FAQ Category: Cervical Spine

Both. Whiplash has two separate phases very close to what you’ve described. In the first phase, the person’s head actually goes backward into extension. The head and neck then
return to the neutral, upright position before going forward and snapping back again. It happens so quickly the person isn’t really aware of all the distinct movements.

Strain to the joints and ligaments occurs at different points in this movement. The neck ligaments are strained the most during that first backward phase returning to neutral. Then the joints are pressed together and slide forward and back. Any of these motions can go beyond where the joint is normally capable of going.

It’s hard to say. Sometimes the position you’re in on the operating table can leave a patient stiff or sore. For a cervical spine fusion you can be placed in one of three positions. You may be face up, face down, or on your side.

In the case of a posterior cervical fusion you’re face down. The arms may be held in place with tape. Weights may be used to pull the arms away from the spine. This helps hold the arms and gives the doctor better access to the surgical site.

Some fusions are done from the side. This gives the doctor room to reach the side and part of the back of the neck. In a neck fusion operation you can end up with afterward pain if your arms are positioned in one place too long. The same thing can happen if your arms aren’t fully supported.

Be sure and talk to your doctor if your symptoms don’t go away in a few days. Finding and fixing problems early can prevent complications.

Spontaneous fusion isn’t an everyday thing, but it’s not uncommon. It usually occurs withv aging, arthritis, or disc degeneration. Bone spurs form around a joint or on either side of the spine and stop motion. Bridges of bone can also form to fuse the spine.

Sometimes the fusion site isn’t stable and an operation is needed. Bone graft and/or plates, screws, or wires can be used to gain a solid fusion. Your doctor will be able to see the fusion on an X-ray. The presence of any movement may signal the formation of a false joint. Increased pain will alert you to any problems.

Myelopathy refers to any disease or condition affecting the spinal cord. Degenerative disease in the discs refers to damage to and break down of the disc material. Degenerative disc disease is common in the older adult. It often becomes symptomatic in middle age and gets worse as we age.

In the neck, when the disc pushes out of its space, it can put pressure on the spinal cord or the spinal nerves as they leave the spinal cord. The result can be pain, weakness, and numbness and tingling into the arms. The symptoms are very bothersome, but not usually life-threatening.

Treatment with drugs, physical therapy, and sometimes, surgery can be very helpful.

As a general guideline, degeneration of the cervical spine (neck) refers to three structures: the bones, the discs, and the joints. X-rays are usually used to make this diagnosis. First the doctor looks at the height of the disc space where the fusion took place. This measurement is compared to the height of discs that show no sign of
degeneration.

If up to 25 percent of the disc height is lost, there’s mild degeneration. A loss of up to half the disc height is considered moderate. Severe is shown by a loss of more than half the disc height.

A second measure of degeneration in the cervical spine is the presence of bone spurs called osteophytes. As the disc degenerates, the joints start to get pressed together. The joints start to get worn. The body responds by adding more bone around the joints. This can actually result in less movement at the joint.

The spine can get stuck in a position of too much flexion called kyphosis or too much extension called lordosis. The degree of these curves can also be graded as
mild, moderate, or severe.

A recent study from Belgium followed 180 patients for up to 15 years after cervical spine fusion. They found patients had disc degeneration at the levels above and below the fusion site as more and more time went by.

Although 92 percent had degenerative changes on X-ray, only six percent needed another operation. Reoperation is done only when there are clear signs of nerve pressure or spinal cord compression. Even then, patients usually must try other treatment before a
second surgery is advised.

The greater occipital nerve is located in the head and neck. Chronic pain from this nerve is called neuralgia. The cause is often unknown. Sometimes when the nerve passes
through a muscle it gets stretched and becomes painful.

Researchers have shown some changes in anatomy such as bone spurs or large veins can cause this problem. Some cases of severe arthritis affecting the upper part of the neck have been reported as a cause. Without a known cause it can be difficult to treat. Even with treatment the painful symptoms can come back.

Fibromyalgia is a condition with many different symptoms of muscle pain and other problems. Many patients with fibromyalgia report headaches and neck pain. However, other things can cause these symptoms.

For example, infection, trauma, inflammation of arteries, and tension can cause headaches. Tumors, increased blood pressure, and bleeding inside the skull can also cause head pain. The key feature in your case is increased pain with neck flexion. This points more to a problem with the neck joints, muscles, or a nerve.

Don’t assume all new symptoms are the result of your fibromyalgia. See your doctor if the headaches and neck pain don’t go away in a reasonable amount of time.

The feeling of numbness in the back of the head can be very unpleasant. It is a well-known complication of an operation to release a nerve. Some patients also report scalp
hypersensitivity or scalp pain instead of numbness.

Loss of sensation as described can be permanent. Return of nerve function can take up to 18 months. If you don’t have normal sensation in another year, you aren’t likely to get it later.

If this symptom gets worse or you develop new problems, talk to your doctor. There may be treatment available.

Some doctors ask their patients to wear a brace to help stabilize the spine until it heals. No one knows for sure how IDET (intradiscal electrothermal therapy) really
works. Using a brace may help patients get a better result after the operation.

A survey done of patients in the Los Angeles area showed 79 percent wore the brace more than six hours every day. Some stopped wearing it after a month. Others continued to wear it for more than a year.

You should discuss this with your doctor. Find out what his or her thinking is on bracing, and share your concerns about the brace at work. You may be able to wear the brace in a schedule that better fits your lifestyle.

Head and neck injuries are common after car accidents, even minor ones. Many people develop what’s called a whiplash-associated disorder (WAD). Your symptom may be caused by a WAD.

Movement of the head and neck uses information from three systems. The muscles in the head and neck send information to the brain about position, speed, and movement. The inner ear (vestibular system) keeps us upright without dizziness and falls. Data from the eyes (ocular system) is also an important part of staying upright and moving through space.

