FAQ Category: Cervical Spine

Studies show that women involved in low-speed motor vehicle accidents are most likely to develop whiplash associated disorders (WADs). Symptoms range from neck pain to headache,
dizziness, and blurred vision. Some patients even have changes in their thinking and memory.

There are three systems at work here: (1) the vestibular (inner ear) system, (2) the ocular (eye) system, and (3) the neck (cervical spine). Any or all of these can be damaged in low speed accidents. Researchers report on impact, the head and neck move forward and back on average 2.5 times the speed of the struck vehicle.

Your situation is not uncommon.

Imaging studies don’t always show the cause of problems that last long after an injury. In the case of whiplash, chronic problems from bony or soft tissue injuries are called
whiplash-associated disorders (WAD).

Chronic muscle pain, neck pain, headaches, and vision changes have all been reported after a whiplash injury. Weakness, stiffness, numbness, and loss of memory have also been found with WAD. Imaging studies often look perfectly normal.

Check with your doctor before going through the time and expense of a CT scan. A physical exam may reveal just as much information as imaging studies currently available.

Studies of whiplash injuries don’t support the use of cervical collars. Many doctors still suggest rest and a collar right after this type of injury. Since it’s been a week already you may not need it now. However you should always call your doctor before stopping any advised treatment.

Researchers report better neck motion and more pain relief after a whiplash injury with early physical therapy using joint mobilization. Joint mobilization is a way the therapist can move each neck joint through part or all of its normal motion.

There is much we still don’t know about how to treat whiplash injuries. Physical therapists are actively studying this problem. Researchers are comparing different treatments for neck pain after whiplash from drugs to the use of ice packs to exercise and physical therapy.

The doctor and therapist are the best ones to answer this question. Ask the therapist this question again after he or she sees your wife and makes a full examination. Once a week visits for injuries of this kind is common in a prepaid health care plan. Older
injuries are allowed even less frequent treatments.

The therapist will probably instruct your wife in ways to manage her pain at home. Self care and exercises are common ways to treat patients who have limited time with the therapist. It may be possible to petition the health care administrator for more visits if the doctor and the therapist think it’s needed.

You can also always pay out of pocket for more visits. Most clinics are willing to work out a payment plan that meets your financial needs while also meeting your wife’s physical needs.

You didn’t mention if imaging studies were done to confirm a specific problem in the thoracic spine.

Assuming no injury was seen on X-ray or CT scan, the proof may be seen in the results of your treatment. If treating the thoracic spine improves your symptoms, then you either got better over time or the methods used made a difference.

Scientists studying the cause of symptoms with whiplash and the best treatment for this injury still aren’t sure what works best. Some people seem to get better with treatment and some get better on their own while others have pain lasting months and years.

It’s long been recognized by groups of chiropractors and some physical therapist that a whiplash injury has two places where the spine is “whipped” and “lashed” back and forth. First the head and neck snap backwards. The head and neck fulcrum over the middle of the upper back. Then the head and neck move forward again before returning to a midline position.

Even with the use of head rests in cars today, the middle of the upper back still takes much of the force of the injury. Treating just the neck may not resolve your symptoms. It seems reasonable that your team of health care specialists is treating this additional area.

Good question and one that researchers at the University of Queensland in Australia are actively studying. They have done a series of studies comparing patients with neck pain to normal subjects without neck pain.

They are looking at two groups of muscles. The first group are deep and attach to the bones of the neck. These are called the deep cervical flexors and include the
longus colli and the longus capitus muscles. These muscles support the spine and keep it from buckling under the weight of the head.

Using computer models and electromyographic (EMG) studies they are finding out which muscles contract in normal adults versus patients with neck pain. They are also looking
at when neck movement occurs based on which muscles are firing. The small motion required during nodding occurs because of the deep cervical flexors. When they stop firing as they should, other muscles take over instead.

The body tries to keep normal motion going any way it can. The result may be pain and loss of motion as the muscles stop working normally. The head nodding exercise is a powerful tool used to restore normal muscle activity. It’s actually a retraining exercise. You are helping the deep flexors return to normal.

Whiplash is a soft tissue injury to the neck. Sometimes it’s called a neck sprain or neck strain. The injury occurs most often during a car accident. Injury to intervertebral joints, discs, ligaments, neck muscles, and nerve roots can lead to neck pain, headaches, and other symptoms.

Symptoms may be present right away after the injury or they may be delayed for several days. The final outcome doesn’t seem to depend on when the symptoms first appear.

