Pain in the cervical spine
Pain in the cervical spine is pain on the back of the neck, which is aggravated by head movements. The symptom may be accompanied by painful muscle spasms, headaches, dizziness. The main causes of pain in the cervical spine are inflammatory diseases of the vertebrae and soft tissues, osteochondrosis, traumatic injuries. To detect the etiological factor, radiography, CT and MRI, electromyography, electroneurography, laboratory tests are performed. NSAIDs and physiotherapy methods are used to eliminate the pain syndrome.
Causes of pain in the cervical spine
Chronic stress on the neck muscles
Cervical osteochondrosis
Neck injuries
Spinal canal stenosis
Infectious processes in the spine
Tumor pathology
Connective tissue damage
Neurological infections
Reflected pains
Rare reasons
Diagnostics
Treatment
Help before diagnosis
Conservative therapy
Surgical treatment
Prices for treatment
Causes of pain in the cervical spine
Chronic stress on the neck muscles
The cervical spine periodically hurts 3/4 of the adult population. Most often, unpleasant sensations are caused by prolonged stay in a forced position with the head tilted forward and the back hunched, which is typical for office workers, students, seamstresses. Pulling pains in the back of the neck occur in the evening, are aggravated by turns of the head. Sometimes the patient feels a “crunch” in the cervical region during movements. If the pain increases over time or there is an irradiation of the pain syndrome in the area of the upper arm and shoulder blades, you need to visit a specialist to figure out why the disorder occurred.
Cervical osteochondrosis
The most common causes of severe pain in the cervical spine are degenerative changes in the intervertebral discs and the vertebrae themselves. With a slight lesion of the discs and ligamentous apparatus, discomfort is felt in the neck area, which increases after active head movements, sleeping in an uncomfortable position, exposure to drafts, physical exertion. In addition to pain syndrome, paresthesia, a feeling of “crawling goosebumps”, numbness of the cervical region are possible. In order not to aggravate the pain, patients try to keep their neck and head motionless, turn their whole body.
As osteochondrosis progresses or with a sudden unsuccessful movement, patients complain of “lumbago” when the cervical spine hurts. The pain is very intense, acute, pulsating or burning in nature, felt as if in the depth of the neck. When the fibrous ring breaks, an intervertebral hernia forms, in which constant severe pain is felt in the neck. Pain syndrome forces a person to take a lying position on his back, head turns are impossible due to sharp shooting pains. This condition requires qualified medical care.
Neck injuries
Pain syndrome, which occurs due to a traumatic cause, is detected immediately after mechanical action on the cervical region or after some time. Soreness is often combined with changes in the skin in the injury area – redness and swelling are observed, bruises, abrasions are detected. If the integrity of the bone structures is violated, the contours of the neck are deformed, the head may hang on the chest. The most common mechanical causes of pain in the cervical spine:
Spinal contusions. Most often, soft tissues are damaged by bruises. The patient reports a sharp throbbing or pulling pain, head movements are possible, but sharply limited due to soreness. A large bruise is often formed at the site of the impact.
Fractures of the vertebrae. Such injuries occur as a result of car accidents (the so-called “whiplash injury”), falling from a height, a direct blow to the neck from behind. Movements in the cervical region are impossible, typical complaints of severe pain, impaired sensitivity.
Spinal canal stenosis
There are constant pains of the type of cervicalgia, which can have different intensity. A person describes the pain as pulling, shooting, burning. In addition to the pain syndrome, there are sensitivity disorders in the posterior cervical regions, restriction of the ability to perform active and passive movements. When the spinal cord is compressed, the cervical spine hurts very much, to alleviate the condition, patients take a forced stationary position on their back.
The involvement of spinal cord matter (compression myelopathy) in the process is evidenced by sensory and motor disorders. There is numbness of the skin of the cervical region, “crawling of goosebumps”. Later, weakness appears in the muscles of the arms, their tone decreases, individual muscle fibers twitch, muscle atrophy is possible. When the vascular bundle is infringed, vertebral artery syndrome occurs – complaints of periodic or constant ringing in the ears, dizziness and pre-fainting states are noted.
Infectious processes in the spine
Inflammatory causes cause sharp throbbing pains in the cervical spine, which constantly bother. The pain is very intense, painful, often patients do not sleep at night. The symptom is detected against the background of deterioration of the general condition, an increase in body temperature, chills and cold sweat are possible. Soreness is more often caused by osteomyelitis of the vertebrae. Intense pain with signs of para- and quadriplegia is noted during the formation of an epidural abscess, complicating the destruction of the cervical vertebrae.
Tumor pathology
Among all oncological diseases, the most common causes of pain in the cervical spine are metastases to the spine. This type of metastasis is characteristic of neoplasia of the lungs, uterus, stomach. Symptoms increase gradually: at first there is slight discomfort or moderate pulling pains in the back of the neck, then the pain syndrome increases. Vertebral fractures are possible even when exposed to minor traumatic factors. Primary tumor causes of cervicalgia are osteogenic sarcoma, myeloma, leukemia.
Connective tissue damage
Systemic inflammatory diseases (rheumatic pathology) always occur with the involvement of bone and cartilage structures in the process. Usually pain is caused by the progression of rheumatoid arthritis. At the same time, the cervical spine periodically hurts a lot, the greatest intensity of pain is observed in the morning after waking up. Morning stiffness in the neck lasting more than 1 hour is also characteristic. Cervicalgia is often a sign of other collagenoses: scleroderma, dermatomyositis, nodular periarteritis.
