Jaydeep M. Bhatt, M.D.
Neck & Back Pain Syndromes
For many, neck and back pain is a source of frustration and disability. It is also a common cause of employee absenteeism.
There are several pain-sensitive structures in the neck and back, including nerves, bones, blood vessels, and connective tissue. Discomfort in these areas, coming from these structures, may require urgent attention. Therefore, it is important for you to seek medical attention as soon as possible.
Cervical (neck) or lumbosacral (low back) radiculopathy refers to a common cause of pain that occurs when large nerves or “roots” in the neck are irritated. This is usually due to compression from other structures.
Many roots emerge from each side of the spinal cord in the neck and back. They eventually form peripheral nerves that move muscles and convey sensation. The roots are initially protected by bones called vertebrae, but they are potentially vulnerable. Gel-like structures called intervertebral disks may shift sideways and compress the root.
Sometimes, the vertebrae themselves grow bony extensions called ridges or spurs that irritate roots. Often, the roots are affected at multiple levels by a combination of these two processes.
The predominant symptom in cervical radiculopathy is sharp pain. It is usually located over the shoulder blade and radiates down the arm, the distance of which depends on the level of the affected root. The pain may be accompanied by numbness, tingling, muscle spasm, and even headache.
In several cases, there is a clear inciting event or action, such as a whiplash injury or a fall; but many patients simply cannot remember any incident and simply “wake up with it.” The pain usually worsens with neck extension and lateral movements.
Other conditions affecting the spinal cord or shoulder and its supporting structures may mimic the symptoms of cervical radiculopathy. This is another reason why you should see a neurologist when experiencing new onset pain or a change in the character of chronic neck pain.
There are a number of causes that may result in irritation or damage to nerve roots:
The first two causes (injury and aging) are responsible for the majority of cervical radiculopathies seen by neurologists.
Tests that help with diagnosis may include:
There are several pain-sensitive structures in the neck and back, including nerves, bones, blood vessels, and connective tissue. Discomfort in these areas, coming from these structures, may require urgent attention. Therefore, it is important for you to seek medical attention as soon as possible.
Cervical (neck) or lumbosacral (low back) radiculopathy refers to a common cause of pain that occurs when large nerves or “roots” in the neck are irritated. This is usually due to compression from other structures.
Many roots emerge from each side of the spinal cord in the neck and back. They eventually form peripheral nerves that move muscles and convey sensation. The roots are initially protected by bones called vertebrae, but they are potentially vulnerable. Gel-like structures called intervertebral disks may shift sideways and compress the root.
Sometimes, the vertebrae themselves grow bony extensions called ridges or spurs that irritate roots. Often, the roots are affected at multiple levels by a combination of these two processes.
The predominant symptom in cervical radiculopathy is sharp pain. It is usually located over the shoulder blade and radiates down the arm, the distance of which depends on the level of the affected root. The pain may be accompanied by numbness, tingling, muscle spasm, and even headache.
In several cases, there is a clear inciting event or action, such as a whiplash injury or a fall; but many patients simply cannot remember any incident and simply “wake up with it.” The pain usually worsens with neck extension and lateral movements.
Other conditions affecting the spinal cord or shoulder and its supporting structures may mimic the symptoms of cervical radiculopathy. This is another reason why you should see a neurologist when experiencing new onset pain or a change in the character of chronic neck pain.
There are a number of causes that may result in irritation or damage to nerve roots:
- Compression from disks and bony elements arising from direct physical injury
- Compression from misplaced disks and bony extensions due to degeneration and aging
- Compression from overgrown ligaments and other types of connective tissue
- Infections of the roots by bacteria or viruses, e.g., Lyme Disease
The first two causes (injury and aging) are responsible for the majority of cervical radiculopathies seen by neurologists.
Tests that help with diagnosis may include:
- EMG (a recording of electrical activity in muscles)
- Nerve conduction studies
- Imaging studies such as CT or MRI of the spine
- Sometimes blood tests searching for infection or inflammation may be needed
Treatment
The treatment for neck or back pain depends on the cause and severity of your injury. The majority of patients with pain due to root irritation improve with conservative management. This entails physical therapy and a limited course of anti-inflammatory medicine to reduce inflammation and swelling of the cervical root. Other causes require attention to the underlying problem.
Sometimes the pain from this condition can be so severe that it may be necessary to administer a local injection of medication. This is known as a therapeutic root block and the effects vary. They may be negligible, temporary, or may last for weeks or months.
In some instances, the degree of injury in the neck due to trauma or aging can be so severe that it damages the integrity of the spinal cord and nerve roots. If ignored, sustained damage may lead to severe weakness and even disability. When conservative rehabilitative measures aren’t enough, cervical spine surgery may be required. Referral to a neurosurgeon, who works closely with a neurologist, is essential for the best outcome.
Sometimes the pain from this condition can be so severe that it may be necessary to administer a local injection of medication. This is known as a therapeutic root block and the effects vary. They may be negligible, temporary, or may last for weeks or months.
In some instances, the degree of injury in the neck due to trauma or aging can be so severe that it damages the integrity of the spinal cord and nerve roots. If ignored, sustained damage may lead to severe weakness and even disability. When conservative rehabilitative measures aren’t enough, cervical spine surgery may be required. Referral to a neurosurgeon, who works closely with a neurologist, is essential for the best outcome.
