News Category: Cervical Spine

When the neck is extended suddenly, the spinal cord can get compressed. Serious damage to the spinal cord can also occur from car accidents, diving, and falls. Symptoms of pain, burning, and numbness in the arms and hands signal a condition called acute cervical central cord syndrome (ACCCS). Muscle weakness may also be present.

Treatment for this problem ranges from a “wait-and-see” approach to surgery. Doctors are looking for ways to tell who will get better without an operation and who needs surgery right away. A study in Japan reports that good predictors of full recovery have been found.

Younger age with a normal MRI is the best predictor. No bone fracture and no bleeding are also good factors. Swelling or other signs of hemorrhage are bad signs. How fast the patient improves in the first few weeks after injury is even more important than the signs and symptoms present at the time of the trauma.

Trauma to the neck and spinal cord without fracture or bleeding has a good result. Surgery isn’t needed and the patient usually recovers fully within the first six weeks. This applies to patients with only arm symptoms. Symptoms in the arms and legs is different and requires different medical strategies.

Disc problems in the neck can cause severe headaches. In some people, these headaches come with nausea, arm pain, dizziness, and vision problems. When no other treatments work, surgery may become necessary. But how well does surgery work?

These doctors looked at nine patients with extreme headaches caused by the discs in the upper part of the neck. All patients had a specific type of surgery called anterior cervical discectomy and fusion (ACDF). In this surgery, the surgeon works from the front (anterior) part of the neck. The problem disc is removed in a procedure called a discectomy.) Bone graft material is then put in place of the disc. The bone graft eventually grows into the vertebrae above and below, fusing them into one solid bone.

The patients were followed for an average of three years after surgery. In that time all of the patients got relief from their pain. Five of them reported total relief from their headaches. The main complication of the ACDF surgery was a problem with swallowing in some of the patients, but this went away with time. Notably, all nine patients said they would have the same surgery again. The researchers conclude that ACDF can be an effective treatment for patients whose headaches are coming from problem discs in the upper part of the neck.

Scientists still haven’t unlocked the mystery of the whiplash injury. After being rear-ended, why do some people walk away without any neck pain and soreness, while others suffer months of painful symptoms? Researchers are looking for some answers.

In England, a quarter of a million adults report a whiplash injury every year. This has a huge cost in terms of money, loss of work, and legal fees. There are only a few known factors that help tell who will have problems. These include psychologic factors and ongoing legal battles.

One study in England measured the levels of a muscle enzyme normally present after muscle injury. This is called creatine kinase (CK). CK levels go up after other injuries that have muscle damage. As the CK level rises, muscle soreness occurs. CK levels remain unchanged after whiplash injury. No change occurs within 24 hours, 48 hours, or three months later.

These findings suggest that the painful symptoms from a whiplash injury aren’t coming from the muscle. Many of the patients with long-term symptoms are involved in a legal dispute. There is an absence of reported whiplash in countries where insurance and legal aid don’t exist.

According to this study, whiplash injury does not appear to be a problem with muscle damage. Additional studies are needed to provide more answers about the causes of pain long after a whiplash injury.

Why do patients on worker’s compensation tend to have a harder time recovering from neck and back pain? There are many theories but no answers. This study looked at over 2000 patients with neck pain. All the patients filled out a standard survey about their background and their health.

Patients who got worker’s compensation were compared to other patients. There was one main difference: worker’s compensation patients rated their ability to do physical activities lower than other patients. Worker’s compensation patients were also more likely to be younger and heavier than other patients. They had less education and were more likely to have been regular smokers at some time in their lives.

This study raises more questions than it answers. More research into the issue will help doctors understand what is stopping some worker’s compensation patients with neck pain from getting better.

Most people are familiar with the idea that low back pain can be caused by disc problems. But discs can also cause problems in the neck. Damaged discs in the neck can cause muscle weakness, hand numbness, arm pain, and even bowel or bladder problems.

Similar treatments to those used for the low back area may be used. Surgery may be done to remove part of the disc and to fuse the vertebrae above and below the problem area. The difference is in how it’s done. In the low back area, the incision is commonly made from the back of the body, moving toward the spine. In the neck, the surgeon most often goes in from the front of the neck.

After this kind of surgery, hoarseness and problems with swallowing can occur. These may happen as a result of swelling in the neck area. If more than one disc is removed, the chance of these problems occurring goes up. This is because more soft tissue is cut, and there is a greater chance to damage the nerves in the area.

Doctors are finding ways to reduce these problems. For example, the breathing tube used during the operation can put pressure on the nerves. This can be changed. Once the tube is in the trachea, the doctor lets the air out in the cuff that’s holding the tube in place. Then just enough air is allowed back in to keep the airway open.

