- WHAT IS CERVICAL SPONDYLOSIS (NECK PAIN)?
- Cervical Spondylosis is an age-related degeneration ('wear and tear') of the vertebrae and discs in the neck. To an extent, we all develop some degeneration in the vertebrae and discs as we become older. It tends to start sometime after the age of about 30. One feature of the degeneration is that the edges of the vertebrae often develop small, rough areas of bone called osteophytes.
Also, over many years, the discs become thinner. In many people, the degeneration does not cause any symptoms. For example, routine X-rays of the neck will show these features (osteophytes and disc thinning) in many people who do not have any symptoms.
However, in some people, the nearby muscles, ligaments, or nerves may become irritated or 'pressed on' by the degenerative changes. So, cervicalspondylosis can be a cause of neck pain, particularly in older people.
Not all types of neck mean that an individual is suffering from cervical Spondylosis.
But, if not looked after and treated carefully, neck pain may take the form of CervicalSpondylosis.
- WHAT ARE SYMPTOMS OF NECK PAIN / CERVICALSPONDYLOSIS?
- Symptoms of CervicalSpondylosismay manifest differently in different individuals, varying from mild to severe. The most common of them being
- Neck pain
- sometimes headaches mostly in back of head (occiput)
- Movement of the neck makes the pain worse.
- Occasional pain in the shoulders,
- Often accompanied by neck muscle stiffness.
- Pain radiate to the upper arm, forearm or hand
- Giddiness & vertigo associated with pain and stiffness.
- Fatigue, disturbed sleep, and impaired ability to work.
- Pain in the upper arm.
- WHAT ARE CAUSES OF NECK PAIN?
- Long standing degeneration (wearing away) of the vertebrae and the intervertebral discs is the primary cause behind this disorder. Now this can be triggered due to a number of reasons such as
- Advancing age
- Repetitive neck injury
- Poor Muscle tone
- Joint Problem – Cervical Facet Arthropathy
- Ligament or muscle injury
- Disc problem – slipped disc or tear in disc
- Occupational trauma – lifting heavy loads on head, gymnastics, working on the computer for long hours
- Occupations requiring minute concentration wherein people work with bent neck for long time
- Any kind of odd postures that put a strain on the neck
- HOW NECK PAIN IS DIAGNOSED?
- The history of your complaints and the examination findings often provide most of the details necessary to diagnose CervicalSpondylosis. However, some tests may be required to confirm the diagnosis as well as to assess the extent of damage that has already occurred. It can also be used to track the progress of the condition over a period of time.
Here are some of the tests that can be done to confirm the diagnosis
- X-ray of the Cervical spine (neck) – detects the development of spurs (bony outgrowths) on the vertebrae
- MRI (Magnetic Resonance Imaging) spine – determines the extent of neural damage, if any
- EMG – Electromyogram – to detect abnormal muscle electrical activity in case of nerve affection
- X-ray or CT scan after dye is injected into the spinal column (myelogram)
- Diagnostic block: This is considered a gold standard test for diagnostic cervical facet pain. If we suspect that pain is coming from a cervical facet joint. We put some local anaesthetic around cervical facet joint. After injecting a local anaesthetic injection if patients has pain relief for the duration of that particular local anaesthetic. We can confirm our diagnosis of cervical facet pain. And we can consider these patients for radiofrequency ablation of medial branch.
- WHAT ARE TREATMENT OPTIONS FOR NECK PAIN?
- EXERCISE YOUR NECK AND KEEP ACTIVE
- Aim to keep your neck moving as normally as possible. During flare-ups the pain may be quite bad, and you may need to rest for a day or so. However, gently exercise the neck as soon as you are able to do. You should not let it 'stiffen up'. Gradually try to increase the range of the neck movements. Every few hours Gently move your neck do isometric exercise several times a day. Often good physio can help you for this. Applying heat over painful area can be very helpful.
As far as possible, continue with normal activities. You will not cause damage to your neck by moving it.
- Painkillers are often helpful. Pain killer as well as anti-inflammatory medicine can help you to move your neck for exercise. As well as it help to reduce an inflammation in neck. Pain killer are good role in early spondylotic changes.
In advance stages pain killers are not much useful. Also in long run pain killers can have a adverse effect on Kidney, liver and other major organs. So you should not take pain killers by your own, consult your doctor for this.
- If pain is not controlled with pain killer or exercise than role of intervention become important.
- CERVICAL EPIDURAL INJECTION:
- This is an x ray guided injection, where anti- inflammatory drug is injected around affected vertebrae and nerve in neck. This helps you to reduce inflammation and keeps neck relaxed and moving. Once a neck is relaxed you can do a good exercise and keep it more fit. This injection we give under local anesthesia and under continuous X ray guidance.
We are injecting a drug under x ray guidance so we are sure that we are putting our drug at exact site where pathology is and it also required a less amount of drug.
- RADIOFREQUENCY ABLATION
- This is newer techniques. If cervical spondylosis is not getting cured with other sort of treatment. Than radio frequency ablation of nerve which carries pain sensation of that particular joint/s can be helpful. Under live X ray guidance we insert a radiofrequency needle in neck. Proper position is confirmed under x ray machine.
We also do proper sensory and motor stimulation to confirm our needle position. Once we confirmed needles proper position we use radiofrequency current to make it numb. This procedure only numbs sensory part of joint and nerve and does not affect any function of nerve.