Neck pain is a common condition, with approximately 35% of people reporting neck pain each year.5
anatomy of the neck sets the stage for a better appreciation of potential causes of pain in the region. There are 7 cervical vertebrae, they are connected via intervertebral discs as well as by two joints:
Uncovertebral joints (also called the joints of Luschka) Zygapophyseal joints (also called z-joints or facet joints)
- Motor (efferent)fibers exit the cord to the ventral (Anterior) root, and then merging with sensory afferents to become the spinal nerve.
- Sensory (afferents)fibers exit via intravertebral foramen and merge with spinal cord through the dorsal(posterior) horn.6,7
Different Types of Neck Pain:
Dysfunction of one or more cervical spinal nerve roots or that is a fancy way of saying nerve compression in the neck region that causing arm pain. (most common due to disc herniation)
Signs and symptoms: Deep aching neck pain with numbness, tingling, sharp stabbing pain or weakness in the arm/hand. Pain might be reliving when affected arm brought in tight to the body while head leaning toward the affected side.
Age group 20-40 most commonly due to cervical disc herniation. 40+ years old, usually due to morphological changes (Spondylosis). Spondylosis refers to normal age-related degenerative changes of the vertebrae and intervertebral discs.
Risk Factors: Manual labour (heavy), driving or operating vibrating machinery, collision sports, motor vehicle accidents, degenerative changes.
It is a narrowing of the spinal canal, most commonly due spondylosis (age related degenerative changes). Structures that may compress the spinal cord are: ostephytes (cervical spine out growth due to age related changes), thickening of the ligamentous structures and ischemia (loss of blood flow or venous drainage to the affected area) to the affected segment of the spine.8
Mechanical Neck Pain
Local neck pain without nerve dysfunction or any shoulder/arm/hand symptoms. Frequently, this kind of neck pain co-exist with headaches, poor pasture, sedentary life style, and prolonged seating. This kind of neck pain is recurrent or persistent in nature.
Imaging (X-Ray and MRI)
X-Ray should be considered only in cases in which the history and examination have yielded red flags for serious disease. Abnormal curvature that doctor may see on the radiograph does NOT predict the level of neck pain or any muscle spasms.
Clearly MRI is the choice for diagnostic imaging for the serious underlying disease such infection, cancer or pathological fracture. However, positive MRI finding as nerve root or spinal cord compression should be read carefully and correlated to patient’s history and physical examination findings. What I mean is; if there are finding on MRI or X-Ray of disc herniation, narrowing of the foramina where the nerves exit. It does not mean that this is the cause of patient’s pain. Review of cervical spine MRI scans performed on 100 asymptomatic patients showed 57% of the patients did not have any pain. Average age of the study was 64 years old. Therefore, by the age of 60, 60% of people will have some kind of cervical disc dysfunction and will not have any pain.9
First step for any patient with any kind of complaint, should be correct diagnosis. Doctor needs to identify the cause or the root of the problem to be able to eliminate it. And not treat the where it hurts.
Spinal manipulation, soft tissues work, acupuncture, electrical stimulation and exercise at home have shown to be beneficial to reduce the neck pain.
May be considered for neck pain with the arm pain IF conservative treatment has failed. Steroidal injections have some supporting evidence however, the benefits are short lived, therefore, patient will experience short term symptom relief.
In the presence of mild to moderate arm pain that originates in the neck (radiculopathy), short-term outcomes of pain relief, decreased numbness, and weakness are better with surgery compared with conservative management, but that difference disappears with longer-term (1–2 year) follow up. In the presence of mild to moderate myelopathy, short term benefits have been reported, but long term follow up 3 years does not delineate benefits over conservative treatment.2,3,4
What it means
People that underwent surgical procedure got more immediate pain relief compared to conservative treatment. However, within one to two years pain level difference between surgical and conservative treatments drastically decreases and within three years, there was no difference between surgical and conservative treatment options. Although, patients with severe or progressive arm pain that did not respond to conservative treatment should consider surgical option.1
If patient experiencing mild to moderate disc herniation that causing an arm pain. Conservative treatment plan should be put in place for that patient. However, the doctor is obligated to provide reassurance and clarify time frame of the intervention for the patient. So the patient can clearly elect the desirable treatment plan.
McCormick WE, Steinmetz MP, Benzel EC. Cervical spondylotic myelopathy: make a difficult diagnosis, then refer for surgery. Cleve Clin J Med 2003
Kadanka Z, Mares M, Bednarık J, et al. Approaches to spondylotic cervical myelopathy: conservative versus surgical results in a 3-year follow-up study.
Carragee EJ, Hurwitz EL, Cheng I, et al. Treatment of neck pain. Injections and surgical interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders. Spine 2008;33(4S):S153–69.
Fouyas I, Statham P, Sandercock PA. Cochrane review of the role of surgery in cervical spondylotic radiculomyelopathy. Spine 2002;27(7):736–47.
Vernon HT, Humphreys BK, Hagino CA. A systematic review of conservative treatments for acute neck pain not due to whiplash. Journal of manipulative and physiological therapeutics. 2005 Jul 1;28(6):443-8.
Zhang J, Tsuzuki N, Hirabayashi S, et al. Surgical anatomy of the nerves and muscles in the posterior cervical spine: a guide for avoiding inadvertent nerve injuries during the posterior approach. Spine 2003;28(13):1379 84.
Carette S, Fehlings MG. Cervical radiculopathy. N Engl J Med 2005;353: 392–9.
McCormick WE, Steinmetz MP, Benzel EC. Cervical spondylotic myelopathy: make a difficult diagnosis, then referfor surgery. Cleve Clin J Med 2003; 70(10):899–904.
Nordin M, Carragee EJ, Hogg-Johnson S, et al. Assessment of neck pain and its associated disorders. Results of the Bone And Joint Decade 2000– 2010 Task Force on Neck Pain and its Associated Disorders. Spine 2008;33(Suppl): S101–22.