FAQ Category: Cervical Spine

Following a car accident or some other injury that could cause whiplash, if you feel neck pain, you should be checked by your doctor, in order to rule out anything more serious. Whiplash can appear up to a couple of weeks following the initial injury. Symptoms of whiplash include pain in the neck, back, shoulders, or arm. You could feel dizzy, fatigued, and have trouble with your memory.

If you do have whiplash, your doctor might recommend applying ice off and on for the first 24 hours following the accident. You will be encouraged to move your neck gently, perhaps doing some prescribed exercises. You may also be given some medications to relieve the pain or relax the muscles.

It’s possible there is a connection between your sister’s Chiari malformation (CM) and her appendectomy. But it’s also possible the two are separate, unrelated problems.

And without a before and after MRI, it may not be possible to find out what happened. The MRI would show changes in the position of the cerebellum and the amount and location of cerebrospinal fluid (CSF).

In CM, the cerebellum (part of the brain at the base of the skull) slides down through the opening for the spinal cord. Pressure on the cerebellum can cause serious neurologic symptoms. The CSF around the brain normally moves in gentle waves with every heartbeat.

Anything that blocks CSF movement can cause it to build up in tube-shaped pockets along the spine. These pockets of CSF are called syrinxes. Pressure from the syrinx can damage and even destroy the spinal cord.

Problems could have occurred if your sister had a spinal injection of anesthetic for her appendectomy. The procedure could have caused a tear in the lining around the spinal cord. CSF could have leaked out, collecting in a little pool around the base of the spinal canal.

Pressure on the spinal cord from the built up fluid could have caused her symptoms. Careful study of MRIs may help identify the cause of the problem. The treatment is likely to be decompression of the spinal cord.

The surgeon will remove a piece of bone from around the cerebellum. Symptoms usually resolve quickly after this operation. In the future, your sister should make sure her doctors and surgeons know she has a CM before planning any treatment for her.

Arnold-Chiari refers to the physician who first described this condition. Children born with a defect of the spinal cord called myelomeningocele or spina bifida often have an Arnold-Chiari malformation.

In 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.

There may be no symptoms with this condition, so the problem remains hidden. An MRI of the cervical (neck) spine would show the abnormal anatomy. But MRIs are expensive. They are not done routinely just to see if there’s a problem unless there’s a reason to do so.

It is not likely that the cousins of a child with a Chiari malformation (your children) would be affected as well. However, you should bring this piece of family history to your pediatrician’s attention, and seek his or her advice.

Most likely, no testing will be recommended unless your child develops some kind of neurologic signs or symptoms.

A group of physical therapists in New South Wales, Australia looked at using a tool normally used with low back pain patients. The Core Outcome Measure was first proposed for use in 2003 based on research at that time.

This seven-item test was pared down to a five-question tool and tested on three groups of whiplash patients (acute, subacute, and chronic). The first test results suggest that this condensed version called the Core Whiplash Outcome Measure (CWOM) is a valid and responsive tool for a broad range of whiplash patients.

It was a good test to use for patients in primary care or for those with private insurance. It was equally responsive at various stages of whiplash. And it could be used to assess short-term or long-term results.

More study may be needed, as the CWOM doesn’t measure all aspects of health in patients with whiplash. For example, patient satisfaction and emotional health aren’t measured using the CWOM. The test also asks patients about the number of days missed at work or school. This information may not apply to all patients.

For now, it looks like the five-item CWOM can be recommended for use as a brief measure of health outcome for all whiplash patients.

There doesn’t appear to be a standard definition of recovery from chronic whiplash, also known as whiplash-associated disorder (WAD). Information on recovery after whiplash isn’t even measured the same from patient to patient or from study to study. When health outcomes are measured with different tests, results can be varied and confusing.

Recently, a few studies on WAD have defined recovery for their particular research project. Recovery was defined as no pain or neck symptoms, minimum to very low scores on disability, tests, and successful return to work.

You may have to contact your representative or case manager at the insurance company to find out how they define recovery. Ask what basis they use for their definition. If you do not match their criteria, then you have a right to challenge the closure of your claim.

