FAQ Category: Cervical Spine

The authors of a recent study feel that electrophysiological testing to evaluate the silent period is more sensitive to change in neurological integrity within the spinal cord in persons with syrinx. Somatosensory evoked potentials and motor evoked potentials may be normal and not detect more subtle, early changes that silent period testing can.

There are several possible reasons why you might be experiencing a “clunking” sensation when you extend or hyperextend your head and neck. There could be some misalignment of the cervical spine causing one vertebra to slip over another. As you move your head, you may be subluxing (partially dislocating) the unstable vertebral segment.

In some cases, the bone is already out of place and the movement brings it back into neutral alignment. This is referred to as a reduction of the subluxation. In either case, there is likely some soft tissue damage allowing the vertebra to slide and glide in one direction more than it should.

You may benefit from some medical testing. There are some clinical exams the doctor can perform to test the integrity of the soft tissues, especially the joints and ligaments. X-rays may reveal a fracture or other bone involvement. A more advanced type of imaging may be needed such as CT scan or MRI.

Once the problem is identified, then a treatment or intervention plan can begin. Once the cervical spine is stabilized, the clunking should go away.

There’s a wide range of exercises and activities that can help maintain and/or improve strength in the shoulders. Some require lighter weights than others while still providing a positive benefit.

For example, shoulder shrugs (lifting the shoulders up towards the ears) can be replaced with lateral raises (raising arms from next to the body out to the side). The amount of weight needed to activate the trapezius muscle (neck and shoulder muscle) is less for lateral raises compared to shoulder shrugs. And you still get the benefit needed.

Another option is to use wrist weights instead of handheld weights. These can be purchased at a sporting goods store or on-line. It’s also possible to make some simple velcro strap-on wrist weights.

For those who have a membership in a health club or fitness center with a pool, pool therapy can be an excellent alternative to traditional strength-training exercises. The buoyancy of the water supports your weight while also offering resistance during movement. Many people find this a relaxing way to strengthen and tone muscles.

The muscle along the neck, shoulders, and upper back is the trapezius. It has several separate but interconnected sections (upper, middle, lower trapezius). The uppr trapezius mmuscle is the one that shrugs the shoulders. Overuse or chronic repetitive use of this muscle can lead to a painful condition called itrapezius myalgia.

Office workers often complain of trapezius myalgia. A few simple stretching and strengthening exercises may help. It’s always a good idea to take frequent, short breaks during the work day. Just bringing the arms overhead and taking a deep breath can relax tense muscles and improve blood flow. Lifting the shoulders up toward the ears and relaxing them back down (shoulder shrug) is another quick and easy exercise for this problem.

A strengthening program can also help. Studies show that muscle pain is reduced with high levels of activation. The most commonly used exercises for trapezius myalgia include shoulder shrugs, one-arm rows, upright rows, reverse flys, and lateral raises. These exercises are done with handheld weights.

Depending on your work situation, you may be able to do these exercises during short morning and afternoon breaks. When getting started, some people prefer training with a physical therapist or other qualified exercise care specialist. This can help prevent improper form and technique that can lead to injury.

Once you’ve established a program of regular exercise, you’ll find it much easier to

You have described what sounds like a whiplash associated disorder (WAD). The first step would be to get an accurate diagnosis of what’s going on. Although the X-rays were normal, there could be some soft tissue damage that doesn’t show up on plain radiographs.

You may benefit from more advanced imaging such as magnetic resonance imaging (MRI). The MRI can show the discs and soft tissues of the cervical spine more clearly than other types of imaging studies. If there are any torn or damaged ligaments, the signal intensity of the MRI will change indicating a problem.

The results of more definitive testing should help guide treatment. If there is no obvious ligament, disc, or bone damage, then you may be a good candidate for physical therapy. The therapist will help you regain full motion, strength, and function.

Restoring normal motor control is also an important part of rehab for chronic head and neck pain after a whiplash injury. Give conservative (nonoperative) care at least three to six months to make a difference. If it does not change your symptoms or alleviate your pain, then you may be a candidate for surgical intervention.

A surgeon recently studied outcomes of 170 of his patients who underwent single level ACDF without instrumentation. Their outcomes are similar to outcomes of surgeons who advocate the use of ACDF with plate instrumentation.

Traditionally, ACDF without instrumentation has usually been treated postoperatively with the use of a rigid cervical collar. One advantage of ACDF with instrumentation is that most surgeons do not require the use of a rigid cervical collar postoperatively. A surgeon who recently studied 170 of his patients who underwent ACDF without instrumentation and without the use of a rigid cervical collar feels that outcomes are similar to published outcomes of ACDF with instrumentation.

