Sunday, August 07, 2011

Cervical spondylosis


“Utinam populus Romanus unam cervicem habere!” (“Would that the Roman people had but one neck!”) in Suetonius’ Lives of the Caesars, Gaius Caligula, Sect. Caligula (AD 12-41), Roman Emperor

MANILA, Philippines — A NEW patient of mine – with cervical spondylosis – also happens to be an IT professional. He says that with CGMA’s superhyped neck condition, there was a tremendous surge in the Internet search of the topic. While it’s certainly a good thing people have suddenly become more aware of their necks, not all the pain comes from spondylosis or arthritis.

Where does neck pain come from? Consider the garden-variety neck strain. This usually results from overuse of the soft tissues of the neck – muscles and ligaments. A neck sprain comes from injury or overuse of the bones and joints such as from a whiplash accident. You can get a strain or sprain from poor sleeping habits. The head must be nestled on a pillow that is neither hard nor soft. A firm pillow will support the head in a manner that will relax the neck. Strains and sprains go away in a matter of days. When the pain stays or worsens, there can be more serious causes.

Cervical Radiculopathy. Disks are gelatin-like cushions in between the spine bones (vertebrae). Normally, disks are soft and elastic absorbing the shock of constant loading and movement of bones. Past the age of however, the disks begin to degenerate and harden (degenerative disk disease). A bad result of this is the narrowing of the space between bones where nerves exit. Sometimes even the disk itself will protrude and pinch the nearby nerve as well (herniated cervical disk). This is the neck pain from hell. It doesn’t go away. In fact, the pain and numbness and later on, weakness will show up in the shoulder, the arms, the forearms or hands (cervical radiculopathy). These are the areas supplied by the affected nerve. Finally there is spinal stenosis. The source of chronic neck pain is the narrowing of the free space in the spinal canal. A usual suspect is osteoarthritis where arthritic joints enlarge and compress nerves and even the spinal cord itself. Arthritis makes the neck stiff and painful.

Time to see the doctor. How much neck pain can you live with? Remember that it isn’t normal to have it for more than a week or so. The emergency medicine doctor, the family physician, the rehabilitation medicine specialist (physiatrist), the rheumatologist, the neurologist, the neurosurgeon, and the orthopedic surgeon are the doctors capable of treating this sort of neck pain.

Diagnosis. Doctors talk about localizing a lesion and this is the aim of your physical examination or P.E. Note that other causes of neck pain such as infection (meningitis) or tumor have to be ruled out. The doctor may order some blood tests. Imaging of the neck may be as cheap as an X-ray or as expensive as an MRI (magnetic resonance imaging).

Treatment. When the exact cause of cervical radiculopathy has been revealed, a treatment program is started. Most patients are made well by rest and medication (usually NSAIDs or non-steroidal anti-inflammatory drugs such as diclofenac and ibuprofen, muscle relaxants, and the COX-2 inhibitors (celecoxib and etoricoxib). A neck collar, a form of immobilization, may help. Chronic pain is better handled with physical therapy. These include cervical traction, electrical stimulation, heat or cold therapies, massage, and stretching exercises.

Surgery. Recalcitrant neck pain may benefit from surgery. An operation is recommended not only if neck pain doesn’t go away but especially when it is becoming worse. There are many procedures but the common ones involve removal of impinging material such as disks, and parts of bones and joints. Neck pain, like any pain, is a warning sign. It must be heeded. Its cause must be aggressively sought. There is no virtue in waiting.

Dr. Pujalte is an orthopedic surgeon. E-mail



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