Painful symptoms in the neck that go down the arm are called cervical radiculopathy. Pain, numbness, and weakness are common with this condition. Pressure on the nerve as it leaves the spinal cord and travels down the arm is the cause of these symptoms.

Sciatica is a similar pattern of symptoms down the leg. Pressure or irritation of the sciatic nerve is the source of these painful symptoms. Steroid injection into the space around the spinal cord or spinal nerve has been of some help to many patients with this problem.

Studies do not show that the results are enough to use steroid injections on a regular basis. Although the injections are safe, they aren’t always effective or effective enough to warrant their use.

Right now there isn’t enough data from studies to show that steroid injection is a good treatment plan for cervical radiculopathy. It may be best if you had a thorough assessment by a medical doctor first to find out the cause of the problem. There may be a better treatment choice for you.

You are right that there is a wide range of outcome measures used by researchers and clinicians. Which one measures changes in pain and disability the best after treatment for whiplash? Good question.

A group of researchers from Canada set up a study to compare the most commonly used scales of pain and disability. They tested a group of 132 chronic whiplash pain patients using the same tests over a six week period of time.

The tests were given before treatment and then six weeks later. Some patients were only given advice and followed up by telephone. Others followed an individualized six-week long exercise program.

The best measure of change in disability was the Patient-Specific Functional Scale (PSFS). It is quick and easy to use with patients. It’s a valid and reliable tool. And it is responsive in measuring clinically important changes.

The SF-36 is still a good overall measure of fitness, general health, and includes disability and pain. Many clinics use this tool along with others such as the PSFS that target more specific measures.

Spinal fusion is usually done when there is confirmed evidence of an unstable spine segment or segments. There is usually a massive disc herniation, severe spinal stenosis, or serious spondylolisthesis.

Spinal stenosis is a narrowing of the spinal canal where the spinal cord is located. Bone spurs, overgrowth of the spinal ligaments, and arthritic changes often cause spinal stenosis in the aging adult.

Spondylolisthesis is the forward displacement of a vertebral bone over the vertebra below it. A fracture in the supporting columnm of the vertebra allows the vertebral body to slip forward. This slippage can cause a pull or traction on the spinal nerve resulting in pain and disability.

Fusion is not usually done unless the patient has been treated conservatively without surgery for at least six months. Nonoperative treatment may include pain relievers or antiinflammatory drugs. Physical therapy to calm the symptoms and increase spinal stability may be helpful. For chronic pain patients, a team approach at a pain clinic may be needed.

A surgeon should be consulted when making treatment decisions. X-rays and other imaging tests may help identify the problem. There are pros and cons to every operation that must be considered. Your surgeon can help you sort out what your treatment options are and what’s the next step.

A spear tackle is a dangerous way to stop an opponent. The player is picked up and turned upside down, then dropped on the ground (head first). It is a very dangerous move and can result in neck fracture, spinal cord injury, and even death.

In American football prohibits spear-tackling. The rules haven’t always been enforced but recent data showing how often serious injuries occur have started to change the picture. Permanent spinal cord injury causing quadriplegia has brought this problem to the forefront.

In Europe spear tackling is much more common among rugby players. Several Australian rugby players are actually well-known for this tackling technique. The National Rugby League penalizes any player seen lifting another player past the horizontal position. The Australian Football League can suspend a player for a spear tackle.

There is still great debate on when the courts should intervene regarding violence in sports. Some maintain spear tackling is a violent assault that is not part of the game and should not be tolerated. Others claim this move is just careless or an error in judgment.

In American football, driving the player’s helmet into his body is a subtle form of spear tackling that isn’t always easy to recognize. Right now referres make the call but in the future, the courts may be deciding criminal liability.

The Short Form-36 (SF-36) is a survey given to many patients with a variety of health care problems. It measures a person’s sense of his or her own overall health. It is a generic measure, as opposed to one that targets a specific age, disease, or treatment group.

The SF-36 includes eight different subscales of functional status. These eight areas are scored in two general sections: physical and mental. There is an even shorter survey form (the SF-12 Version). It has only one page and takes about two minutes to fill out.