Other solutions to the problem include using drugs to reduce the swelling. New imaging technology is also making it possible to see the problem area before cutting open the skin. This limits the amount of surgical damage. For patients with disc problems at several levels, it may be best to reach the discs from the back surface of the neck.

Pressure on the spinal cord from a protruding disc or other cause can be serious. In the neck, this condition is called cervical myelopathy. If it gets worse, the patient can end up with major problems. There can be weakness that never gets better, bowel or bladder problems, and other nervous system symptoms.

Degeneration is the most common cause of cervical myelopathy. This cause of pressure on the spinal cord in the neck is called spondylotic cervical myelopathy. In the past, it has been common for doctors to recommend surgery for mild to moderate symptoms arising from this condition. The operation is designed to get the pressure off the spinal cord. Mounting research is calling this method into question when the condition is mild to moderate and isn’t getting worse.

A group of doctors in the Czech Republic wondered if surgery is a better choice when viewed years later. They followed patients for three years and still didn’t see a better result with surgery than without. This doesn’t mean that surgery for this condition is never needed. Surgery is still the number one choice in cases where the opening for the spinal cord is too small, or where symptoms are severe or worsening.

Doctors have entered a time when it is vital to match the right treatment for each condition they see. Better surgical results come from selecting patients carefully before recommending surgery.

It seems that neck pain is no respecter of persons. Young and old alike suffer from neck and shoulder pain and symptoms. At least 15 percent of all teenagers suffer from painful neck and shoulder symptoms on a weekly basis. And these symptoms among teenagers have reportedly increased during the past 10 years. The number of people affected increases with age.

Some of this is because of work-related factors. The main culprits are repeating the same task over and over with the arms raised overhead, or working with the neck bent forward. There are some psychological factors, too. People with high expectations of themselves or low control over their jobs are more likely to be affected.

Many studies have shown links between emotional and psychological stress with neck and back pain. So far, no one has been able to show what changes are going on inside the spine when this happens. A large study in Finland was undertaken to actually view the spine and what is happening.

Magnetic resonance imaging (MRI) was used to get baseline information. MRIs were taken of 826 high-school students between the ages of 17 and 19. Some had neck and shoulder pain at the time of the study, while others didn’t. Seven years later, the MRIs were repeated when the students were 24 to 26 years old.

Abnormal MRI findings were present in both groups (those with neck pain and those without). Changes in the disc were common in the cervical spine area. This surprised doctors because the group was so young. Only disc herniation as seen on MRI could be linked to the neck pain.

Changes observed in the spine only explain part of the neck and shoulder pain reported in young adults. It’s likely that neck and shoulder pain aren’t just caused by disc disease or disc protrusion. Other factors such as workload and psychosocial factors add to the risk of these problems.

The cost of health care is rising quickly. Conditions that are expensive to treat and don’t improve are being examined. One of these is in the area of spine conditions. Low back pain and its treatment have been studied a lot. Now neck pain under the label of “cervical spinal disorders” (CSD) is being studied.

One important question has been raised. It concerns worker’s compensation patients. Do these patients have a worse result after surgery to fuse the neck than patients who don’t have surgery?

In one study, two groups of patients with chronic neck pain and disability were compared. One group included 52 disabled patients on worker’s compensation. These patients had surgery to fuse the cervical spine (neck) at one or more levels. The second group was also chronically disabled, but they didn’t have surgery.

The surgery group was disabled twice as long as the nonsurgical group. They had twice the number of lawyers involved. They also saw the doctor or other health care worker more often. The surgical group was less likely to return to work after surgery, and they reported a higher rate of depression.

Work-related neck problems may not get better with surgery to fuse the neck if the patient is on worker’s compensation. According to one study in Texas, their results are no better than for patients who don’t have surgery.

Headaches happen to almost everyone at some point. Among the most common kinds are migraine headaches and tension headaches. Almost one-fourth of all headaches come from neck joints or muscles. These are called cervicogenic headaches.

In a cervicogenic headache, the patient’s pain commonly begins in the neck and spreads to the head. It ranges from a dull, deep ache to severe, heavy pressure. The pain usually stays on one side of the head, and the patient often reports dizziness and lightheadedness. These symptoms are similar to migraine headaches — but the treatment is much different.

Physical therapy is a proven treatment for cervicogenic headaches. The therapist can actually produce the pain by pressing on tender muscles or moving the neck in a certain position. The therapist must examine each patient with headache pain carefully. Finding those who can be helped by physical therapy is important.

