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Neck Pain 

Introduction

The neck is a very vulnerable part of the spine.  It is susceptible to injury.  Muscle, ligament, nerve, and spine injuries are common causes of neck pain.  Poor posture and “wear and tear” can also cause neck pain.  Degenerative diseases, such as arthritis, can cause the spinal structures to break down and put pressure on the spinal cord or nerves. 

Neck pain can spread to the head, shoulders, arms, and hands.  It can be acute or chronic.  Acute neck pain begins suddenly, usually after an injury.  Acute neck pain resolves as the injury heals, usually within several days or weeks.  Chronic neck pain lasts longer than three months.  Chronic pain may be constant and caused by structural changes in the spine from degenerative diseases.

A medical examination is necessary to identify the cause of the neck pain and to determine the appropriate course of treatment.  Neck pain is usually treated with non-surgical methods.  However, if symptoms progress or continue, there are a variety of spinal surgeries to relieve neck pain.

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Anatomy
The spine is divided into regions that are defined by their curvature and function.  The cervical spine is located in your neck.  The cervical spine supports your head and connects it to your trunk.  The cervical spine supports less weight than any other portion of the spine.  It also has the greatest amount of mobility and flexibility.  Your neck can bend forward and backward or tilt from side to side.  Your neck can also turn or rotate to the right and left, a motion used when checking for traffic before crossing a street.
 
Seven small vertebrae make up the cervical area of your spine.  Vertebrae are the series of small bones that align to form the spine.  The back part of the vertebra arches to form the lamina.  The lamina creates a roof-like cover over the back opening in each vertebra.  The opening in the center of each vertebra forms the spinal canal. 
 
Your spinal cord, spinal nerves that travel to your arms and hands, and arteries that supply blood travel through the protective cervical spinal canal.  The top section of the cervical spinal canal is very spacious.  It allows more room for the spinal cord than any other part of the spine.  The extra space helps to prevent pressure on the spinal cord when you move your neck.
 
Intervertebral discs are located between the vertebrae in your cervical spine.  The discs are made of strong connective tissue.  Their tough outer layer is called the annulus fibrosus.  Their gel-like center is called the nucleus pulposus.  The discs and two small spinal facet joints connect one vertebra to the next.  The discs and joints allow movement and provide stability.  The discs also act as a shock-absorbing cushion to protect the cervical vertebrae. 

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Causes
Neck pain is caused by abnormalities in the soft tissues, nerves, discs, or vertebrae of the neck.  The soft tissues--muscles, tendons, and ligaments, can strain from over exertion, poor posture, physical stress, and injury.  Motor vehicle crashes, sports, falls, or violence are causes of neck injuries.  Soft tissue injuries can cause painful muscle spasms or tightening of the neck muscles.
 
The spinal cord or spinal nerves cause neck pain when they are compressed, pinched, or irritated.  This commonly occurs from structural changes in the spine.  Bone spurs, abnormal bone overgrowths caused by Osteoarthritis, can grow in to the spinal canal or nerve root openings on the vertebrae.  Bone spurs can also contribute to a condition in which the spinal canal is narrowed, called Spinal Stenosis.  Some degenerative diseases can cause the spinal structures to thicken and extend into the spinal canal over time.  The narrowed canal causes pressure on the spinal cord and nerves, resulting in pain.
 
Changes in the intervertebral discs can also cause neck pain.  As we age, our discs lose water content.  Our discs become shorter and less flexible, a condition called Degenerative Disc Disease.  Once the discs are injured, they do not have the blood supply to repair themselves and they deteriorate.  Without the protective disc, the spine can become structurally unstable and unable to tolerate stress.  Degenerative Disc disease can also lead to a herniated disc. 
 
A herniated disc occurs when the outer disc layer, the annulus, ruptures.  When the inner content, the nucleus pulposus, comes out of the disc, it can cause pressure on the nerve tissue.  When the inner contents of the disc come in contact with the spinal nerves, a chemical reaction occurs that causes irritation, swelling, and pain.
 
Osteoarthritis and Rheumatoid Arthritis are degenerative diseases that cause changes in the discs and vertebrae.  Normally, the discs act as a cushion between the vertebrae.  Without the disc functioning well, pain can occur. Spondylosis is a condition that results when Osteoarthritis or a fracture causes disc degeneration and the overgrowth of bone.  Spondylosis causes stiff and painful joints.  Spondylolisthesis is a condition that results when a weakened vertebrae slips out of alignment on the spine.
 
Osteoporosis is a medical condition that can cause the cervical vertebrae to weaken.  Osteoporosis causes more bone calcium to be absorbed than is replaced.  Bone calcium is necessary to keep your bones strong.  The weakened bones are susceptible to multiple fractures.  Osteoporosis can cause the cervical spine to curve, resulting in hunched posture and neck pain.

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Symptoms
The type of pain that you feel depends on the cause of your neck pain.  Your pain may range from mild to severe.  The pain may begin suddenly and gradually get better, or it may start gradually and persist over time.  The pain may spread to your head, shoulders, arms, and hands.  You may get headaches.  Your neck may feel stiff.  You may not be able to completely move your neck.  Your shoulder, arm, and hand muscles may feel weak.  You may also experience numbness or tingling in your forearm, hand, or fingers.
 
You should seek immediate medical attention if you experience severe neck pain following an injury, such as from a motor vehicle crash, diving accident, or fall.  You should not move your neck until it can be examined.  To avoid the risk of further injury or paralysis, a medical professional should immobilize your neck.  In rare cases, the loss of bowel and bladder control accompanied by significant arm and leg weakness indicates a serious problem.  If you experience these symptoms, you should also seek immediate medical attention.