A more complete evaluation of client function can be obtained. Look for a more disease-specific tool such as the Low-Back SF-36 Physical Functioning survey. Or for cervical spine patients, consider the Neck Disability Index (NDI).

The NDI measures the impact of spinal disorders on 10 different aspects of daily life. Personal care, level of activity, and recreational activities are just a few of the areas tested. The down side of the NDI is that it does not measure small changes in symptoms as a sign of improvement.

Finally, there is the Cervical Spine Outcomes Questionnaire (CSOQ). Studies show this is a reliable and valid tool. It is specific to the cervical spine, which is something you are looking for, and it is just as good as the SF-36 or NDI. It may even give you a more complete job or work-related picture than you have now.

What you experienced is called the ceiling and floor effect. A ceiling effect occurs when you choose the highest answer possible for a question, but then you get better and need a higher number to choose from.

The same is true at the opposite end (the floor effect). The lowest number on the scale seems to describe you best at first, but later your symptoms or function have changed enough that you could pick an even lower number to describe yourself.

The problem isn’t with you: it’s with the tool being used to measure improvement. The survey you took wasn’t able to discriminate accurately enough. There may be a better questionnaire available. Some questionnaires are meant to be general. Others are more disease-specific.

Your doctor may have what he or she is looking for, but it would be a good idea to raise this question the next time you are in the doctor’s office. He or she may not be aware there is a potential problem that could be solved with a different (possibly better) survey.

Cancer recurrence is more likely when the surgeon is unable to remove the entire tumor. This happens for a variety of reasons. For example, the tumor may be wrapped around vital blood vessels or nerves in the cervical (neck) spine.

You are probably scheduled for regular follow-up visits with your surgeon or primary care physician. It’s important to keep these appointments even if you feel fine. MRIs taken at regular intervals (every six months) will help identify any changes that might suggest tumor regrowth.

Early symptoms of cancer recurrence can be very subtle. Many people tend to ignore vague changes in health or mild symptoms. Anyone with a past history of cancer should not take a wait-and-see approach.

Let your doctor know if you start to have head, neck, or arm pain. Other symptoms to watch for include weakness (arms or legs), numbness and tingling, and loss of bladder or bowel control. Night pain or pain at rest that doesn’t go away with pain relievers is a red flag and should be reported right away.

Persistent pain is a common problem for many people who have had a whiplash injury. Finding an effective treatment has been the goal and focus of many physical therapists around the world.

In a recent Australian study, advice such as you received was offered to one group. A second group was given the same advice along with a six-week program of exercise. The exercises included aerobics, flexibility stretches, and strength training.

Patients in both groups reported improvements in pain and disability. The exercise group had the best results. And it seems that people with the most severe pain got the most help.

Some patients in both groups did seek out other treatment. Magnetic therapy, chiropractic, acupuncture, and massage were the most common additional treatments received.

Even with all the extra treatment, results were about the same. Small gains were made and kept for up to a year. Exercise isn’t a miracle cure, but it can be a helpful tool for many people.

Persisting pain and disability is a common problem after whiplash injuries. Studies show that only about one-third of adults with this problem are free of pain and disability by the end of three months.

And those same studies have data to show that the results aren’t much better by the end of six months. The remaining two-thirds of the patients will have mil-to-severe pain and disability.

What can be done about this? That’s the center of much debate and study. For some patients, radiofrequency (RF) heat treatment to cut off nerve messages may be an option. This is called a RF neurotomy. Special testing must be done to prove the problem is coming from the neck joints before a neurotomy is done.

Exercise may be the best treatment known. It’s clear that physical activity and exercise won’t cause any further damage to the whiplash injury. By five months, the underlying soft tissues have healed. So patients are encouraged to keep moving and not to let fear of pain restrict activities.

What kind of exercise is best? Most of the studies show a benefit no matter what kind of exercise is done. A physical therapist can help you get set up on a program that best suits your age, fitness level, and baseline pain and disability. The therapist will guide you in progressing the program along.

The best advice today supported by research is to start a lifelong exercise program. Not only will it help with your current symptoms, but it can help speed up recovery should you have any other injuries in the future.