Usually the prognosis for anyone with whiplash is good. The neck and head pain clears within a few days or weeks. Most patients recover within three months after the injury. A small number of people have neck pain, headaches, and other symptoms that last much
longer.

Recovery may occur sooner with treatment. Treatment for whiplash may include drugs for pain and swelling, antidepressants, or muscle relaxants. A soft neck collar may be prescribed and worn for a short time. Range of motion exercises, physical therapy, and cervical traction may also be used. Later, limited heat may help relieve muscle tension.

Even with a computer-based job, there are some things you can do to relieve stress on the neck. If you wear bifocals, beware of moving your head and neck up and down over and over as you switch your focus from the computer screen to the keyboard. Get single focus glasses that are right for the screen and the keyboard. Your local optometrist can help you with this Remember to use them!

Next, even if you can’t leave your computer area, take short breaks often. To give your eyes a rest follow the “20/20 rule”. This means every 20 minutes, look 20 feet away for 20 seconds.

In other words, change the focus of your eyes to some other part of the room or even out a window if you have one. Make sure your computer screen is at eye level and not above forcing you to look up. There are computer software programs designed to interrupt your work and tell you to take a break.

Shrug your shoulders up and down a couple of times. Take some deep breaths. Reach your hand straight out in front of you and up over your head. Breathe deeply as you do these movements. If you can, just standing up and sitting down again can give your body the break it needs. It’s all the better if you can stretch in the standing position.

Pancoast tumors were first reported and named by Dr. Pancoast in 1924. The tumors are located in the upper part of the lungs. Pancoast disease is a form of lung cancer. It is treatable if caught soon enough. The downside is that the patient usually doesn’t have any symptoms until the tumors spread outside the lungs.

Neck and shoulder pain can occur when the tumors extend into the nearby tissues and put pressure on the nerves to the neck and shoulder. Sometimes the ribs and diaphragm are affected. There may also be joint swelling and skin and nailbed changes.

Make sure your aunt reports any changes she notices to her doctor. For the best possible results, treatment should not be delayed.

Constant pain in the neck or shoulder can be caused by a variety of diseases and illnesses. Lung cancer is one cause; heart attack, tuberculosis, and kidney disease are other possibilities.

Older adults can have very complicated health concerns. It isn’t always clear when pain comes from aging, collapsing bones and when symptoms come from diseases of the organs. Delay in diagnosis is common and doesn’t reflect negligence on the part of the doctor or
other health care professional.

Sometimes diseases have so few symptoms, it isn’t until the condition gets much worse that the cause can even be found.Only a few cancers can be detected by a blood test. X-rays are often negative for any signs of disease except severe arthritis.

A recent study did show that Pancoast tumors (a form of lung cancer that can cause shoulder and neck pain) can be seen on X-rays in some patients. The doctor must know what to look for to see it early. X-rays of the neck and shoulder usually do show the lung
fields. While focusing on the joints and spine, the lung changes may not be seen.

Horner’s syndrome is a group of symptoms that include sinking in of the eye with drooping eyelid and an absence of sweating. Horner’s syndrome and neck or shoulder pain can be related when they are both caused by pressure on the nerves to those structures.

A form of lung cancer called Pancoast tumor is the most common cause of neck or shoulder pain with Horner’s syndrome. In this type of cancer, tumors fill the upper lung lobes. When cancer cells leave the lung and extend further up, the nerves to the arms, neck, and face can be affected.

These conditions can be very serious. You may want to make an appointment to talk with your father-in-law’s doctor and get the full details.

There is a wide range of beliefs about treating whiplash injury. Doctors, therapists, and chiropractors often have difference ways of approaching the same problem. And today’s modern research hasn’t cleared up the confusion yet. That’s because no one, single treatment is known to work the best for this problem.

One thing most everyone agrees on is rest versus activity. Most health care professionals will advise patients with post-whiplash pain to work through the symptoms. Rest is okay in small doses, but complete bed rest is not advised.

Emotional and psychologic factors can play a role in ongoing neck pain. More often the patient has developed fear avoidance behaviors. This means the fear of pain causes him or her to avoid certain movements or activities.

And research shows impaired movement can occur after neck injuries of this type. The muscles get out of balance so that some are contracting too much, others not enough, and some at the wrong time.

Find out if your doctor has a plan in mind for helping you manage your symptoms. If not, you may want to think about other types of treatment for chronic pain. This could include acupuncture, physical therapy, or chiropractic care. Activity and exercise are always advised in either the acute or chronic whiplash injury.

