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| What
causes neck pain? |
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There
are many causes of neck pain, and the pain itself can be divided
into the categories of: mechanical, coming from the joint or the
disc; radicular, coming from a nerve or nerve root; or myelopathic,
coming from the spinal cord.
The
spine is composed of segments that have essentially three joints,
the disc in the front and two facet joints in the back. These structures
are very resistant to wear-and-tear for the first two decades of
life but often during our twenties, these tissues start to wear
out. This mechanical pain is called degenerative disease and is
the most common reason for neck pain. Radicular pain is usually
sharp, electrical type pain that goes down the upper extremity in
a particular pattern. It may be associated with numbness or weakness.
It can be aggravated, or relieved by different motion or positions
of the head or neck. Myelopathic pain refers to symptoms coming
from compression of the spinal cord. This pain is usually in both
arms and can go down into the legs. It is also associated with numbness
or weakness in the extremities in the arms and legs.
Because
there are so many reasons for neck pain, it is very important that
the physician do a very careful history and physical exam of the
cervical spine. The physical exam can also include an examination
of the entire body, as well as the neurologic and vascular system
to determine exactly where the pain is coming from.
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| What
is a herniated disc? |
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| A weakening
of the disc wall, which we call the annulus, causes a herniated disc.
The defect in the disc wall allows the central portion of the disc,
called the nucleus, to be displaced from the central portion of the
disc out into the spinal canal. The shape or the morphology of the
disc herniation can vary. It can be just a slight focal defect in
the disc wall, or the herniation may go trough the entire disc wall.
A smaller disc herniation can cause neck pain or arm pain, while a
larger herniation with more compression and inflammation on the nerve
root tends to cause nerve root type pain. It is possible for a herniation
to be so large that is can also compress the spinal cord as well as
the nerve root, causing radicular symptoms as well as spinal cord
symptoms. |
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| What
is the difference between a herniated disc and a bulging disc? |
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A bulging
disc represents degenerative disc disease. The disc is showing
signs of wear-and-tear. It is losing some of its fluid content
and therefore, it is drying out. As it dries out, the disc
tends to decrease in height, or it starts to settle. As it
does this, the wall of the disc tends to bulge or buckle outward.
It generally bulges in a symmetric manner, much like the side
walls of a deflated automobile tire would tend to bulge outward
in a symmetric fashion. A herniated disc, on the other hand,
is a specific defect in the disc wall that allows the central
portion of the disc to protrude into the wall of the disc
or even into the spinal canal. The location of the disc defect
is usually specific, but not symmetric. The automobile tire
analogy in this case would be a tire that has been damaged
by something, such as a rock or a nail, and has a specific
defect with a bleb or outpouching of the tire in one spot.
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| Are
bulging or herniated discs normal? |
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No,
they are not normal. The normal shape or morphology of the disc
is that it should be a uniform height with an abundant fluid content
without any bulging of the disc wall into the spinal canal. A bulging
disc reflects degeneration, which is physiologic (normal) process
of aging, but the disc itself is not normal. It is showing signs
of wear-and-tear. A herniated disc obviously is not normal. It is
essentially a torn or broken disc. However, the fact that a disc
is bulging or herniated does not necessarily mean that it is symptomatic
or painful.
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| Does
whiplash cause herniated discs? |
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A whiplash
injury is a specific type of injury to the neck. It is basically
a flexion/extension injury to the neck and can cause a herniated
disc in the neck, or even just a tear within the wall of the disc
becomes painful. The mechanism of injury in a whiplash is specific.
As a person sits in a car, the trunk of the body is closely associated
with the seat. However, the head and the neck are generally not
supported and act as a free body. As another car hits the rear of
the initial car, the initial car is thrown forward with rapid acceleration.
The trunk of the body goes with the seat and the car rapidly forward.
The unsupported head and neck, however, do not accelerate as quickly
as the body does. Therefore, the head and neck go into extension.
This can cause compression on some elements of the cervical spine
and tension on the other elements of the spine.