Spinal injuries are a common result of falls from hunting tree stands. In fact, in 1989, the Centers for Disease Control and Prevention (CDC) reported tree-stand falls were a leading cause of hunting-related injuries in the United States.

Spinal cord paralysis represents a large percentage of the injuries sustained from these kinds of falls. Fractured and dislocated vertebrae can compress and/or sever the spinal cord. Death can occur, though this is less common than paralysis.

Significant delay in treatment can make a difference. Today, high-dose steroids are given to reduce inflammation (swelling). The sooner this treatment is given, the less pressure is put on the spinal cord. A complete spinal cord injury with total paralysis can be minimized to a case of partial paralysis. And patients who might have otherwise been partially paralyzed have a chance at full recovery.

Delays can also be accompanied by hypothermia with its own long-term consequences. Additional treatment for multiple other problems extends the risk of possible complications.

The lack of communication with outside help is a disadvantage in a serious injury of this type. Patients who lay undiscovered for a long period of time may have a worse outcome than those who are transported to a medical center immediately.

Brown-Séquard syndrome is a group of motor and sensory symptoms that occur when one side of the spinal cord is compressed or damaged. Usually, it’s caused by a tumor in the spinal cord, trauma (e.g., gunshot wound or stab wound to the neck or back), or loss of blood to the area.

Less often, infectious or inflammatory diseases such as tuberculosis or multiple sclerosis can cause this problem. Disc herniation as a cause of Brown-Séquard syndrome is very rare. Your husband is only one of 25 cases ever reported.

Predicting the outcome of treatment is difficult given that the number of cases to judge from is so small. As with any spinal cord injury, the earlier the treatment, the better the chances for recovery. With a protruding disc, the surgeon’s task is fairly straightforward: remove the disc and stabilize the spinal segment.

Minimally invasive microsurgery may be possible. This procedure prevents damage to the soft tissues (e.g., muscles, ligaments) and speeds up recovery. After the operation, a rigid collar is worn while the bone fusion heals.

Once the operation is complete, the surgeon will be able to give you a report of what was done and what to expect. Even though limited in numbers, results of cases reported in the literature are very favorable.

Several studies have evaluated the role of collision characteristics, age, gender, psychological factors, and initial pain intensity with regards to whiplash injuries. According the available literature, initial pain intensity seems to be the most consistent predictor of late whiplash syndrome.

A recent literature review found that no studies specifically addressed the benefit of conservative care such as physical therapy, spinal manipulation, use of heat or cold, massage, or medication in the treatment of cervical facet joint dysfunction. There are limited studies and conflicting evidence regarding the effectiveness of intra-articular facet joint injections or medial branch blocks. Limited studies regarding radiofrequency neurotomy have shown that they may provide lasting pain relief for several months.

There are two recognized causes. Trauma such as whiplash, and degeneration.

Late whiplash syndrome, LWS, is the presence of pain, restriction of motion or other symptoms six months or more after a whiplash injury. Restrictions may be in areas such as the ability to return to normal activities such as driving, work, or recreation.

Nonoperative treatment with immobilization can be done using a halo-thoracic vest. The vest is kept on for up to four months. The surgeon relies on X-rays to show if healing is taking place before transitioning the patient to a stiff cervical collar for another four weeks.

This type of management is possible when the fracture is nondisplaced (hasn’t moved) and the patient is without symptoms. The very young and very old are treated with conservative care most often.

Nonunion of the fracture (failure to heal) can occur requiring follow-up fusion surgery to achieve spinal stabilization. Patients with diabetes, rheumatoid arthritis, or other serious health conditions seem to be at increased risk for delayed healing or nonunion.

When surgery is done to fuse the C1-C2 segment, immobilization with a soft or hard collar is used for at least six weeks — sometimes longer. Rehab to restore overall neck motion and function takes place six to 12 weeks after surgery.

The upper cervical spine starts with two bones labeled C1 and C2. C2 has a peg-like bony structure called the odontoid process. It sticks up like a tooth through the round ring that makes up C1.

A fracture of the odontoid process can be very serious. If it is unstable, the bones slip. Pressure on the spinal cord can cause permanent neurologic damage. Paralysis is even possible. For this reason, fusion of the spine at the C1-2 level is usually advised.

Surgery is done to stabilize the fracture and prevent neurologic problems and complications. Sometimes, older adults who are inactive can be treated with nonoperative management. The risk of anesthesia may be too great or there may be other health concerns preventing surgery.

Without surgery, the patient may experience neck and head pain, stiffness, and loss of cervical spine motion. Occasionally, dizziness and weakness of the arms occurs. But these symptoms are far more manageable than permanent paralysis of the chest, arms, and lower body.

