FAQ Category: Cervical Spine

The association between Chiari malformation, type I (CM-I) and connective tissue disorders (CTDs) has only recently been discovered. A group of neurosurgeons noticed that some patients with CM-I who had a failed surgery had other suspicious symptoms.

Further physical examinations and genetic testing showed a second inherited condition (one of several different types of CTD). The combination of these two problems resulted in hypermobility of the upper cervical spine. Hypermobility refers to excess motion as one vertebra slides over the one below it.

Patients with CTD often have joint dislocations, loose and fragile skin, and poor wound healing. Muscle and tendon rupture can also occur. Easy bruising, hernias, and changes in blood vessels have also been reported.

CM-I results in a herniation or downward slip of the lower brain through the foramen magnum. The foramen magnum is the natural opening in the skull through which the spinal cord descends.

When CM-I is present along with CTD, there is a greater degree of herniation. Instability of the upper cervical spine also results in cranial settling. This means the cranium (skull) slips down over the vertebrae of the upper cervical spine.

Slightly more than 10 per cent of patients with CM-I also have a CTD. The chance of having both these problems at the same time is estimated to be around one to five for every 10 million people. In other words, it’s very rare. When it does occur, there is a strong positive family history of CM-I, CTD, or both.

You most likely had a whiplash injury. It is a term that describes neck pain that is caused by an energy force that is transferred to your body. The neck and head bend backward and forward, like a whipping motion.

Three-fourths of people who have whiplash will completely recover by 12 months. A small percentage of people will have chronic moderate to severe pain in spite of physical therapy and a regular strengthening exercise program.

Chronic pain from whiplash is more likely due to facet joint injury or less commonly, disc injury. Facet joint pain can be diagnosed by specific injections. If it is determined that facet joints are causing your pain, there is a treatment called radiofrequency ablation or neurotomy available. If the facet joints are not the major source of pain, most likely the disc is. A fusion surgery may be considered.

It is common to avoid activity for fear of increased pain or injury. However, people who remain active despite pain following their injury fare better than those who rest too much, or avoid activity.

Physical therapy should include strengthening and endurance exercise for the neck and upper back. These are more helpful than stretching. Benefit will be only temporary if not done regularly. Manipulation by a physical therapist or chiropractor may also have benefit when combined with strengthening exercises. Body mechanics training at home, work, and during recreation is shown to be beneficial also.

In most cases you should avoid bracing or collars. The most useful drugs are anti-inflammatories, opiods (narcotics), and muscle spasm medication for up to 14 days after the accident.

People who experience chronic pain of any kind may find it difficult to work or participate in every day activities. If someone has a chronic neck or back pain, this may result in them calling in sick to work (cost to the employer), seeing doctors more frequently (cost to self or health insurance),and taking more medications.

If the pain becomes severe, they may not be able to care for themselves and require either hospitalization or some sort of home health care, if it is available.

Research has also shown that people with chronic conditions can become depressed or anxious. This can also lead to other issues that can have economic impacts. By dealing with the disorder before it becomes chronic, it is possible to avoid the economic fall out.

A spinal fusion done in the neck is usually done because the discs are deteriorating, causing much pain and limited movement. If your surgeon has decided that a fusion is the best approach for you, this decision was likely made taking into account many factors about your particular situation.

You can always ask the surgeon why a particular procedure has been chosen over another, and this may help you understand the process a bit better.

Fusion does make the neck less flexible and this is one of the drawbacks, however, for many people, this procedure has reduced pain significantly and added to their quality of life.

Syringomyelia is a general term used to describe a cavity that forms within the spinal cord. This tube-shaped cavity or cyst is sometimes referred to as a syrinx. The syrinx can expand, getting longer if it extends over several spinal levels. Over time, the syrinx can destroy the center of the spinal cord.

Arnold-Chiari refers to the physician who first described the condition. In the case of syringomyelia with Arnold-Chiari malformation, the lower part of the cerebellum protrudes from its normal location in the back of the head.

The word cerebellum means little brain. It is a separate, smaller part of the brain located at the base of the skull just above the cervical spine. It slides down into the cervical or neck portion of the spinal canal.

