Hertfordshire Spine Clinic Mr Sajjad Mushtaq

Back and Neck pain with Disc prolapse/Arthritis

Neck Pain

The first 7 vertebral bones on the spinal column form the cervical spine and are located in the neck region. The neck bears the weight of the head, allows significant amount of movement, and is also less protected than other parts of the spine. All these factors make the neck more susceptible to injury or other painful disorders. Common neck pain may occur from muscle strain or tension in everyday activities including poor posture, prolonged use of a computer and sleeping in an uncomfortable position.

Causes

The most common cause of neck pain is injury to the soft tissues (muscles, ligaments, or nerves) or prolonged wear and tear. Traumatic accidents or falls and contact sports can cause severe neck injuries causing pain in the neck. Neck pain can also come from infections, tumours or congenital abnormalities of the vertebrae. Common conditions producing neck pain include:

  • Rheumatoid arthritis: It is an auto-immune disease in which the body's immune system attacks healthy joints, tissues and organs. The condition occurs most often in the upper neck area causing inflammation of the lining (or synovium) of joints resulting in neck pain, stiffness, swelling and loss of function.
  • Cervical disc herniation: Disc herniation is the bulging or rupture of the soft fibrous tissue, discs, cushioning the vertebrae. Cervical disc herniation refers to herniation of discs in cervical spine region or neck region. Because of this the soft central portion called nucleus pulposus bulges out through the tear in the capsule. The condition can be caused by the normal ageing or by traumatic injury to the spine. The condition results in painful, burning, tingling or numbing sensations in the neck.
  • Cervical Spondylosis: Cervical spondylosis refers to abnormal degeneration of the cartilage and bones in the neck region. The condition results in neck pain radiating to arms or shoulder and neck stiffness that gets worse over time.
  • Cervical Stenosis: Cervical stenosis refers to narrowing of the spinal canal that protects the spinal cord and its branching nerves. The condition causes neck pain radiating to arms and hands.
  • Degenerative disc disease: Degenerative disc disease refers to gradual deterioration of the disc between the vertebrae and is caused due to ageing. As people age, intervertebral discs lose their flexibility, elasticity and shock absorbing characteristics, resulting in neck pain.

Diagnosis

Diagnosis of neck pain is made with physical examination and other imaging techniques including electromyography (EMG), X-ray, MRI scan, CT scan, blood tests and bone density assessment.

Treatments

Treatment options include rest, ice application, elevation of the injured area, using a soft neck collar and neck immobilization using a splint, cast, or sling. Medications such as anti-inflammatory drugs, analgesics and muscle relaxants may be prescribed to reduce the pain and inflammation. Certain stretching and strengthening exercises may be recommended to strengthen the neck muscles.

Surgical treatment by anterior cervical discectomy with spinal fusion is typically recommended only after non-surgical treatment methods fail to relieve the pain. An anterior cervical discectomy is a surgical procedure performed to remove a herniated or degenerative disc in the cervical (neck) spine. Spinal fusion may be performed to provide stability to the spine.

The following steps may help you prevent or improve your neck pain:

  • Practice relaxation exercises to prevent undesirable stress and tension to the neck muscles
  • Perform stretching exercises for your neck before and after exercise
  • Keep good posture if you work at a computer and adjust the monitor at your eye level. Stretch your neck frequently.
  • If you use the telephone a lot, use a headset
  • Use a pillow that keeps your neck straight
  • Wear seat belts and use bike helmets to reduce injuries

Back Pain

Back pain or backache is the pain felt in the back that may originate from muscles, nerves, bones, joints or other structures in the spine. Back pain is one of the most common medical problems experienced by most people at some time in their life. Back pain can be acute, usually lasting from a few days to a few weeks or chronic, lasting for more than three months.

Back pain can occur as a dull, constant pain or a sudden, sharp pain. Back pain may be confined to one area or may radiate to other areas such as the arm and hand, the upper back, or the lower back and might radiate into the leg or foot. Other than pain, you may have weakness, numbness or tingling in your arms or legs, caused from damage to the spinal cord.

Causes

Athletes participating in sports such as skiing, basketball, football, ice skating, soccer, running, golf or tennis are at greater risk of developing back pain. During these sport activities, the spine needs to bear more stress, take more pressure, undergo twisting and turning, as well as bear more bodily impact. This may cause strain on the back that can result in back pain. Athletes are at high risk of back pain both from trauma and from overuse injuries, especially in sports requiring hyperextension.

