Neck Pain / Cervical Myelopathy

Structure of the cervical spine

The cervical spine (neck) is made of bones (vertebral body), intervertebral discs (cushions in the spine), facet joints (much like joints of the hips and knees) and ligaments. There are muscle attachments to the spine which help in the movement of the spine. The bones in the cervical spine are much smaller than the bones in the lower back (lumbar spine). The spinal cord runs inside the spine and it gives off nerves which gives sensation and moves the arms and legs.

muscles

Causes of neck pain

Neck pain is a very common symptom. In this modern day and age, text neck is becoming a problem where looking down places stress on the neck resulting in neck pain (https://www.straitstimes.com/singapore/health/texting-too-much-can-be-a-pain-in-the-neck). Neck pain may also occur from a change in the structure of the disc. Disc degeneration, where the disc hydration is lost, tears in the lining of the disc (also called annular tears or annular fissures) and prolapsed intervertebral disc or herniated disc (where the disc has slipped out of its confines) may cause neck pain. Problems in the bones of the spine such as a fracture, infiltration by either tumours or infections may also cause neck pain. Facet joints arthritis, often associated with degenerative discs is another cause of neck pain. The commonest level affected by degenerative changes is C5/C6. Problems in the neck can be referred to the back of the shoulder and patients can sometimes mistake a neck problem for shoulder pain. Poor head support from pillows can sometimes be a culprit for neck pain.

Symptoms of cervical radiculopathy and myelopathy

When one particular nerve is compressed in the spine, there may be pain or tingling going down the arm. This is called radiculopathy. There may be associated numbness or weakness of the extremity. It can often be caused by a slipped disc or disc herniation. When the spinal cord is compressed, multiple nerves are affected. This can cause additional symptoms of clumsiness of the hands, numbness in the torso or

Our treatment options

X-rays and/or MRI may sometimes need to be done to obtain further information before deciding on the type of treatment of the spine. Physiotherapy, exercises, medications and sometimes injections are used in the treatment of neck pain from degeneration of the spine. A short course of a neck brace is sometimes prescribed for treatment of neck sprain. Treatment of nerve compression symptoms depends on the nature and severity of the nerve(s) compression. Non-operative treatment of the spine can be instituted first for mild cases.

If there is severe compression of the nerve(s) or spinal cord in the spine, surgical treatment of the spine may sometimes be necessary. This is done to prevent further damage to the nerve(s) and give the nerve(s) a chance to recover. Surgical treatment of the spine may be done from the front. If the offending agent is a disc, the disc can be removed and can be replaced with an artificial disc (cervical artificial disc replacement or ADR). In other cases, fusion (joining the bones together) of the 2 bones (anterior cervical discectomy and fusion or ACDF) may be done after removing the disc that is pressing on the nerve(s). Most patients who undergo a cervical artificial disc replacement or anterior cervical discectomy and fusion can be discharged the next day. In some cases, surgical treatment of the spine surgery is done from the back. This may involve removing part of the bone alone (cervical laminoplasty or cervical laminectomy) or removing the bone and fusing the spine (cervical laminectomy and fusion). Treatment of the spine is highly individualised. Surgical treatment of the spine, if needed, depends on the cause and severity of the compression of the nerves and/or spinal cord.

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Figure: Slipped disc in the neck causing compression of the spinal cord resulting in cervical myelopathy



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