It sounds like you have developed syrinx in the cervical spine. Neck and shoulder pain with loss of cervical flexion are common with this condition. Surgery to remove the bone pressing on the spinal cord can help relieve the painful symptoms. The procedure is called foramen magnum decompression (FMD).

There isn’t much information available about the effect of syringomyelia on cervical spine (neck) motion. Researchers in Japan explored the question of whether cervical motion is affected by the severity of the syringomyelia.

The study was small (30 patients). All had FMD for syringomyelia associated with Chiari malformation. Motion was measured before and after the operation. There was no significant difference pre- and postoperatively.

It does not appear that the loss of motion is linked with how severe the deformity is. More studies are needed to find out what restricts neck motion. With more information, treatment to improve motion may be possible.

Syringomyelia is a general term that refers to a spinal cord disorder. A tube-shaped cavity (cyst) forms within the spinal cord. The cyst is also called a syrinx. Syrinx comes from a Greek word that means hollow reed. The word syringe also comes from this word.

The syrinx can expand and elongate down several levels in the spine. In the process, the spinal cord can be damaged or even destroyed. This damage may result in pain, weakness, and stiffness in the back, shoulders, arms, or legs. Some patients report headaches or temperature loss in the hands. They can’t feel hot or cold sensations.

Shrinkage of the syrinx occurs after surgery in three-fourths of the patients. The remaining quarter (25 per cent) experience a change in symptoms but no change in syrinx size.

Experts suspect that location of the syrinx, not its size, is the key factor. This may explain why you got relief from your symptoms without a change in the degree of syrinx size.

Studies show that physical problems from long hours and days at the workstation (and especially in front of a computer) can take their toll on workers. Headaches, neck and arm pain, and stiffness are common complaints.

A good employer should address these concerns. Preventing problems before they begin can help maintain workers’ quality of life. It can also prevent the high cost of worker disability. And it can take a long time to recover from physical problems caused by excessive computer time.

Group therapy is a cost-effective way to get the word out. Instead of taking an hour to train each individual worker, a small group meeting can train six to 10 workers in the same hour. This makes good sense from the business side of employment.

Studies also show that workers are more likely to be compliant with the program and benefit from the results. In a large group, general awareness and education is easy to impart. In a small group, solutions can be found that can be tailored to each individual.

Any program that requires behavioral changes takes time. Support from others along the way can only help. Discussing common problems and finding ways to solve them is more likely to happen in a group setting. Even if you don’t speak out yourself, you may be able to benefit from what others have to say.

You are not alone. It is estimated that on any given day, one-fourth of the computer work force shares similar symptoms. Neck, shoulder, arm, wrist, and hand pain and stiffness are common problems. Numbness, tingling, and weakness may occur if the nerves are pinched.

Studies have been done trying to find solutions to this problem. Changes in the workplace and workstation adjustment top the list. The effects of exercise programs and lifestyle changes are also being studied.

More recently, there’s been a shift in research. The focus is now more on changing work style and increasing physical activity. Workers are encouraged to find ways to balance the physical and psychologic stress.

Taking shorter breaks more often to stretch the body and give the mind a rest is advised. Paying attention to the work station and body posture is important.

Meeting with others who have similar computer work may help workers find ways to cope with the high work demands. Adding physical activity such as walking, biking, gardening, and sports has been suggested but not proven yet as an effective way to alter symptoms.

More studies are underway to find single solutions as well as to study the effects of multiple steps taken. The goal is to reduce neck and upper limb symptoms and speed up recovery time.

Behavioral changes seem to work but they do take time to take effect (up to one year or more). Don’t give up if something doesn’t seem to be working right away.

Every patient is individual in his or her recovery from fusion surgery in the neck. In general, patients are advised not to lift heavy objects for a few weeks after surgery and advised to take it easy for about four to six weeks after surgery. Whether sports can be resumed at that time depends on the type of sport and the recommendation of the individual doctor.

When someone has chronic pain, especially if it is affecting quality of life, it can be discouraging to find that traditional medicine may not be as effective as they would hope. Treatment from other cultures, such as from Asia, are often called alternative medicine because they differ from their approach to helping patients with their pain; they provide an alternative form of treatment.

