Understanding Neck-Related Problems; A Simplified Approach
As a spine surgeon, a good number of my patients who come to my clinic are suffering from a neck-related problem. Indeed, complaints related to the neck, or cervical spine, are among the common reasons for patients to see a doctor. When combined together with back problems, they are considered the second most common cause of disability in adults, 18 years of age or older, in the U.S. In addition, a population-based cohort study, published in 2004 in Pain, found that 0.6% of the population, or 6 in every 1000 people, developed disabling neck pain annually1.
Our spine consists of multiple vertebrae that are connected to one another by the disc in the front and the two facet joints in the back of the spine. The cervical portion of the spine serves several important functions. It provides structural support to the head, allows mobility of the head and neck, and protects the spinal cord. Furthermore, there are different muscle groups in the neck that also contribute to the stability and mobility of the head and neck. As a result, conditions and problems of the neck could arise from any of these structures.
One simplified approach to understanding neck problems is to classify them based on the structure(s) involved. Therefore, problems of the neck, or cervical spine, can be related to;
- The spinal cord,
- The cervical nerve roots, or
- The supporting structures of the neck, such as, the vertebrae, discs, facet joints, ligaments and muscles.
The spinal cord is a very important structure that serves as the highway through which all trafficking and communications between the brain and the rest of the body occur. Compression of the spinal cord, for example as a result of stenosis and narrowing from a herniated disc, could lead to “blockage” in this highway that in return could result in delay of communications between the brain and other parts of the body. The entity that results from spinal cord compression is described as cervical myelopathy and could lead to the development of weakness of the hands and legs, instability with walking, bladder dysfunction, clumsiness and changes in handwriting and dexterity.
If the spinal cord is the highway, then, the nerve roots are the exits off of the highway. Each nerve root leaves the spinal cord and travels to innervate a specific group of muscles and provides sensory input from a specific area of the skin in the upper extremities. Compression of a nerve root, as a result of a herniated disc or a bony spur, for instance, could lead to “blockage” of the exit, which could result in the development of muscle weakness, changes in sensation, or sharp shooting pain down the arm. Such findings are consistent with cervical radiculopathy.
The supporting structures of the neck and cervical spine could also suffer from various pathological conditions that could compromise their ability to provide stability and/or mobility to the neck. For example, degenerative changes of the discs and/or facet joints could lead to loss of the normal curvature of the cervical spine leading to muscle spasm, neck pain and stiffness, and/or cervicogenic headache. Also, the various types of arthritis affecting the cervical spine could be placed into this category.
It is important, however, to note that in some cases there is more than just one category involved. For instance, degenerative conditions of the cervical spine could lead to neck pain that might be associated with myelopathy,radiculopathy, or radiculomyelopathy (if there is compression of the spinal cord, nerve root, or both).
In a physician-patient relationship, perhaps one of the most important predictors of a positive outcome is when a patient could walk out of their doctor’s office with a good comprehension of their condition. Using this simplified classification scheme, many of my patients have been able to understand, and actively participate in the management of their neck-related problems!
- Côté P, Cassidy JD, Carroll LJ, Kristman V. The annual incidence and course of neck pain in the general population: a population-based cohort study. 2004 Dec;112(3):267-73.
Mohamed Abdulhamid, MD
Follow Me on: