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Treating Common Problems of the Cervical Spine

Posted by Midwest Orthopaedic Consultants on November 6, 2017

treating-common-problems-of-the-cervical-spine.pngMany different problems can affect the neck — or cervical spine — especially with age. Treatment for neck conditions can range from a conservative approach that involves rest and over-the-counter medication to spinal surgery. Neck conditions may occur with age, trauma or disease, or a combination of factors. This blog describes common cervical spine conditions and how they are treated. 

Degenerative diseases of the neck

Degenerative processes of aging occur at different rates and locations on the body, based on people's unique attributes. Factors known to influence degenerative diseases of the spine include:

  • Lifestyle
  • Work patterns
  • Diet
  • Genetics

Cervical spondylosis is a general term encompassing a number of degenerative conditions, including degenerative disc disease (DDD) and spinal stenosis, a narrowing of the spine. These can occur with and without:

  • Degenerative facet joints, which are the joints that allow your spine to bend and twist
  • Formation of osteophytes, or bony growths that are also called bone spurs
  • Herniated disc

One single component as a diagnosis is rare in these cases.

Degenerative disc disease

The process of degenerative disc disease is thought to begin in the annulus fibrosis — or the tough exterior of the intervertebral disc that encircles the softer core — with changes to the structure and chemistry of the concentric layers. Over time, these layers suffer a loss of water content and the protein proteoglycan. This loss changes the disc’s mechanical properties, making it less resilient to stress and strain.

Degenerative disease can affect the facet joints because changes in disc structure and function cause changes in the articular facets, especially hypertrophy, or overgrowth. This results from the redirection of compressive loads from the anterior and middle columns to the posterior elements of the spine.

There also may be hypertrophy of the vertebral bodies adjacent to the degenerating disc. These bony overgrowths are known as osteophytes, or bone spurs.

The progressive degeneration of a disc, or traumatic event that affects a disc, can lead to a failure of the annulus to adequately contain the nucleus pulposus, the soft inner core of the vertebral disc. This is known as herniated nucleus pulposus (HNP) or a herniated disc.

The symptoms of a herniated disc

A disc may be herniated to varying degrees. In some cases, the disc bulges. In cases of a disc bulge where there are mild symptoms, there is rarely a need for surgery. These usually go away with nonoperative treatment.

In cases where there is herniation — or extrusion — with moderate to severe symptoms, nonoperative treatment may be possible.

Symptoms of a herniated disc may include:

  • Neck pain
  • Shoulder pain
  • Arm pain
  • Dysthesias, or abnormal sensations
  • Anesthesias, or losses of sensation

Symptoms may resemble carpel tunnel syndrome, rotator cuff problems or gout.

Spinal stenosis

Conditions termed “spinal stenosis” may differ slightly. Central stenosis involves the narrowing of the central part of the spinal canal. Foraminal stenosis involves the narrowing of the foramen — the bony archway that contains the spinal nerve roots — resulting in pressure on the exiting nerve root.

Symptoms may include:

  • Neck pain
  • Pain
  • Dysthesias in the arms and hands
  • Anesthesias in arms and hands

Pain may affect both sides of the body.

A diagnosis of spinal stenosis will typically be made using a patient exam and an MRI or computerized tomography (CT) scan. Nonoperative treatment usually includes rest, nonsteroidal anti-inflammatory (NSAID) medication, physical therapy and epidural steroid injections.

Cervical Spondylotic Myelopathy

The most common type of spinal cord dysfunction in patients older than 55 years old is cervical spondylotic myelopathy, which occurs with neurologic symptoms. The onset is usually insidious, with long periods of fixed disability and episodes in which it worsens. The first sign is commonly gait spasticity, followed by upper-extremity numbness and the loss of fine motor control in the hands.

Symptoms include:

  • Pain in the neck, subscapular area, or shoulder
  • Anesthesias or paresthesias in the upper extremities
  • Sensory changes in the lower extremities
  • Motor weakness in the upper or lower extremities
  • Gait difficulties

Unlike most degenerative conditions of the back and neck, conservative treatment is not recommended with cervical spondylotic myelopathy. Performing spine surgery relatively early — within one year of the onset of symptom — typically results in a substantial improvement in neurologic prognosis.

Delaying surgical treatment can result in a patient's permanent impairment. What kind of spine surgery makes sense may be dependent upon the patient's anatomy and the lordosis,  or curvature, of the affected segments of the sppine, and the surgeon's preference. They may include: 

  • Posterior cervical fusion
  • Laminoplasty

Surgical care may involve an adjunct anterior fusion procedure to address the spondylosis, or the degeneration of discs. 

Cervical Spondylosis Without Myelopathy

For this condition, surgical care may be needed to address radicular, or radiating, and neurologic symptoms, not for axial neck pain.  The kind of procedure needed for treatment may depend on the patient's anatomy and the lordosis, or curvature, of the affected segments of the spine, and the surgeon's preference. Surgical treatments may include:

  • Anterior cervical discectomy and fusion
  • Anterior cervical corpectomy 
  • Adjunct posterior-instrumented fusion, in some cases

Surgical treatments

Anterior Cervical Discectomy and Fusion (ACDF): This procedure involves disc removal and decompression and a graft of bone or other material for fusion. Plates are usually implanted. It has a high rate of success at above 90 percent. 

Anterior Cervical Corpectomy (and Fusion): This surgical treatment for multilevel spondylosis and spondylotic myelopath involves disc and vertebra removal, decompression and a graft of bone or other material for fusion. It always includes plating. 

Posterior Cervical Fusion: This surgical treatment fo cervical spondylotic myelopathy involves decompression and a graft of bone or other material for fusion. 

Laminoplasty: In this treatment for stenosis and spondylotic myelopathy, laminae of the spine are hinged laterally like an open door, creating more space, and nerve and cord decompression is performed. 

If you have questions about cervical spine injury or think you might need surgery for neck pain, consult an orthopedic specialist. They can provide a diagnosis and determine the best surgical or non-operative treatment for your specific issue.

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Topics: Spine