When looking into alternative medicine, it might be best if you consider it to be complementary medicine, which is treatment that can be used along with the traditional western treatments. This may give a patient the best of both worlds.

If you do decide to look into alternative or complementary medicines, it is vital that your doctor know that you are following this path. This is very important to ensure that there are no side effects or cross over of treatment that could end up hurting you.

Your concern is understandable and well-founded. Radiation is used first to shrink the tumor. This can help preserve the remaining bone and the surrounding tissue.

Once the bone is removed, the surgeon uses metal plates, screws, and titanium cages to support the spine. This is called spinal fixation with instrumentation. The cages used are round or cylindrical in shape. They can be inserted wherever the disc and/or vertebral bone is removed. This means you shouldn’t lose any height after the excision.

Some of this may depend on how many and how much of the bone is removed. Neurosurgeons and plastic surgeons work together to minimize any disfigurement. Often, except for a scar, there is no outward sign that any bone has been removed.

It may be best to make an appointment with your surgeon to discuss the operation. Find out what are your options. Ask about both possible and likely complications or problems that can develop. Make a list of questions so that you don’t forget to ask what you want to know before surgery.

You may be experiencing a transition from the acute injury to a more chronic whiplash syndrome. Patients with ongoing symptoms from a whiplash injury are said to have a whiplash associated disorder (WAD).

Symptoms linked with WAD can include headaches, neck pain, changes in vision, and dizziness. Muscle weakness and numbness or tingling are also possible. Difficulties with memory and concentration have been reported along with negative mood or mood swings.

The force of the injury isn’t always consistent with the symptoms experienced. And the degree of injury doesn’t always predict who will or won’t develop WAD.

At best, studies show that patients with the highest level of symptoms early after an accident have the worse outcomes and prognosis.

Pneumocephalus literally means air on the brain. Immediate headache after epidural injection at C6-C7 is the first sign of a possible pneumocephalus. The patient may also experience nausea and vomiting, which doesn’t help the headache.

Movement makes the headache worse. Lying still doesn’t really help but keeps it from getting worse. It usually takes about two days for the symptoms to go away.

Most often this complication occurs when the patient moves suddenly during the procedure. Patients are usually sedated to avoid or at least minimize movement. Medications are given before the procedure begins to help keep patients quiet and close to immobile.

If the needle gets dislodged, it must be repositioned to prevent a pneumocephalus. The use of fluoroscopy, a special kind of X-ray that allows the injectionist to see the needle can also help prevent this problem.

Although a pneumocephalus is viewed as a major complication of epidural steroid injection, it does not lead to permanent damage. Your wife may need to remain hospitalized for another day or two until she has stabilized.

Epidural steroid injections (ESIs) are often an effective way to treat neck and arm pain that doesn’t go away after a trial of more conservative care. ESI is a safe and effective procedure. But it does come with some problems from time to time.

Minor problems such as nausea, vomiting, and fever usually only last a few hours to one day. Some people experience increased neck pain at first but this subsides within 24 hours. Weakness in the arm, tenderness at the injection site, and even insomnia can occur after ESI.

Less often but more serious are the potential major complications. These include puncture of the dura with headache, hematoma (pocket of blood), infection, and abscess. If the needle punctures a nerve root, there can be nerve damage that may or may not get better.

Permanent spinal cord injury and even death are the most serious complications. Fortunately, these are very rare.

Many, but not all, complications can be prevented with careful technique. The injectionist studies the MRI to find the best place to insert the needle. Areas of constricted or tight tissue are avoided.

The patient is sedated but not completely asleep so he or she can report any signs of nerve root or spinal cord damage. Sometimes a special type of X-ray imaging called fluoroscopy is used to guide the needle as it is inserted. Complications from the way the injection is made can be minimized with the use of fluoroscopy.

Some side effects of the injection simply can’t be avoided. For example, facial flushing is a well-known side effect of steroid injections. For other systemic reactions such as nausea and vomiting, it doesn’t matter how the injection is made.

Without a doubt, study after study has shown the powerful advantage of wearing a seatbelt. Not only are there fewer deaths, there are also fewer and less severe injuries.