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Diagnosis
Your doctor can determine the cause of your neck pain.  The cause must be identified in order to treat your symptoms appropriately.  Your doctor will perform a physical examination.  Your doctor will ask you about your symptoms and medical history.  You will be asked to perform simple neck movements to help your doctor assess your muscle strength, joint motion, and joint stability. Your doctor will test the reflexes and sensation in your arms and legs.  Your doctor may order lab studies to rule out disease processes that may affect your neck. 
 
Your doctor will order imaging studies to identify the location and source of your neck pain.  Your doctor will order X-rays to see the condition of the vertebrae in your cervical spine and to identify fractures, misalignment, narrowed discs, or damaged facet joints.  Sometimes doctors inject dye into the spinal column to enhance the X-ray images in a procedure called a myelogram.  A myelogram can indicate if there are pinched nerves, herniated discs, bone spurs, or tumors. 
 
A bone scan may be used to show fractures, tumors, infections, or arthritis.  A bone scan requires that you receive a small harmless injection of a radioactive substance several hours before your test.  The substance collects in your bones in areas where the vertebrae are breaking down or repairing. 
Your doctor may also order Computed Tomography (CT) scans, a Discogram, or Magnetic Resonance Imaging (MRI) scans to get a better view of your spinal structures.  CT scans provide a view in layers, like the slices that make up a loaf of bread.  The CT scan shows the shape and size of your spinal canal and the structures in and around it.  Your doctor may inject dye into the disc area to enhance the CT images in a procedure called a Discogram.  A Discogram provides a view of the internal structure of a disc and can help to identify if it is a source of pain.  The MRI scan is very sensitive.  It provides the most detailed images of the discs, ligaments, spinal cord, nerve roots, or tumors.  X-rays, myelograms, bone scans, CT scans, and MRI scans are painless procedures and simply require that you remain motionless while a camera takes the pictures.
 
Nerve conduction studies may reveal how your cervical spinal nerves are working.  Doctors commonly use a Nerve Conduction Velocity (NCV) test.  During the study, your spinal nerve is stimulated in one place and the amount of time it takes for the message or impulse to travel to a second place is measured.  Your doctor will place sticky patches with electrodes on your skin that covers the spinal nerve.  The NCV test may feel uncomfortable, but only during the time that the test is conducted.
 
An Electromyography (EMG) test is often done at the same time as the NCV test.  An EMG measures the impulses in the muscles to identify nerve and muscle problems.  Healthy muscles need impulses to perform movements.  Your doctor will place fine needles through your skin and into the muscles that the spinal nerve controls.  Your doctor will be able to determine the amount of impulses conducted when you contract your muscles.  The EMG may be uncomfortable, and your muscles may remain a bit sore following the test. 

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Treatment
The treatment for neck pain depends on its cause, severity, and duration.  The majority of neck problems are treatable with pain medications, short periods of rest, and physical therapy.  You may wear a soft neck collar for support.
 
Over-the-counter medication or prescription medication may be used to reduce your pain.  If your symptoms do not improve significantly with these medications, your doctor may inject your neck with pain relieving medication.  Occupational or physical therapists can provide treatments to reduce your pain, muscle spasms, and swelling.  These include modalities, such as heat, ultrasound, and electrical stimulation.  The therapists will also show you exercises to gently stretch and strengthen your neck muscles.  Aquatic therapy may help ease your pain, relax your body, and provide support for you to exercise your joints.  

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Surgery
Surgery is recommended when non-surgical methods have provided minimal or no improvement of your symptoms.  Surgery may be required if a herniated disc, bone spur, or a narrowed spinal canal is pressing directly on a nerve or the spinal cord.  Surgery may also be required to stabilize a fractured vertebra after traumatic injury.  The goals of neck surgery are to remove the pressure from the nerves or spinal cord and establish neck stability.  There are several options for surgery, depending on the cause of the neck pain.  Some of the more common surgeries are described below.
 
An Anterior Cervical Discectomy and Fusion is the type of surgery most frequently used for a herniated cervical disc.  An Anterior Cervical Discectomy and Fusion involves removing all or part of a herniated disc or discs.  The surgeon also fuses or secures two or more vertebrae together to stabilize the area.
 
Spinal Fusion is the type of surgery most frequently used for degenerative disc disease.  Spinal Fusion involves removing the degenerative disc from between the vertebrae.  The vertebrae are fused together to stop movement. 
 
The most common surgery for Spinal Stenosis is a Laminectomy.  The goal of this surgery is to relieve pressure on the spinal cord and nerves by enlarging the spinal canal where it has narrowed.  To do so, the surgeon removes all or part of the lamina on the affected vertebrae. 

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Recovery
Recovery from surgery depends on the cause of your neck pain and the type of surgery that was performed.  Most surgeries require at least an overnight stay in the hospital.  Your physician will let you know what to expect.
 
Individuals usually participate in physical therapy following surgery.  Physical therapy exercises will help strengthen your neck muscles.  Overall, most individuals achieve good results with surgery and are able to resume their regular lifestyles. 

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Prevention
It is important that you adhere to your restrictions and exercise program when you return home.  It is important to keep your muscles strong and flexible.  You should use proper posture when lifting, standing, sitting, and moving your body.
 
It can be helpful to maintain a healthy weight.  Do not smoke.  Smoking increases the risk of surgical complications and hinders bone fusing. 

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.