The physical therapy program for headaches has several parts. Treatment includes restoring normal motion to the joints, improving posture, and strengthening muscles. Controlling the use of muscles and coordinating their actions is also part of the program. For those who sit at a desk or computer, the therapist usually offers training in reducing strain on the muscles and joints.

Physical therapy to improve joint motion can help reduce some types of headache pain. Improving how and when the muscles contract is part of this success. Using tests and measures, the therapist attempts to find the exact cause of the problem. This makes a specific treatment approach possible.

Physical therapists are sometimes left scratching their heads. This is the case when they try to decide which test to use to look for cervical radiculopathy (CR). CR is a disorder of the spinal nerve root as it leaves the spinal cord in the neck area.

CR is most commonly caused by a problem with the disc. The disc is the gel-like cushion between each vertebra. For example, a protruding disc may put pressure on the spinal nerve root, causing pain and other symptoms of CR. Sometimes bone spurs or tumors cause CR.

There are more than 30 tests a therapist can use to examine a patient for CR. It would be helpful to find one test or a cluster of several tests that rule out or confirm CR. A group of therapists at the U. S. Army-Baylor graduate program in physical therapy studied this problem.

They found that one test in particular was most accurate: the upper limb tension test A (ULTTA). In this test, the patient lies face up on the exam table. The therapist applies pressure to hold the scapula (shoulder blade) down while moving the arm and neck through a series of six positions.

The test can confirm that the cause of the patient’s symptoms is CR. If the symptoms increase or decrease during the test, it’s positive for CR. If there is no change in symptoms, then CR is probably not the patient’s problem. Researchers also found that patients with a positive test for ULTTA plus two other tests may need further medical tests. Range of motion measures are also helpful.

Knowing which tests are the best predictors can help physical therapists disgnose CR early. An early diagnosis may help patients avoid more expensive and painful tests when they aren’t needed.

Doctors at the Johns Hopkins Medical Center in Baltimore, Maryland, needed a way to measure and describe neck pain. They wanted a survey that also shows the results of treatment.

This tool needs to be reliable and valid. This means it can be counted on to be accurate from patient to patient, and that it measures what it says it’s going to measure.

Following a long series of steps, a group of researchers put together and tested just such a tool. It’s called the Cervical Spine Outcomes Questionnaire (CSOQ). The authors put together questions that could be used to assess neck problems. An editor and an English professor reviewed everything to make sure it was easy to understand. They tested it out on a group of 216 neck pain patients.

The CSOQ does all that it’s supposed to do and more. It can be used before and after treatment. The CSOQ is easy to use and patients like it. Besides the severity of pain, it also measures function, disability, mental distress, and how satisfied patients are with treatment.

The CSOQ can be used to monitor patients with neck problems throughout their treatment. It is a good way for doctors to measure change after treatment. The CSOQ can be used to follow patients in a clinic or to carry out further research on neck problems and pain.

Doctors in Japan are trying to improve an operation for a condition called cervical dystonia. This is a problem of unknown cause that affects the muscles around the neck and face. The muscles contract on their own, causing twisting movements and strange postures.

Treatment is usually injections of a drug called botulinum toxin (Botox). Botox is injected into the muscle that is contracting. It blocks the release of chemicals from the nerve to the muscle that tell the muscle when to contract. The muscle becomes “denervated.”

Other treatment includes therapy with an occupational or physical therapist. When these treatments fail to correct the problem, surgery may be needed. The doctor uses a microscope to magnify the area and find the nerves to the problem muscles. The nerve root to each muscle involved is cut so the muscle can’t contract.

There are many problems with this operation, including blood loss, damage to blood vessels, and loss of feeling. Other problems such as strokes and trouble wallowing or breathing can also happen. For these reasons, doctors are looking for ways to improve the current operation.

Using new microscope technology with high magnification, doctors are able to make a smaller, straighter cut into the skin. Surgeons don’t have to move or tug on the nerves or muscles. The nerve roots are easier to see and cut in just the right spot. This new operation has less blood loss, less time in the operating room, and fewer problems after surgery.

Neck problems that involve pressure on the spinal cord or spinal nerves may require surgery. Doctors usually know whether surgery is needed in these cases. But they haven’t always been certain whether patients whose main problem is neck pain should go ahead with neck surgery. This type of pain, called mechanical neck pain, starts in the neck and may spread into the upper back or to the outside of the shoulder. Mechanical neck pain usually doesn’t cause weakness or numbness in the arm or hand because the problem is not coming from pressure on a spinal nerve.

