How Aging Affects Your Cervical Spine
Why neck pain may develop, diagnosing the cause and reducing symptoms.
The aging process can affect cervical spine, your neck and possibly shoulders, upper back and arms. This doesn't mean that everyone, as we get older, will develop neck pain, but the everyday wear and tear we put our spines through can lead to degenerative spinal conditions. Here you can learn about your cervical spine anatomy, degenerative spinal disorders that can cause neck pain, and the diagnosis and treatment of neck-related pain and symptoms.
The cervical spine consists of the top 7 vertebrae of the spine. Doctors often refer to these vertebrae as C1-C7, with the "C" indicating cervical, and the numbers 1-7 indicating the level of the vertebrae. C1 is closest to the skull, while C7 is closest to the thoracic (chest/rib cage) region of the spine.The cervical spine is particularly susceptible to degenerative problems because (1) it is very mobile with a large range of motion, (2) it supports the skull and (3) the anatomy of the neck is complex.For example, cervical motion segments (ie, a disc with a vertebral body above and below) consist of five "joints" (an intervertebral disc, two facet joints, and two uncovertebral joints). Many degenerative problems, including osteophytes (bone spurs), can develop in these motion segments.
Neck Pain Symptoms Related to Degenerative Spinal Conditions:-
There are several symptoms that may indicate the presence of a degenerative condition in the cervical spine. Symptoms include:· Neck pain· Pain around the back of the shoulder blades· Arm complaints (pain, numbness, or weakness)· Rarely, difficulty with hand dexterity or walking.
Degenerative Spinal Conditions Affecting the Neck:-
The spinal degenerative process may begin in any of the joints in the cervical spine, and over time it may also cause secondary changes in the other joints.For example, an intervertebral disc may be primarily affected. As the disc narrows, the normal movement of that segment is altered, and the adjacent joints (also called osteoarthritis or degenerative joint disease) are subjected to abnormal forces and pressures, leading to degenerative arthritis (joint inflammation).Neck pain as a result of spondylosis (spinal osteoarthritis) is relatively common. The pain may radiate, or spread, into the shoulder blade(s) or down the arm(s). Patients may have arm pain or weakness caused by a bone spur (osteophyte) compressing a spinal nerve root.Dysphagia (difficulty swallowing) can result from large anterior osteophytes (bony growths at the front of the spine), although this is rare.
Diagnosing Cervical Spine Conditions:-
When a patient with a cervical degenerative disorder is examined by their doctor, one or more symptoms are likely to be apparent. The doctor will ask the patient many questions to gain a detailed history of the condition. A thorough evaluation of the patient will be conducted, including several types of tests to accurately identify the cause of neck pain and symptoms.· A neurologic examination is performed to rule out neurologic problems· A shoulder examination will also probably be done to ensure that the symptoms are indeed originating from the neck· Various diagnostic tests.
X-rays are useful for identifying such problems as:·
Narrowing of the intervertebral disc space· Anterior osteophytes (bony spurs)· Spondylosis (ie, arthritis) of the facet joints· Osteophytes from the uncovertebral joints.
CT Scans (computed tomography) can highlight bony changes associated with degenerative spondylosis (osteoarthritis). Osteophytes can be observed and evaluated as well. However, CT does not provide for optimal evaluation of discs; although it may sometimes show spinal disc herniations.
MRIs: (magnetic resonance imaging) is a powerful tool in the assessment of patients with cervical spondylosis. MR imaging can help doctors to identify disc herniations, osteophytes, and joint arthrosis a type of osteoarthritis. MRI is best suited for soft disc herniations, but often times more information is needed.
Myelogram/CT is the "gold standard." It is often utilized incomplex cases involving multi-level spinal disease or suboptimal MRI images. Itis very useful in delineating bone spurs from safe disc herniations.
Treatment Options for Degenerative Cervical Spine Disorders
After the doctor has conducted the necessary tests to identify the cervical spine problem, a treatment plan is developed.
Nonsurgical Neck Pain Treatment
Nonsurgical treatment of cervical degenerative disease provides good to excellent results in over 75% of patients. A multi-disciplinary approach includes:
Immobilization of the neck using a collar or brace may be most beneficial during acute exacerbations of pain to reduce motion at the symptomatic levels.
Physical therapy (PT) and manipulation (chiropractic) can be useful to decrease muscle spasms that can contribute to pain and symptoms. Both PT and chiropractic care may involve use of heat, electrical stimulation, and exercise to help maximum benefits.
Medications include over-the-counter analgesics, nonsteroidal anti-inflammatories, muscle relaxants and/or sometimes opioids. I Often, nonsurgical treatment provides good long-term pain and symptom relief.
Surgery for Cervical Degenerative Disorders
A surgeon is likely to consider surgical treatment for a cervical degenerative disorder if one or more of the following criteria are met:
Nonsurgical treatments - have been tried and failed
Spinal cord dysfunction (eg, myelopathy) develops
Arm pain and/or weakness (neurological symptoms) persist Depending on the patient's diagnosis, one type of surgical procedure that may be recommended is removal of the bone spur(s) and possibly cervical spinal fusion that joins two or more vertebrae. However, keep in mind the surgical procedure recommended by your surgeon is based on you, your diagnsosis, general health and other factors.Your surgeon will explain the recommended surgical procedure to you with great care and clarity.
In most instances, the preferred approach is an anterior (ie, from the front) interbody fusion. Using the anterior approach, the surgeon can perform a complete discectomy (removal of the disc between two vertebrae), and then seek to restoring normal disc space height and lordosis (the concave curve in the cervical spine) by implanting an interbody device or bone graft. A cervical plate may be affixed over the interbody device or graft to stabilize the neck, which may avoid the need to wear a brace after spine surgery.
A posterior approach (from the back of the spine) may be considered when a cervical disc has herniated laterally (to the side).
What You Can Do for Cervical Degenerative Disorders
Cervical spine degenerative disorders can be diagnosed more accurately and treated. Under the guidance and treatment of an expert medical team, most patients can hope to see a significant improvement in their condition and neck pain.
Dr.SUSHIL JOSHI (PT)