Neck pain

George Rappard, MD

Neck pain is usually caused by degenerative conditions of the spine, most commonly arthritis. Patients will typically experience pain along the neck. This may worsen with turning of the head or flexion, extension of the neck. Neck pain may be referred to the shoulders or to the upper back. Sometimes, arthritis may result in compression of the nerves of the neck. With involvement of nerves, radiating pain may be present to the shoulder, arm or fingers. If severe enough, this involvement may progress to weakness in the muscles supplied by the involved nerve. In the most severe cases, compression of the spinal cord may be present and may lead to weakness of the legs or loss of bowel and bladder function. Some patient suffer from headaches caused by injury or arthritis to the neck. This syndrome is referred to as cervicogenic headache. In cervicogenic headache, arthritis or injury to the neck may result in pain being experienced in the low-back portion, or occipital, part of the head. Examples of causes of cervicogenic headache include disc arthritis at C2/3 or C3/4 or vertebral joint arthritis (facet arthritis) at these levels. Typical symptoms include pain to the back of the neck radiating to the shoulders or pain at the back of the head or pain just below the head. The first step in the evaluation of neck pain or cervicogenic headache not improved by medications and therapy is an MRI of the cervical spine. An MRI, along with a careful clinical examination, will usually identify the source of pain. The first line of therapy for neck pain without weakness or spinal cord symptoms is therapy. Intensive therapy involves muscle stimulation, thermal therapy, distraction, range of motion exercises and resistance training. Some patients with neck pain that doesn’t improve with therapy may benefit from pain injections. Minimally invasive or conventional surgery would be limited to patients with continuing or worsening symptoms. Patients with symptoms of neurologic compromise would be recommended for surgery. If cervicogenic pain is unresponsive to medical therapy or physical therapy, then injectional therapy can be used to identify the causes and teat the pain. This may involve an injection to the nerves of the neck joint or may involve ablation of those nerves. Minimally invasive or c surgery would be limited to patients with continuing or worsening symptoms.

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