Neurological infections
The cervical spine can be very painful in the initial period of meningitis or encephalitis. The pain is dull or aching, persists for one to two days. Over time, the pain syndrome passes to the head area: unbearable pains in the occipital and frontal areas are bothering, multiple vomiting is also noted. When the inflammatory process spreads to the spinal canal, in addition to intense pain, paresis and paralysis, sensitivity disorders develop. Inflammation of the brain is caused by such infectious causes as:
Viral agents: polio pathogens, Coxsackie viruses and ECHO.
Pathogenic bacteria: meningococci, hemophilic bacillus, pneumococci.
Reflected pains
The cervical spine can hurt with pathologies of nearby internal organs (esophagus, trachea), which is explained by the presence of viscero-somatic reflexes. Pain impulses from the affected organ are transmitted to soft tissues, which leads to pain in the neck. The remaining symptoms depend on the cause that caused cervicalgia. With tracheitis, there is a barking dry cough and a subfebrile body temperature. For esophagitis, excruciating heartburn and acid belching, chest discomfort are typical.
Rare reasons
Spinal abnormalities: hypoplasia of the axis tooth, Klippel-Feil syndrome.
Damage to the intervertebral joints: Bekhterev’s disease (ankylosing spondylitis), reactive arthritis.
Spinal cord tumors: benign meningiomas and ependymomas, malignant spinal neoplasia.
Psychogenic pains.
Tuberculosis of the vertebrae.
Diagnostics
Patients with pain in the cervical spine turn to an orthopedic or traumatologist. A comprehensive examination of the vertebral column and adjacent anatomical structures is carried out using modern instrumental methods. Laboratory tests are needed to clarify the cause of cervicalgia. The greatest diagnostic value are:
Neurological examination. During the study, the deep and superficial sensitivity of the posterior parts of the neck is checked to exclude radiculopathy and myelopathy. The results of functional tests for coordination of movements are indicative. Be sure to evaluate the muscle strength of the upper extremities, the volume of active and passive movements in the cervical region.
X-ray examinations. The method effectively detects the main reasons why the spine in the cervical region may hurt. On radiographs, you can notice signs of spondylitis and spondylolisthesis, volumetric formations. To identify the instability of the spine, a functional radiography of the neck is performed in the position of flexion and extension of the vertebral column.
Neuroimaging methods. For a detailed study of the cervical vertebrae, a CT scan of the spine is used. The study allows us to assess the structure of bone tissue, the presence of fractures or displacement of fragments. Visualization of intervertebral discs, ligamentous apparatus is achieved using MRI. To exclude spinal canal stenosis, myelography is performed.
Functional diagnostics. If the cervical spine hurts periodically, and the intensity of pain is low, this may be due to damage to the cervical muscles. Electromyography is prescribed to study the state of muscle structures. To confirm or refute the radicular syndrome, electroneurography, a study of evoked potentials is shown.
Laboratory methods of examination are of auxiliary importance. To confirm the infectious cause of pain, general and biochemical blood tests are performed, hemoculture is examined. Additionally, serological reactions are recommended to identify the most typical pathogens of neuroinfections. To exclude the rheumatic etiology of pain in the cervical spine, the level of rheumatoid factor and antinuclear antibodies in the blood is determined.
Treatment
Help before diagnosis
Patients whose cervical spine hurts very much should ensure functional rest for the neck, avoid head movements, especially turns from side to side. To reduce the tension of the neck muscles, it is necessary to take regular breaks from working at a computer or machine. To find out the cause of cervicalgia and the selection of treatment, you should consult a doctor as soon as possible. Before the diagnosis is verified, it is permissible to take analgesics from the NSAID group to relieve excruciating pain. Independent use of warming compresses is prohibited.
Massage of the cervical spine
Massage of the cervical spine
Conservative therapy
Medical tactics depend on the cause of the disease and the clinical stage. In the absence of pronounced destructive changes in the vertebral column, a combination of medication and physiotherapy is sufficient. Physiotherapy procedures are prescribed after acute pain in the cervical spine subsides, acupuncture, percutaneous electrical stimulation, ultrasound and electromagnetic methods are the most effective. With chronic pain syndrome, manual therapy is resorted to. Of medicines , they are usually used:
NSAIDs. They belong to the first line of drugs for the treatment of acute and chronic pain in the spine. Effectively eliminate pain syndrome, reduce inflammatory reactions in joints and soft tissues. To minimize side effects, selective COX-2 inhibitors are preferred.
Local anesthetics. If the spine is unbearably sore in the cervical region, therapeutic blockades are recommended. Anesthetics in combination with glucocorticosteroids are administered as close as possible to the lesion: in the neck muscles, facet joints, less often perform epidural blockades.
Neurotropic vitamins. To enhance the analgesic and anti-inflammatory effect of other medications, B vitamins, especially thiamine, are used. The drug inhibits pathological pain impulses, increases the concentration of the most important endogenous analgesic substances.
Anticonvulsants. These drugs are combined with antidepressants for chronic resistant pain syndrome, psychogenic pain. Additionally, short courses of muscle relaxants are used. In case of vascular disorders, venotonics are administered.
Surgical treatment
In unstable fractures of vertebral bodies and arches, operative reposition of fragments with their subsequent stabilization by methods of bone osteosynthesis is shown – usually metal plates with transpedicular fixation are installed. In benign spinal tumors, their removal is performed after preliminary decompression of brain structures. In the case of osteomyelitis of the spine, sequestrectomy is necessary with further restoration of the anatomical integrity of the spinal column.
Surgical methods of treatment used for osteochondrosis can be divided into two groups: decompression and stabilizing. Decompression operations are designed to reduce pressure on the spinal canal and relieve radicular syndrome. For this purpose, laminectomy, endoscopic discectomy, facetectomy are performed. Stabilizing operations are required when the cervical vertebrae are displaced in the frontal plane and there is a risk of spinal cord injury. Perform anterior or posterior fusion (fixation of bone structures to ensure their complete immobility).