This study looked at 87 patients who had been dealing with mechanical neck pain for at least a year. All patients underwent a surgical procedure called anterior cervical discectomy and fusion. This surgery is done through the front of the neck. The surgeon takes out one or more problem discs and replaces it with a bone graft. Some doctors use screws or plates on the front of the spine to help hold and heal the graft.

In a survey four years later, 82 percent of these patients rated the outcome of surgery as good, very good, or excellent. Less pain was reported by 93 percent of the patients. They also rated improvements by 50 percent in their ability to do routine activities. The authors conclude that neck conditions that cause pain can be helped by this type of neck surgery.

Neck pain is just as common as low back pain in Canada and the United States. There are many studies on low back pain, but very few on neck pain. Most of the studies only report short-term results (less than one year).

To help change this, a group of chiropractors and medical doctors placed 191 patients into three different treatment groups. The first group received spinal manipulation only. The second group received manipulation and exercise. The final group joined a rehab exercise program.

All three groups were followed for varying lengths of time. Surveys were given to all the patients to measure results at five and 11 weeks. These were repeated at three and six months, then at one and two years.

Patients in the two exercise groups reported less pain and greater satisfaction than those who had only spinal manipulation. The exercise groups also gained increased strength and range of motion. These changes were still present two years after treatment.

The authors of this study think there may be an advantage to exercise or manipulation and exercise combined as a treatment for neck pain. These treatments were compared to treatment with just spinal manipulation. This study also confirmed the results of other studies showing that supervised exercise is better than exercise alone at home.

Changes sometimes occur in the neck as we get older. Unless we have neck and shoulder pain or other symptoms, we probably aren’t aware of these changes. For example, the bones in the neck called vertebrae commonly form bone spurs. The spurs can be smooth and round but are usually spiked and sharp. The ligaments around the bones may get thicker or thinner.

These changes alter the shape and size of the spinal canal, making it smaller and oval in shape instead of round. This is called stenosis. The canal is the space where the spinal cord passes through the spine from the skull to the low back. Less space for the spinal cord means possible pressure on the cord. Pressure causes neck and shoulder pain. Pressure on the nerve roots as they leave the spinal cord can cause numbness and tingling in the arms. A stiff neck and arm pain are also possible.

The changes of of aging can also affect the way the bones move. The bones may start to slip and slide on top of each other. When one bone moves forward over the bone below it, the spinal canal gets even smaller. The neck becomes unstable.

Surgery may be needed to make the spinal canal larger. The operation is called a laminoplasty. There are different ways to do this operation. A group of doctors in Japan found a way to reattach bones and muscles that were cut during the procedure. The technique can be used with patients who have bone slippage and instability. The results after surgery are the same for patients with and without instability. This method may even hold the spine steady and keep the bones from slipping.

Headaches are common in adults of all ages. Most of us recognize the age-old “tension headache.” These headaches are caused by face, scalp, and neck muscles contracting for long periods of time. Tension headaches may come and go, but they don’t usually last weeks or months at a time. Other headaches are caused by muscle or joint problems in the neck. These are called cervicogenic headaches.

Physical therapists (PTs) often see patients with headaches. There is some question whether physical therapy is helpful for headaches. There is very little research to shed light on the subject. Therapists in Southern Australia offer some new information on the PT treatment of headaches.

Two hundred patients with cervicogenic headaches were divided into four groups. These groups were based on the kind of treatment given. The control group received no PT treatment. A second group was given an exercise program. A third group received manual therapy, a form of joint motion that includes neck manipulation. The fourth group received both manual therapy and exercise in the same treatment session.

The three groups given some form of manual therapy or exercise had better results than the control group. Neck pain and headache were less intense and less frequent with manual therapy, exercise, or both combined. The effects of treatment continued for up to 12 months. There was no change in posture with any of the treatment options. Manual therapy alone didn’t change muscle function, but the prescribed exercises did.

A large study of adults from Southern Australia agrees with the use of both manual therapy and exercise for cervicogenic headaches. These treatments are given by a PT for six weeks. Almost three-fourths of the patients in the active treatment groups had fewer, less intense headaches.

Disc problems commonly affect the low back. Less often, disc material can press against the spinal cord of the neck. This is called cervical myelopathy. Myelopathy can cause problems with the bowels and bladder, change the way you walk, and affect your ability to use your fingers and hand.

When all other treatment has failed, surgery is the next step for cervical myelopathy. The best surgical method for this problem is unknown. Surgeons have tried many different ways to take the pressure off the spinal cord. This is hard to do without causing other problems in the neck.

A group of doctors at a large spine center compared two methods of surgery for cervical myelopathy. The first is called cervical corpectomy and involves removing the front of the spine bone, the vertebral body. A bone graft is put in its place and fused to the vertebra above and below it.

The second surgery is called laminoplasty. In this operation, the doctor removes a piece of bone over the back of the spinal cord. This covering of bone is called the lamina. There are two laminae for each vertebra, one on each side. By cutting all the way through one lamina and making a hinge on the other, this section of bone can be opened like a door. This takes the pressure off the spinal cord.

Corpectomy and laminoplasty can keep myelopathy from getting worse. The laminoplasty has fewer complications after surgery. Patients have better motion and uses fewer medications after a laminoplasty.

The first study to compare results of surgery in the neck for cervical myelopathy has been reported. Only two of the possible methods were compared. Both had similar results, but laminoplasty had fewer problems after surgery.

Muscle pain from work activities is often treated with exercise and stress management. How well do these programs work? And how long do the benefits last?

A group of physical therapists in Sweden studied 126 working women with neck and shoulder pain. The women were divided into four groups. Three groups were given exercises three times a week for 10 weeks. Each group did a different set of exercises. The fourth group took classes on stress control and didn’t exercise. The therapists followed up with each group several times over the next three years.

Right after the program, exercises to improve muscle strength had the best results. Women who did these exercises had less pain than women in other groups. Over time, however, there weren’t any differences between the groups in terms of pain relief, sick days, and work status. In general, women who exercised regularly seemed to be in better health.

People who have neck and shoulder pain for more than six months often improve with exercise. The type of exercise doesn’t seem to matter. Exercise can reduce pain. Exercise also brings a sense of well-being that helps people cope with lasting neck and shoulder pain.

As a group, it seems that Japanese people have an unusual amount of myelopathy. Myelopathy is the medical term for pressure against the spinal cord. When this occurs in the neck, it is called “cervical myelopathy.” Anything that causes the spinal canal to narrow in size can cause this problem. Examples include arthritic changes, inflammation, trauma, or problems in the bone structure at birth.

Every bone in the spine has an opening for the spinal cord to pass through. This is called the spinal canal. Having a narrow spinal canal is the main reason people end up with cervical myelopathy.

Gender is also an important factor in cervical myelopathy. According to researchers, Japanese men have this problem more often than Japanese women. A third risk factor is large spine bones. Is there a relationship between these three risk factors?

To answer this question, researchers looked at X-rays of people newly hired by a large company in 1975. This company required a physical exam and spine X-ray of all its new employees. There were 107 men and 116 women in all.

Three measurements were taken from each X-ray: (1) the height of the individual neck bone, (2) the size of the neck bone from front to back (diameter), and (3) the size of the spinal canal opening.

The researchers found that the height of the neck bone had no connection to the size of the spinal canal. This was true for both men and women. However, in men only, the size of the neck bone from front to back made a difference in the size of the spinal canal.

Three risk factors for cervical myelopathy have been identified in the Japanese population. These are male sex, narrow spinal canal, and large bone size. For men, the size of the bone is linked to the size of the spinal canal. This is called the canal/body ratio. The canal/body ratio of the cervical spine is smaller in Japanese men than in women, which may be why cervical myelopathy shows up more in Japanese men.

If you have muscle pain in your neck and shoulders, you may wonder exactly where it comes from. Is it from doing the same tasks over and over at work? From job demands, or the amount of control and support you feel in the workplace? Or does neck pain come from personal factors such as your age, activity level, and personality?

These researchers collected information from over 3,000 workers in 19 industrial and service settings. The workers mostly did unskilled, blue-collar work.

Seven percent of the workers who did the same physical tasks over and over had neck and shoulder pain. Only four percent of workers who didn’t do repetitive tasks had pain.

The researchers looked at videotapes of people working to identify specific risk factors for neck and shoulder pain. In particular, they watched for repetitive work, use of physical force, neck posture (working with the neck bent forward), and lack of shoulder rest time. All of these were associated with neck and shoulder pain. Repetitive tasks that used force were especially related to pain.

High job demands and lack of job control were both linked to neck and shoulder pain. Lack of support from coworkers and supervisors was not linked to pain, however.

Women were more likely to have neck and shoulder pain than men. So were people who had lower tolerances for pain and those who were highly invested in their work. The strongest risk factor for neck and shoulder pain was previous neck or shoulder injury. Age, body size, and physical activities done outside of work were not related to neck and shoulder pain.

Neck and shoulder pain have a strong impact on workers’ lives. The more pain and muscle tenderness these workers had, the poorer their health-related quality of life. This research shows that a variety of factors, both personal and work-related, are important to neck and shoulder pain. All of these factors should be considered in prevention and treatment.