Common causes of back pain in athletes include:

  • Musculoligamentous strain: It is the most common sports injury caused by injury to the soft tissues around the spine.
  • Spondylolysis: It is most commonly found in athletes who participate in sports such as gymnastics, pole-vaulting and football. All these activities require frequent hyperextension of the lumbar spine.
  • Spondylolisthesis: It is a condition of the spine which occurs when one vertebra is displaced or has slipped forward over the other below it.
  • Herniated nucleus pulposus: When injury occurs, the central core of the disc is pushed through a tear in the outer hard layer of the disc, causing a bulge and pressing on nearby nerves. If the herniated disc presses on a spinal nerve, it can cause back pain.

Other causes include growth-related problems such as scoliosis and Scheuermann's kyphosis.

Diagnosis

Your physician will diagnose back pain by asking appropriate questions or by taking a history of your problem and examining your spine. A complete examination includes examination of the signs of unusual curves of the spine, a rib hump, a tilted pelvis, and tilting of the shoulders and a test of your sensations. Other diagnostic tests may be needed to confirm the diagnosis.

Treatment

Treatment for back pain is usually non-surgical and includes:

  • Anti-inflammatory medications, or NSAIDs are recommended to provide relief from pain
  • Cold packs, heat packs or both applied to the back to help ease much of the discomfort and relieve stiffness as well the pain
  • Sleeping with the pillow between the knees while lying on one side or placing the pillow under your knees when lying on your back may help relieve back pain
  • Exercises to strengthen your trunk and back muscles

These measures help relieve your back pain. However, in certain conditions the pain may not be resolved and may require surgical treatment. Your physician will decide on the appropriate surgery based on several factors.

Disc Prolapse/Arthritis

Degenerative spinal conditions are a group of disorders that causes loss of normal structure and function of the spine. These disorders may be caused due to aging, infection, tumours, muscle strains or arthritis. Degenerative joint disease is commonly known as arthritis that affects feet, fingers, hands, spine and weight-bearing joints. It is caused due to the inflammation of joints because the articular cartilage covering the bones may be damaged or worn out.

Degenerative disc disease refers to gradual deterioration of the disc between the vertebrae.

Causes

As people age, intervertebral discs lose their flexibility, elasticity and shock absorbing characteristics. Annulus fibrosis, outer fibres surrounding the disc, become brittle and is more easily torn. At the same time, nucleus pulposus the soft gel-like substance located in the centre of the disc, starts to dry out and shrink.

Symptoms

Every patient is different and it is important to realize that not everyone develops symptoms because of degenerative disc disease. When the condition becomes painful or symptomatic, it can cause several different symptoms due to the compression of the nerve roots. Depending on the location of degenerative disc, it could cause back pain, radiating leg pain, neck pain, and radiating arm pain.

As the discs between the intervertebral bodies start to wear out, the entire lumbar spine becomes less flexible resulting in back pain and stiffness.

Diagnosis

The diagnosis of degenerative disc disease begins with patient’s history and a complete physical examination.  Examination of the back for flexibility, range of motion, and the presence of certain signs that suggest nerve roots are being affected by degenerative changes in your back. This is done by testing the strength of your muscles and your reflexes to make sure that they are still working normally.

A series of X-rays is also usually ordered and if degenerative disc disease is present, the X-rays will often show a narrowing of the spaces between the vertebral bodies, which indicates the disc has become very thin or has collapsed. Bone spurs formed around the edges of the vertebral bodies and around the edges of the facet joints in the spine can be seen on an X-ray. Thus, the space available for the nerve roots starts to shrink. The nerve roots exit the spinal canal through a bony tunnel called the neural foramen and it is at this point the nerve roots are especially vulnerable to compression.

In most cases a MRI or a CT scan may be ordered to evaluate the degenerative changes, determine disc herniation and nerve root compression. A CT scan is often used to evaluate the anatomy in the spine which can show how much space is available for the nerve roots and within the neural foramina and spinal canal.

Treatment

Both surgical and nonsurgical treatment options are available for degenerative conditions and the choice depends on various factors such age of patient and severity of disease.

Nonsurgical treatment – For people with no evidence of nerve root compression or muscle weakness conservative treatment such as medication, rest, exercise and physical therapy are typically recommended.

Surgical treatment – Surgery is offered only after conservative treatment options failed to adequately relieve the symptoms of pain, numbness and weakness over a significant period. Decompression of the spinal cord accompanied by a discectomy or an anterior cervical discectomy and fusion will be performed to remove the affected disc and fuse the associated vertebrae to stabilize the spine in that area.

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