Most experts agree that bed rest is NOT advised for neck pain from a whiplash injury. In fact, activity and exercise are helpful even during the painful phase. Only about one in 100 doctors tells patients to stay home from work until the pain is gone.

Most doctors and chiropractors tell patients to resume as many normal activities as they can during the healing phase. Exercise therapy is often provided by physical therapists. Chiropractors may also recommend acupuncture, traction, and massage therapy.

Let your doctor know you’re ready to return to work. If there are no safety concerns, his or her approval is a good idea before resuming normal work activities.

No known cause for chronic neck pain after frontal impact has been discovered yet. Scientists are studying the problem carefully. Many theories have been proposed including:

Artificial disc replacements (ADR) are currently used only in the lumbar spine. Researchers are trying to develop an ADR for the neck (cervical spine). Thoracic disc replacements will probably come next.

The first cervical ADR was done in 2002 by surgeons at the Indiana Spine Group (Indianapolis, Indiana). Clinical trials are currently underway. Two artificial cervical disc replacement devices undergoing FDA approval are the Bryan disc and the Prestige disc.

The Bryan disc is a metal-on-plastic design. The Prestige disc is metal-on-metal (stainless steel). The results of this trial will be ready in the next year or two. The FDA will use the study results to decide if cervical ADRs can be released for use in the general public.

Ten centers in the U.S. are also doing clinical trials using PRODISC-C® Total Cervical Disc Replacement. You can go on-line and find a list of these centers (http://www.spineuniverse.com/displayarticle.php/article2461.html). You may want to contact the closest one to you to see if you qualify to participate in the study.

Sometimes patients have part or all of a disc removed to take pressure off the spinal cord and/or spinal nerves. This operation works well to relieve pain. About 80 percent of the patients have a good or excellent result.

Just taking the disc out without repairing the damage can lead to problems later on. A large number of patients report neck and shoulder pain. Getting rid of one pain only to gain another is not a successful operation.

Most discectomies are just part of the operation. The surgeon usually fuses the two vertebral bones together on either side of where the disc used to be. A titanium cage filled with bone chips may be inserted between the two vertebrae to help keep the normal disc space.

A new development may change all this. In 2004, the FDA approved a new device called an artificial disc or disc prosthesis. It’s designed for use in the lumbar spine but studies are underway to use it in the neck as well. Once the disc is removed, a disc implant can be inserted between the vertebral bones. The end result is pain free motion in all directions.

By definition a fusion means two parts are held together permanently. There’s no movement between the two parts. In the case of a spinal fusion, there’s motion at the segment above and below, but not at the level fused. The idea is to hold the section steady or stable. You’ll lose motion but you should also stop having the difficult symptoms.

Usually a fusion at only one level will not prevent you from doing what you need to do. You may have to be a little creative for those shots that require just the right twist and bend of the neck. You can carry small pillows and props to help for still photography or viewing wildlife for long periods of time.

One other option may be available soon. That’s an artificial disc replacement for the neck. Surgeons at several centers around the United States are already using these implants in the low back (lumbar spine). It’s only a matter of time before they will be ready for the neck (cervical spine). Ask your doctor about this option for you.

Disc replacements for the spine are not far off, but actual bone replacement isn’t ready yet. Only about a dozen spine centers around the United States are using disc replacements and only discs in the low back or lumbar spine are being replaced at this time.

However, some say it’s only a matter of time before a similar device is ready for use in the neck. Right now studies are being done on cadavers. These are spines preserved for study after death. Scientists at the Orthopaedic Biomechanics Lab in San Francisco studied the use of a special ball-and-socket implant design for the cervical spine (neck).

The results were very good in terms of restoring disc height and neck motion. The disc replacement gave the cadavers normal motion in all directions. Future studies will look at the amount of load put on the discs and joints above and below the implant.

ACIF refers to anterior cervical interbody fusion. This is a way to fuse two cervical (neck) vertebrae together from the front of the spine (anterior). The disc is taken out from between two vertebral bones. A bone graft is used to hold the bones
together. During the healing process, the vertebrae grow together forming a solid piece of bone out of the two vertebrae.

Eighty-five to 90 percent of all patients with an ACIF have good results during the first
five years. This figure drops to around 84 percent by 10 years and 67 percent at 17 years. Not everyone who has a return of symptoms needs surgery. Most patients get better with conservative care.

A recent study of this problem reports only seven of 112 patients (about six percent) had
another fusion at the next level. The authors of the study say it’s likely these patients
already had disc disease at the next level. Over time it just got worse and needed
fusion.