Cervical Disorders: Spinal Stenosis, Disc Herniation, Spondylosis

Cervical Disc Herniation
Disc degeneration can sometimes follow a slightly different course. In the process of sustaining increased mechanical loads, the outer aspect of the disc, known as the anulus (an-you-lus), can become stressed. With time, small tears can form in the anulus. This outer ring normally keeps the soft, gel-like center of the disc contained. The gel center, known as the nucleus, can be ejected from the disc through an anular tear. This is called a disc herniation (her-knee-aye-shun). If the disc herniates in the direction of the spinal cord or nerve root, it can cause neurologic compromise. Disc herniations in the cervical spine can be serious. If significant enough, they can cause paralysis of both the upper and lower extremities, though this is extremely rare.

In most cases, a patient complains of neck pain associated with radiating pain to one arm. This is caused by compression of a nerve root, rather than the spinal cord itself. With time some herniated discs resolve or shrink by themselves. Sometimes, disc herniations can persist, causing prolonged symptoms and neurologic problems, which may lead to surgical considerations.

Cervical Spondylosis
This rather elaborate sounding word is really nothing more than a description of what happens to the vast majority of our cervical spines as we get older. The term spondylosis (spon-dee-low-sis) refers to the bony overgrowths associated with aging of the spine. Though it is hypothesized, as discussed, that osteophytes form because of micro-instability and disc degeneration, this is not certain. It is known that a high percentage of patients without any neck pain or other symptoms have spondylosis of the spine. In some people, however, spondylosis may be associated with neck pain. Spondylosis is likely the end result of disc degeneration that has been present for a very long time.

Differential Diagnosis

What else can be causing my neck pain?
Diagnosing degenerative disorders of the spine starts with a good history and physical examination. Typically, patients have neck pain. This is the most common complaint. Unfortunately, neck pain is a common complaint in the vast majority of people who have nothing more than a stiff neck. It is important to differentiate neck pain related to degenerative spinal disorders from other more serious ailments.

Muscle strains can cause mild pain. This can vary from the occasional "stiff neck" (from keeping your neck in one position too long like during sleep) to neck soreness associated with a low-speed motor vehicle collision (whiplash). The pain and tenderness is not deep and is usually limited to the surrounding muscles around the neck. Often, one side is more symptomatic than the other. Muscle strains are differentiated from degenerative disorders by their self-limited course. Muscle strains usually resolve, or at least dramatically improve, within a couple of days to weeks. Pain that continues for more than three weeks without improving may not be a muscle strain and other diagnoses should be considered.

Patients with rheumatoid arthritis (room-ah-toyed arth-rye-tis) can have neck pain. It is important to recognize this. Any patient with rheumatoid arthritis should have neck x-rays taken. These patients can develop instability in the upper cervical spine that can endanger the spinal cord. This is easily recognized on plain x-rays.

Neck pain can be a presenting symptom of meningitis, an infection of the brain and spinal cord linings. Meningitis can have many causes and may be contagious. Although neck pain is probably the most common symptom, it is important to recognize the others signs. Patients often are extremely sensitive to light, irritable, have high fevers, and actually tolerate very little movement of the neck. Though it is rare, this diagnosis is very serious and should prompt an individual to seek urgent medical care. Other types of infection can also occur in the neck. Infection can occur in the bone or intervertebral disc. This is more common in older patients who may have a weak immune system. Again, as with meningitis a history of fever could be important, but there is not hypersensitivity to bright light.

Tumors can also cause neck pain. One way to clinically differentiate tumor from degenerative disorders is the presence of generalized, or constitutional, symptoms. Unintentional weight loss, feeling of extreme lethargy, persistent low grade fevers, and night sweats are typical constitutional symptoms. A history of cancer elsewhere is also a clue, as the majority of neck tumors are metastases (or spread) from a cancer in the lung, prostate, kidney or breast.

This article is an excerpt from Dr. Stewart G. Eidelson's book, Advanced Technologies to Treat Neck and Back Pain, A Patient's Guide (March 2005).