinous process. The surgeon then swings one side of the bone open like a door and away from the spinal cord. Bilateral means the procedure is done on both sides of the vertebra.

The surgeon may use a modification of the open-door laminoplasty called the double-door laminoplasty. The spinous process is removed at the level of the problem. The center of the lamina is split and opened like double doors. This technique enlarges the spinal canal more than a single open-door procedure.

Once the surgeon assesses the location and severity of your problem, then the specific type of procedure can be planned. X-rays and MRIs are usually taken during the evaluation process. The size of the diameter of the spinal canal is measured.

The smaller the diameter, the more complicated the procedure may be. That’s why MRIs are needed to document the actual size of the canal. The surgeon uses this information to determine how much the nearby soft tissues are compressed and how to proceed with the surgical treatment.

Cervical spondylotic myelopathy (CSM) is a neurologic problem that can cause pain, weakness, changes in bowel and bladder function, and difficulty walking or using the arms and hands. Cervical refers to the cervical spine or neck. Spondylotic means there is bone involvement. In the case of CSM, the vertebral bones with the opening for the spinal cord are the center of attention. Myelopathy tells us the spinal cord is affected.

Myelopathy can be caused by many different things. The most common is a narrowing of the spinal canal (opening for the spinal cord). Anything that causes this narrowing can put pressure on the spinal cord, resulting in neurologic deficits. This narrowing called spinal stenosis can occur as a result of bone spurs or thickening or hardening of the spinal ligament (posterior longitudinal ligament).

Tumors, infection, trauma, and age-related degenerative changes in the spine can also contribute to stenosis. With aging, the vertebral bodies compress and develop a lip around the edge. Even a small amount of lipping alters the position of the facet (spinal) joints.

At the same time, the intraforaminal space where the spinal nerve roots leave the spinal cord get compressed. Likewise, the discs between the vertebral bodies are under increased pressure. All of these factors together can create the CSM condition.

In your case, it sounds like the major cause of CSM is a congenital decrease in the size of the spinal canal. This occurs without an equal decrease in the size of the spinal cord going through the canal. The condition is referred to as developmental stenosis since it is present at birth.

A recent study of patients with CSM caused by developmental stenosis showed no difference in results of A recent study from Japan showed that results of surgery for patients with CSM were no different for patients with developmental stenosis compared with patients who did not have developmental stenosis. Recovery rates were the same for everyone no matter what gender (male or female) or age.

Some studies have shown a slower recovery rate for patients with the most narrow spinal canals. But surgeons can used a specific surgical technique to make more room for the spinal cord in such cases.
Neck motion was less in the group with developmental stenosis but this didn’t appear to affect the final outcome. The loss of motion was attributed to stiffness around the joint as a result of the type of surgery performed.

You should talk with your surgeon about what to expect after surgery. Results can vary depending on the type and extent of surgery performed. There are always potential problems with any surgery. The possible complications will be explained to you before the operation. You should have a chance to ask questions during the pre-operative work-up. Use that opportunity to ask about recovery rates and postop rehab.

It’s definitely not too late. Nerves can regenerate though it can take months to do so. If surgery is needed, the sooner you get treatment, the better your chances are for a good recovery.

Treatment of traumatic brachial plexus injuries can be complex. There are many factors to consider. There is the delay from the time of the accident to the time of intervention. Waiting too long can lead to atrophy of the affected nerves and muscles they control. The location and severity of the injury are also important considerations.

The neurosurgeon will conduct a variety of tests to assess nerve and motor function. Muscle strength, range-of-motion, and function will be checked. Sometimes primary muscles responsible for a movement aren’t working. It’s possible to develop muscle substitutions (one muscle doing the job of another). The presence of any muscle substitutions will be noted. The surgeon will also check for shoulder instability.

Once all the data has been gathered, the surgeon will sit down with you and review your options. There may be a good chance that nerve grafts or a nerve transfer can be used to restore innervation to the muscles. Brachial plexus reconstruction is most successful when performed on young individuals without a long delay between injury and surgery.

Trauma to the upper arm during accidents can result in avulsion (complete tear) of the brachial plexus. The brachial plexus is a group of nerves that start at the spinal cord in the neck area. At this level, the nerves are called spinal nerve roots. The nerve roots branch out and form the three main nerves to the arm.

In the basic nerve transfer procedure, the selected pectoral nerve is divided on one side and then surgically attached to the torn nerve. The nerves are close enough to the area of damage that re-routing them isn’t too difficult. The closer the nerve is placed to the muscle target, the faster the recovery will be. This is important because if a nerve pathway isn’t used, and the muscle doesn’t contract, both soft tissues start to atrophy (waste away).

Pectoral nerves are used for several reasons. The nerve is broken down into several parts or segments. Usually, not all segments are destroyed. So there is some part of the pectoral nerves that are still working. At the same time, there is segmental innervation of the pectoralis major (chest) muscle. Segmental innervation means that more than one nerve controls the muscle. If one part of the nerve plexus is torn, another part can be used to signal the muscle to contract.

The pectoral nerves also have a large number of motor fibers. This increases the chance of success for reinnervation of the affected muscles without losing nerve function to the donor muscle.

The placement of nerve transfers and grafts for brachial plexus injuries depends on where the nerve root was ruptured and how severe the tear was. With the right placement of nerve graft or nerve transfer, new nerve fibers will grow back to the place where the nerve was damaged.

After a segment of the spine is fused, the natural body response is to find a way to increase the range of motion that has been lost. This is usually at the expense of the segment above and or below the level of the fusion. This additional stress on the adjacent segments seems to increase the rate of degeneration at these joints. If this causes pain, further surgery may be needed to extend the fusion.

The authors of a recent study found 43 to 47 percent of the patients they studied would have met the criteria for cervical disc replacement. This is much greater than for the lumbar spine. They found that studies indicate less than one to five percent of patients met the criteria for lumbar disc replacement.