Osteoblastomas can be very agressive locally meaning they can cause wide spread damage where they occur. They do not tend to metastasize (spread) or move to other parts of the body. Once removed, these tumors come back in one out of 10 (10 per cent) of the affected patients.

Surgeons are looking for ways to remove these tumors so that they don’t come back. Preoperative emboliztion may be helpful. An interventional radiologist uses special imaging technology to cut off the blood supply to the tumor before the surgeon removes it.

With complete removal of the tumor, recurrence is much less likely. Neurologic symptoms from tumors pressing on the spinal cord are reversible with this treatment. Pain relief and restoration of motion and function can also occur with proper treatment.

There’s plenty of laboratory evidence that autografts (using your own bone) is superior to allografts (bone donated by someone else). For one thing, the autograft takes hold much faster than allograft tissue.

It has its own blood supply that is compatible with or matches the patient. The immune system recognizes the graft as its own self and doesn’t try to reject it or take it out. The autograft also has a better blood supply than an allograft so fusion is faster.

There can still be problems with an autograft. Pain at the donor site is a common postoperative problem. Researchers are looking for the ideal graft that will give a high rate of fusion with a low rate of complications.

Single-level fusions of the cervical spine have a good success rate. Studies report as high as 96 per cent (or better) fusion rates. It’s true that patients are more likely to have problems with the donor site than the actual fusion.

Most often the donor bone is taken from the patient’s own pelvic bone. Using your own bone for the graft is called an autograft. Possible postoperative problems at the donor site include pain, difficulty walking, and infection. Persistent drainage from the donor site and failure to heal can also occur. Some patients report discomfort over the donor site while wearing clothes.

Most of these complications are more common when this operation was first introduced. Today as many as one-third of the patients with autografts may report one or more problems. Rarely does anyone have all of these problems. But symptoms can last for months to years without improving. Patients are advised ahead of time what might happen, not necessarily what will happen.

Complications after cervical spine surgery are reported in about four per cent of the patients having this operation. Infection, nerve damage, and difficulty swallowing are some of the more common problems. Occasionally, even death can occur. This is more likely to happen to older adults.

Dysphagia is a medical term used to describe the problem your wife is having with difficulty swallowing. Hoarseness or only being able to speak in a whisper accompanied by dysphagia after cervical spine surgery suggests some kind of nerve damage. The condition is often temporary but may be permanent.

Some experts suggest the number and kind of problems reported after cervical spine fusion are actually underreported. Researchers studying outcomes of spinal surgery suggest that complications such as your wife experienced occur more often than was previously known.

If you have not reported this condition to her surgeon, you should contact him or her for a consultation and further follow-up.

Symptoms from pressure on the spinal cord or spinal nerves is called myelopathy. When it occurs in the cervical spine (neck), it’s called a cervical myelopathy.

Degenerative changes in the spine (usually from aging) can cause bone spurs to form around the spinal joints. The joint spaces start to narrow. This condition is called spondylosis. Spondylosis with cervical myelopathy is a common problem causing chronic pain in older adults.

Surgery may be needed to stabilize this condition. Complications occur in about four per cent of the patients. An inpatient hospital survey in the U.S. over a 10-year period showed that adults older than 74 years of age were four times more likely to develop problems after cervical spine surgery. This was especially true for those who had a posterior fusion for spondylosis with cervical myelopathy.

In addition, the same group of patients were 19 times more likely to die during their hospital stay. So although unusual, your mother’s situation is not rare.

Knowing what will happen throughout the course of a disease, illness, or condition is called the natural history. With neck pain, the natural history is often unclear and varies from one patient to another.

Overall neck pain is considered benign, meaning it isn’t life-threatening. It is also referred to as self-limiting, suggesting it doesn’t usually get worse, even if it doesn’t get better.

Pain that lasts more than three months is considered chronic. Sometimes patients have acute flare-ups of their chronic pain. The symptoms get worse suddenly after any number of different triggers for each person.

If you notice the flareups occur less often, are shorter in duration, and recovery time is faster, then you may be seeing a gradual improvement. Many patients do experience full recovery, but no one seems able to predict who will have that response and who won’t.