Spine - Neck
Degenerative disc disease (DDD) is part of the natural process of growing older. Unfortunately, as we age, our intervertebral discs lose their flexibility, elasticity, and shock absorbing characteristics. The ligaments that surround the disc, called the annulus fibrosis, become brittle and they are more easily torn. At the same time, the soft gel-like center of the disc, called the nucleus pulposus, starts to dry out and shrink. Degenerative disc disease is as certain as death and taxes, and to a certain degree this process happens to everyone. However, not everyone who has degenerative changes in their cervical spine has pain. Many people who have "normal" necks have MRI's that show disc herniations, degenerative changes, and narrowed spinal canals. Every patient is different, and it is important to realize that not everyone develops symptoms as a result of degenerative disc disease.
There are soft-tissue discs between the bony vertebral bodies in your cervical spine that are called intervertebral discs. These discs are composed of a soft gel-like center called the nucleus pulposus, and a tough outer lining that surrounds the disc called the annulus fibrosis. The intervertebral disc creates a joint between each of the vertebral bodies that allows them to flex and extend, rotate slightly, and move with respect to one another. When the outer lining that surrounds the disc tears, the soft center squeezes out through the opening, creating a "herniated", "slipped", or "ruptured disc". Each of these terms describes the same process.
Myelopathy is a term that means that there is something wrong with the spinal cord itself. This is usually a later stage of cervical spine disease, and is often first detected as difficulty walking due to generalized weakness or problems with balance and coordination. This type of process occurs most commonly in the elderly, who can have many reasons for having trouble walking or problems with gait and balance. However, one of the more worrisome reasons that these symptoms are occurring is that bone spurs and other degenerative changes in the cervical spine are squeezing the spinal cord. Myelopathy affects the entire spinal cord, and is very different from isolated points of pressure on the individual nerve roots.
Doctors use the term radiculopathy to specifically describe pain, and other symptoms like numbness, tingling, and weakness in your arms or legs that are caused by a problem with your nerve roots. The nerve roots are branches of the spinal cord that carry signals out the rest of the body at each level along the spine. This term comes from a combination of the Latin word radix, which means the roots of a tree, and the Latin word pathos, which means a disease. This disease is often caused by direct pressure from a herniated disc or degenerative changes in the cervical spine that cause irritation and inflammation of the nerve roots.
Stenosis is a term used to describe a narrowing of various parts of the body. Cervical stenosis is a degenerative disease where the spinal canal and neural foramina narrow and compress the spinal cord and nerve roots. Stenosis occurs when pressure increases inflaming the facet joints. The facet joints are overlapping arches that form the spinal canal. These joints are covered with cartilage and a membrane. Degenerative changes and wear and tear can cause the facet joints to inflame. This disorder is most common in people over 50 years of age. However, genetics and congenital factors may predispose a person for stenosis.
Though infections and inflammation of the cervical spine are rare, if they are neglected for a period of time, or if there is a delay in diagnosis, they can become a significant source of pain and disability. Bone and joint infections anywhere in the body can be crippling and life threatening, and infections in the cervical spine are no exception.
Ankylosing spondylitis is a rare condition that can cause back and neck pain. It is a rheumatic inflammatory disease that affects the spine and sacroiliac joints. This disease is three times more likely to develop in men than in women and it usually occurs between the ages of 20 and 40. Although it primarily attacks the spine (usually the low back first), this chronic and painful disease can also attack other joints, tendons and ligaments, and the chest wall. Though its cause is unknown, ankylosing spondylitis tends to run in families which suggests that genetics plays a role in the development of this disease. A patient is 10 to 20 times more likely to have ankylosing spondylitis if a parent or sibling also has this condition.
Juvenile Rheumatoid Arthritis
Juvenile Rheumatoid Arthritis is a type of inflammatory arthritis that affects almost 200,000 children in the United States. JRA is a disease that causes painful, swollen, and stiff joints in children, most commonly in large joints like the knee. JRA has three well-defined subsets: a monoarticular form, which means that that the disease affects only one joint; a polyarticular form, which means that it affects many joints, and a systemic form, which means that it affects other organs in the body besides the joints. The systemic form of the disease is most often associated with high fevers and rash, in addition to arthritis. The polyarticular and systemic forms of the disease are the two types that commonly affect the cervical spine.