Even minor car accidents can cause a problem in one (or more) of these systems. Dizziness suggests a problem in the vestibular system. There are tests that can be done to find out for sure. You may want to make an appointment with your doctor for an exam. Often treatment for this kind of problem is very quick and easy.

Disabilities are faked for many reasons, including getting court awards, out-of-court settlements, drugs, and even sympathy and attention. When someone deliberately fakes an
illness or condition, it’s called malingering. When it’s done unintentionally, we call it illness behavior.

Some doctors say exagerating pain may give some patients time out from work and other ies. Psychologic or social problems may be the real cause of the symptoms. For the patient, the symptoms still may be very real.

We don’t have one single test to answer this question for sure. There are several tests to help give better information. Doctors and therapists perform this kind of exam. Researchers in Iceland have a new test called The Fly to show when head and neck
motions are normal. In time this test may be used to find fakers.

Employees out on work-related injuries usually have a case manager. You may want to contact that person with your questions and concerns.

Trigger point (TrP) is a term used to describe a painful area in the muscle about the size of your fingertip. The area underneath it is often a tight band of tissue. Pressing on this spot causes a full-blown pattern of pain in the tissue around the TrP.

Doctors aren’t sure what happens inside the muscle to cause a TrPs. There are several theories. We do know repeated motions or prolonged activity or postures bring them on. Sitting at the computer and typing for hours every day is just one example of what can cause TrPs in the neck and shoulders.

TrPs are painful and can interfere with daily activities. Treating them may improve the patient’s pain and function. TrPs can be treated by a physical or occupational therapist. The therapist may use ultrasound, stretching, biofeedback, and postural exercises.

The therapist will also help you find out what is bringing on the TrPs. Change in workstation or lifestyle may be needed to get rid of them for good.

Side effects after neck manipulation occur in one out of every three patients. That’s about 30 percent of the people getting this type of treatment. Usually the symptoms go away after a few hours up to a day. Patients report dizziness, ear symptoms, or
headaches. Other side effects can include increased neck pain or numbness and tingling down the arm. Some patients get pain in a new location like the back or chest.

Call your doctor and report your reaction. Make a follow-up appointment or get a medical opinion from another doctor if the symptoms don’t go away.

Small studies have an important place in research. They are a starting point that can lead to larger, better studies. How and when to use data depends some on the type of study done. In the best studies there are several groups. The researcher doesn’t know who gets what treatment. The patients don’t know either. And there’s one group that isn’t treated called the control group. The control group is used for comparison.

Data can be pooled from matching studies. In this way the researchers can take the results from more than one study and combine it together. There are actual groups who base all their findings on this type of study. It’s a very valid way to study problems.

Researchers can use formulas to help them choose the right number of patients or subjects for a study. This can tell them how many must be in each group to have findings that count.

It’s always best to get a medical opinion before you treat yourself for neck pain. Once you know what is the problem, then you can apply treatment known to work for that problem.

How and when muscles contract after injuries and accidents is a major area of study. All we have at this point are theories to guide us. More research is needed to find the real answers.

According to one model, pain causes one group of muscles to decrease activity. Then the opposite muscles increase their activity. Sometimes other “helper” muscles contract at the same time. In the neck area, these helper muscles are called accessory muscles. They include the upper trapezius, sternocleidomastoid, and anterior scalene muscles.

Coordination of the neck and shoulder muscles gets off-balance after a neck injury. Pain keeps the body from getting back to normal. Biofeedback is a good treatment choice to help regain normal motor control.

There are many tests available to help doctors understand their patients better. Some tests help describe the kind of pain the patient is having. What causes it? What makes it better or worse? How severe is it? How long does it last?

Other tests measure the patient’s quality of life, level of depression, or disability. The Neck Disability Index (NDI) score helps identify how limited the patient sees him or herself from the neck pain. This is a scale of perceived impairment.

It specifically measures how much the patient’s daily activities are affected by the neck pain. The patient is asked about pain intensity and affect of pain on concentration. Other questions look at personal care, work, lifting, and driving. Recreational activities are also included.

It’s a good question, but it’s impossible to say. Some doctors might call your previous neck problems a “pre-existing condition.” Others may see these as two separate episodes.

A recent study of neck pain from Australia showed how muscle activity changes after a
neck injury. The painful muscles stop contracting and other nearby or opposite muscles increase their activity instead.

Did the change in muscle activity come after the neck injury or was it present before the neck pain started? Some scientists think it’s possible that altered muscle coordination
already present is what causes the neck pain after a minor injury. More study is needed to iron this one out.

Lots of studies have been done on manipulation for neck pain. Researchers would like to know what works and why. So far they haven’t been able to show that a single session gives short-term pain relief. Manipulation combined with heat isn’t any better.

A recent study reports on the findings of 33 other studies done using manipulation for neck pain. Treatment was given anywhere from six to 20 sessions. Length of treatment ranged from three weeks to 11 weeks. The results were compared to patients receiving other treatment during the same time frame. No difference in results was found between the groups.

Studies comparing one type of manipulation to another show no difference in results. The best results come when manipulation is combined with exercise. Your improvement may be due to factors other than the chiropractic treatment.

Whiplash is a term used to describe the painful symptoms that can occur after the head and neck bend forward and back with force. Whiplash injuries occur most often with
rear-end or side impact accidents. The energy transfer during the forceful movement is what causes the injury.

No findings doesn’t mean there’s no injury. Research shows the damage or injury is difficult to see with imaging studies. But there’s no doubt that muscles, joints, and discs can be damaged. Not only that, but the inner ear, nerves, and even the brain and esophagus can be injured.

Tiny tears in these structures may be the underlying problem. We don’t really know more than that at this time.