With care, nonoperative management can be successful for those patients who can’t have surgery for some reason. This type of treatment can work well for patients who don’t have any symptoms and who have a stable, fibrous union of the odontoid. Most of the time, fusion is strongly advised and provides good long-term results.

As you have probably found out, there are many kinds of pillows on the market right now. Various sizes, shapes, and materials (from high density foam to water) are available. But trying one after another can be very expensive.

There aren’t a lot of studies comparing pillows for neck pain. But there is some evidence that using a water pillow can give pain relief and improve quality of sleep for neck pain patients. The water pillow was compared with using a regular pillow or a cervical roll. A cervical roll is placed at the base or curve of your neck. It is used along with your regular foam or feather pillow.

The firmness of the water pillow can be adjusted by the amount of water added to the pillow. The design makes it possible for the pillow to change shape. This feature means the pillow changes as you move and turn or change your sleeping position.

Providing proper support for the head and neck during sleep can reduce pain intensity and even eliminate morning headaches. The result can be daytime pain relief as well. Better sleep also makes it possible to cope more effectively with stress from chronic pain conditions.

Even minor fender benders can create enough force to cause a flexion-extension injury of the neck referred to as whiplash. Whiplash associated disorders (WAD) and late whiplash syndrome (LWS) are fairly common problems after a car accident. But why one person develops this condition and someone else in the same accident doesn’t, remains a mystery.

Researchers have investigated numerous possible risk factors. They’ve looked at psychologic problems, distress levels, and cognitive level of function as possibilities. Studies have been done looking for a link between personality traits, anxiety, history of emotional problems and whiplash disorders.

There may be some defining or prognostic factors. But the studies that have been done were not well designed. Results of low quality research are not reliable enough to use as evidence.

Some studies of chronic low back pain have found that beliefs about pain and fear of pain can result in a reaction called fear avoidance. Fear avoidance is the belief that certain movements or activities should be avoided to prevent pain or re-injury from occurring.

It’s possible that people who develop chronic whiplash start out with fear avoidance behaviors. Best practice suggests keeping active during the recovery process. It may be helpful to get out together and go for a walk everyday for the next week. The activity may provide a distraction and the movement may help in the healing process.

Posttraumatic stress disorder (PTSD) is a form of anxiety. It was first called shell shock but was later referred to as combat fatigue. Now we know it as PTSD.

This disorder can develop after exposure to a terrifying event that could have caused (or did cause) physical harm. It is considered a severe and ongoing emotional reaction to an extreme psychological trauma. The threat of physical injury or death is so severe that the person is unable to cope. A wide range of symptoms accompanies this condition.

Patients with PTSD who have accidents or injuries may be at increased risk for problems with chronic pain. Studies show poor outcomes for patients with PTSD after whiplash injuries. Their coping mechanism just isn’t able to handle trauma or an event that someone else might consider mild.

A psychologist and a physical therapist working together may be able to help your brother regain a sense of self-efficacy (can do attitude) and coping strategies. Treatment may not be needed right away. But if you continue to see questionable behaviors, attitudes, or actions, don’t hesitate to make the suggestion for a screening exam. Early intervention can make a difference.

As you have discovered, there are some risks with cervical injections. Pain and local infection at the site of the injection is the most common. But some patients have allergic reactions and others develop deep infections at the joint.

More serious problems such as brain or spinal cord injury can occur. There are no known studies to document exactly how often this happens. Usually, case reports or small series are published. This suggests the risks are fairly minimal.

Some experts suggest that the risk of neurologic injury from cervical injections is directly linked to the surgeon’s technique. The use of fluoroscopy to guide epidural injections may help decrease the risk of serious complications. Fluoroscopy is the use of a special type of real-time X-ray. It allows the surgeon to see the needle as it moves through the skin and soft tissues to the target site.

Even with careful technique, there is still the risk of headache and increased pain.

Yes, when looking back at all the data gathered over the last 25 years, it seems that patients with whiplash injuries and whiplash-associated disorders (WAD) have better results with minimal treatment.

Sometimes a few sessions with a chiropractor or physical therapist for manual therapy (joint manipulation or mobilization) is effective. For both WAD and nontraumatic neck disorders, supervised exercise (with or without manual therapy) is another possible option that seems to work better than no care.

But most of the studies show that the best strategy of care for WAD is indeed less is more. Too much treatment too soon seems to interfere with healing and prolongs recovery.

And there’s no evidence that treatment (of any kind or in any combination) for more than six to eight weeks is going to help improve the patient’s condition. Follow your doctor’s advice but keep your follow-up appointment if your symptoms don’t resolve. You may be a good candidate for a short course of manual therapy if things don’t turn around for you.