Rheumatoid Arthritis is among the most debilitating forms of arthritis causing joints to ache, throb and even deform over time. The exact cause of this inflammatory condition is not known, but it is believed to be caused by an attack on the synovium (tissue that lines the joints) by the body's immune system. The upper cervical spine can be damaged by the inflammation that is caused by rheumatoid arthritis. This disease is three times more common in women than in men and usually occurs between the ages of 20 and 50. Just like the gradual destruction of other joints in the body, several joints between the base of the skull and uppermost vertebral bodies in the cervical spine are very susceptible to damage from rheumatoid arthritis.
Tumors of the spine and spinal cord are relatively uncommon. The most common initial symptom that patients with a spinal tumor have is pain. Because neck pain, and pain caused by a cervical (neck) disorder is very common, it is also not a specific symptom of any one disease or medical condition. Spinal cord tumors can be either primary (originating in the spinal cord) or secondary (metastases of cancer that originated elsewhere in the body). Therefore, the challenge is to determine how to evaluate neck pain with the goal of specifically excluding a tumor as the cause of the pain. Luckily, most neck pain is not due to a tumor. However, if a cancer were discovered after a long period of "conservative" management of neck pain, most patients would feel that their problem should have been investigated more thoroughly in the beginning.
Doctors use the term "benign" to indicate that a particular tumor is unlikely to spread to others parts of the body. Benign tumors can still be a significant problem however, depending upon their location, size, adjacent structures, blood supply, and other factors. Fortunately, most benign tumors can be treated successfully.
Doctors use the term "malignant" to indicate that a particular tumor or a cancer often spreads to other parts of the body, and can be difficult to cure or treat. This is very different from "benign" cancers, which are much less likely to spread, are easier to treat and control.
Cervical spine injuries can occur during motor vehicle accidents, in rough contact sports, after a fall, or by hitting your head against a hard surface, such as when diving into a pool that is too shallow. These accidents can cause injuries that range from mild cases of neck pain, called whiplash, to injuries that can cause paralysis of the rest of the body below the level of injury.
Whiplash is the common term used for a hyperextension injury to the neck. Though the neck is a very flexible structure, it can be injured when the weight of the head exceeds the neck's ability to control its motion. The injury usually happens when the head is suddenly jerked back and forth beyond its normal limits during a car accident, rough contact sports, or a fall. This jerking motion can cause over-stretching and tearing of the neck muscles and ligaments and can cause the discs between the neck vertebrae to bulge, tear or rupture.
The discs that act as shock absorbers between the vertebral bodies of the cervical spine can be damaged during an accident. When this happens, the material in the center of the disk can be pushed out from where it normally is, a process called disk herniation. A herniated disk can put pressure on the spinal cord or nerves to the arms and legs. In situations when a disk ruptures very quickly, as in the case of an accident, then the nerve does not have any time to adjust to the increased pressure and it may stop working.
Fractures and Dislocations
Fractures and dislocations of the cervical spine demand early and accurate diagnosis so that treatment can quickly be introduced in order to produce a painless, stable neck and prevent pressure on the spinal cord and/or nerves. When the neck is injured in very violent accidents, the bones in the neck can be broken or pulled forcefully out of normal alignment. Fractures and dislocations of the cervical spine are very serious injuries because there is the potential for damage to the spinal cord if the patient is not taken care of very carefully.
Spinal Cord Injuries
Each year in the United Sates, there will be approximately 50,000 new spinal cord injuries caused by accidents. A spinal cord injury occurs when the cord itself is crushed, stretched, or torn by the accident. Unfortunately, this is still an injury that can not be reversed or cured by modern medicine. More than half of these injuries involves the cervical spine, and most of them happen to young men. These injuries are incredibly devastating to the patient, their families, and also to their communities. There is currently a lot of research being done on ways to minimize spine injuries by designing cars for better safety, improving protective gear like football helmets, and educating people about the dangers of certain activities. There is also a lot of research being done on how to care for someone immediately after they have had a spinal cord injury, and also what kind of rehabilitation is best for them.