Neck Pain & Cervical Spondylosis

Introduction–

Neck pain , a very common problem which we all have gone through, atleast once in our lifetime. In this article we will learn about basic causes of it and some bits of information about Cervical spondylosis and its management.

Causes–

1. Mechanical causes- It is the most common cause due to which one complaints of neck pain.Mechanical causes simply means the problem is causes due to bad posture which is causing muscular spasms and inducing pain.
   
2. Cervical Spondylosis- It is the second most common causes.It occurs due to undergoing pathophysiology which causes degeneration of intervertebral discs due to which vertebrae becomes unstable & disbalance. So, to support it osteophytes grows out,also this undergoing pathology causes the nearby muscles to go into spasm which is responsible to causes pain.
   
3. Neck Arthritis- This may include some serious diseases like Ankylosing spondylitis, Rheumatoid Arthritis,etc.
   
4. Infection- TB of spine may be the issues which is causing pain in neck. But sometimes, even tonsiltis moves back into pharynx i.e retropharyngeal tonsilitis which causes pain. In this situation patient complaints of snoring, severe & jammed neck, and also complaints of pain during swallowing.
   
5. Whiplash Injury- It is caused when there is sudden / severe overflexion or hyperflexion of neck. Whiplash Injury is majorly caused by rear end car accidents, sometimes it may occurs during sports, etc. Severe form of this type of injury may cause fracture.
   
6. Metabolic Diseases- like, osteoporosis, Vitamin D Defficiency, menopause and excessive use of steroids.
   
7. Neoplastic Causes- like, metastatic tumor, myeloma, tumor of spinal cord, tumor of meninges or vertebrae.
   
8. Referred Pain- sometimes the neck pain may be referred from pathology going in any other organ. like sometimes shoulder disease, disease of apex of lung, pneumonia, angina, MI. So, while diagnosis we must be very sure and must rule out that the neck pain is not a referred one.

like, sometime patient complaint of neck pain along with sweating, and sometimes chest pain , and problem sleeping during nights this may be a typical indication of some cardiac disease.

Cervical Spondylosis

Pathology-

It is an intervertebral disc degeneration with osteophytes formation. Due to ageing , intervertebral disc loses water, it gets fragmented leading to degeneration. Osteophytes fomation and muscle spasm occurs which which helps in stabilizing the joint. But sometimes these osteophytes irritates the spinal nerve causing pain and other related problems.

Clinical Features-

• Intermittent neck pain- It is the most prominent symptom, associated with stiffness of the neck.The neck pain may radiate to the shoulder or to the occiput ( Back of the head ) .
• About 1/3rd patient presents with headache only but some patients presents with shoulder, arm or the hand pain.
• Due to involvement of spinal cord there is numbness in the hand and weakness of the hand. Causing the hand to become clumsy and writing becomes difficult.
• Pressure on the spinal cord can also cause weakness of the leg.
• Also in some patients, osteophytes compress oesophagus (pharynx)
• causing dysphagia.
• Lhermite sign- Sometimes during flexion of the neck an electric sensation runs down the body along the back and the limb. This is known as Lhermite sign.
• Some patients complaints of dizziness, vertigo, nausea, scotoma, syncope, these are the very common symptoms by a patient of cervical spondolysis, this occurs due to vertebra-basilar artery insufficiency. It especially occurs during extension of the neck.
• In some patients, there is only weakening of the head & neck.
• In severe cases, when osteophytes apply pressure on nerves supplying hand & leg then it may lead to Quadripresis.

Investigations–

1. X-Ray cervical spine
2. MRI spine
3. CBC
4. ESR
5. X-Ray chest – if patient also complaints of cough
6. Urine Examination- It is of utmost importance, because if proteinuria present then it may be due to myeoloma.

Management–

1. Pain relief by prescribing NSAIDs
2. Nerve stabilizer, in case of complaints of tingling, numbnesss, etc.
3. Tablets containing Mycobalmin, alpha lipoic acid, pyridoxine, folic acid may be added to the list.
4. Patient must be adviced to maintain a good posture
5. Also heat therapy may be advised
6. Physiotherapy
7. In case neck pain is due to some underlying diseases like TB, Cardiac diseases, etc, then it must be diagnosed and treated accordingly.