It
can also cause soft tissue injury to a number of structures, in
addition to the discs. As the car slows down, the trunk of the body
still attached to the seat slows down as well; however, the head
and neck continue to accelerate forward. The head and neck do not
stop at the same time as the trunk of the body does and, therefore,
a flexion injury is caused to the cervical spine. Again, this can
damage the structures of the cervical spine and cause pain.
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| Should
I have a MRI if I have pain? |
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It
depends on how long you have had neck pain and what the symptoms
are. If you have only neck pain, the MRI is not necessarily done
within days or weeks of the injury. However, if the neck pain persists
over six weeks, and particularly if it persists over three months,
then a MRI scan is indicated. In addition, depending on what your
physician feels is the cause of your neck pain, a MRI may be needed
sooner. If you have severe radicular pain with loss of strength
into an extremity, any symptoms of spinal cord compression or myelopathy,
or if there is suspicion of a tumor or infection, a MRI is often
done immediately.
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| Are
there alternative therapies available to help me deal with my pain? |
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| A conservative
approach by skilled practitioners is usually successful in treating
mechanical neck pain without the need for surgery. It is important
for any conservative treatment to include patient education so that
the patient understands the anatomy and pathology of their neck pain.
Treatment often includes active physical therapy such as physical
training, flexibility, and strength training of the muscles in the
neck, shoulders, extremity, and trunk. Manual therapy may also be
used to correct any type of mechanical abnormal motion in the individual
segments within the neck. Heat, traction, muscle stimulation, and
specific therapeutic massage could be included to improve the flexibility
of the soft tissues. Another alternative that is very effective is
therapeutic injections. These injections would be a combination of
a local anesthetic and steroid and are usually directed to the joints
or nerves around the neck. |
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| When
do I need surgery? |
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Surgery
is a reasonable alternative for pure mechanical neck pain
that does not respond to appropriate conservative treatment
and has a specific diagnosis that would predictably improve
with surgery.
Click
here for questions on surgical proceedures
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| When
do I need a fusion? |
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Whether
or not a patient needs a cervical fusion depends on what the
specific diagnosis is and the patient's response to treatment.
In general, if you have failed conservative care then a fusion
may be considered. Fusions essentially immobilize the tissues
that allow motion at a spinal segment. The majority of the
time, a fusion is done after a disc is removed in the cervical
spine and a bone graft is put in its place. Most fusions in
the cervical spine are done from the anterior or front approach.
Fusions are indicated for conditions such as severe degenerative
disc disease with spinal cord compression, deformity of the
cervical spine, tumors, and infections. They are also done
because of trauma where there is a possibility of fracture
or dislocation of the spine or the cervical spine is rendered
unstable. Fusions can also be done from the posterior, or
backside, of the neck for any of the above named reasons as
well as inflammation, neoplasm or for congenital problems
in the neck.
Click
here for questions on surgical proceedures |
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| Will
I have to wear a collar after surgery? |
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| It depends
on what type of surgery is done and what your individual physician
feels is necessary. In general, cervical instrumentation is
very rigid in fixing the spine. Most surgeons would add a collar
just to protect the fusion site, even with metal, for the early
period after the surgery. These collars are generally a combination
of a soft inner lining and a more stiff plastic outer shell.
They are not rigid fixation; they just help support the neck
to decrease the forces on the graft site and the metal. If no
metal is used during the fusion, then you would absolutely have
to use an external collar or brace. If the surgery just involves
a soft tissue operation in the cervical spine, such as a posterior
discectomy/foraminotomy, then you would probably have a soft
collar for symptomatic support for only the first several days
after the surgery. This collar offers no real immobilization
of the spine; it simply rests the posterior musculature so that
the patient is more comfortable after the retraction of the
posterior musculature. |
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| Are there
any other websites that are helpful? |
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| www.spine-health.com
www.esurgeon.com
www.spineuniverse.com
www.allaboutbackpain.com
www.kyphon.com
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