Your brother is correct that the shoulder harness can cause neck sprains during a motor vehicle collision (MVC). In fact, the number of people who develop neck sprain after MVCs is much higher than in groups who do not wear their seatbelt.

The downside of this statistic is that spinal fracture is much higher in the unrestrained group. So although they are less likely to sprain their necks, they are more likely to become a spinal cord injured patient.

Young men between the ages of 18 and 30 are the most likely to engage in risky behaviors. And driving or riding in a moving vehicle without a seatbelt is considered risk-taking. They are also more likely to drive at higher speeds resulting in more serious accidents.

The bottom-line is that the seatbelt may cause a neck sprain. However, it’s more likely to save lifes and protect people from becoming a spinal-cord patient.

Studies clearly show that wearing seat belts saves lives and prevents injuries. For the most part, they also reduce the severity of many injuries.

However, it’s also true that some injuries are more likely to happen when wearing a three-point seat belt system. The three-point system includes the shoulder-lap combo.

For example, the number of cases of neck sprain is higher in seat belt wearers. Compression/burst fractures occur more often in restrained front-seat passengers. Scientists aren’t sure why this happens. They suspect that the shoulder strap holds the chest back as the body is moving forward.

The restraining force acts against the middle part of the spine called the thoracic spine. The thoracic spine tends to be in a forward-curved position. Suddenly and forcibly straightening the thoracic spine increases the load down through the spine. It’s this force that can result in vertebral fractures.

Cervical spine fusion has been the gold standard for treatment of degenerative disc disease (DDD) for many years. But surgeons have been looking for better ways to alleviate their patients’ pain while still preserving motion.

Fusion does exactly that: two or more vertebrae are held together as one-unit. The diseased disc is removed. A titanium bone-filled cage is inserted in place of the missing disc. Bone chips are packed in and around the repair. Sometimes a plate and screws are used instead to hold the spine together.

The major problem with cervical spine fusion is the increased load it puts on the segments above the fused level. And any motion that may still be left can increase the internal stresses on the next disc above.

That’s where an artificial disc replacement (ADR) comes in. The implant stabilizes the vertebra. At the same time, it still preserves motion at that segment. The thinking is that the more normal the biomechanics can be in the spine, the longer it will last without problems.

Fusion is very stable (it doesn’t move at that level) but it’s not mobile. Breakdown is more likely at adjacent levels. At least that’s the theory surgeons are working under.

So far, only short-term results of ADRs are available. And studies comparing ADR with spinal fusion are still fairly limited at this time. Early results after one-year are very positive. Pain relief is possible with both types of surgery. Motion is definitely preserved with ADR.

Patients naturally want to know what to expect after surgery. Will there be less pain? Will I be able to move my head and neck? Can I turn in either direction without damaging the implant?

All of these variables have been worked out first in animal models. Then cadaver studies are done. Cadavers are humans preserved after death for study. When approved, scientists can begin limited studies on live humans. These are called clinical trials.

The Food and Drug Administration (FDA) must approve new devices such as the artificial disc replacement (ADR). Approval is required before they can be used in the general population.

At that point, small studies are often done with results reported at regular intervals months to years later. The hope is to attain positive results that last a lifetime.

In the case of ADRs, special motion X-rays can be taken to measure and quantify spinal motion. The imaging tool that can be used is called a roentgen stereometric analysis (RSA).

The patient lies on his or her back with the head in the middle. X-rays are taken to document the exact location of the ADR. The head is moved by the examiner to different points in the motion and new X-rays are taken.

Three-dimensional markers and computer analysis make it possible to keep track of each patient and compare results over time. Motion in flexion, extension, and rotations can be measured at each segment. This method is both precise and reliable.

If you have neck pain, your doctor will want to do a physical exam to see how much the neck injury is affecting you. He or she will check to see if the pain radiates beyond your neck, such as into one or both arms. This type of information can tell a lot about where your neck is injured.

You will be asked if the pain is more when you bend your neck, twist your neck, or just move in general. Your hand grip will likely be checked to see if there’s a difference between your hands. Your doctor may press on spots on your neck to see if that makes any difference to the pain or sensations.

Many times, a diagnosis is made from your symptoms and your history, and your neck pain can be treated effectively and successfully.