One of the most common neck conditions that occurs with age is cervical spondylotic myelopathy (CSM). Over time, the normal wear-and-tear effects of aging can lead to a narrowing of the spinal canal. This compresses — or squeezes — the spinal cord. CSM can cause a variety of symptoms, including pain, numbness, and weakness.
The vertebral column.
Spinal cord compression is a very common neck condition affecting older people in the United States. Symptoms usually begin after the age of 50, but can occur earlier if there was an injury to the spine at a younger age.
Many people with CSM will have steady progression of their disease. Once symptoms start, they tend to continue. Typically, the disease progresses slowly over several years. In about 5% to 20% of people, CSM worsens more rapidly.
Cause
Neck pain may result from abnormalities in the soft tissues—the muscles, ligaments, and nerves—as well as in bones and joints of the spine. The most common causes of neck pain are soft-tissue abnormalities due to injury or prolonged wear and tear. In rare instances, infection or tumors may cause neck pain. In some people, neck problems may be the source of pain in the upper back, shoulders, or arms.
Inflammatory Diseases
Rheumatoid arthritis can destroy joints in the neck and cause severe stiffness and pain. Rheumatoid arthritis typically occurs in the upper neck area.
Cervical Disk Degeneration
The disk acts as a shock absorber between the bones in the neck. In cervical disk degeneration (which typically occurs in people age 40 years and older), the normal gelatin-like center of the disk degenerates and the space between the vertebrae narrows. As the disk space narrows, added stress is applied to the joints of the spine causing further wear and degenerative disease.
The cervical disk may also protrude and put pressure on the spinal cord or nerve roots when the rim of the disk weakens. This is known as a herniated cervical disk.
(Left) Side view of a healthy cervical vertebra and disk. (Right) A disk that has degenerated and collapsed.
Injury
Because the neck is so flexible and because it supports the head, it is extremely vulnerable to injury. Motor vehicle or diving accidents, contact sports, and falls may result in neck injury.
The regular use of safety belts in motor vehicles can help to prevent or minimize neck injury. A "rear end" automobile collision may result in hyperextension, a backward motion of the neck beyond normal limits, or hyperflexion, a forward motion of the neck beyond normal limits.
The most common neck injuries involve the soft tissues: the muscles and ligaments. Severe neck injuries with a fracture or dislocation of the neck may damage the spinal cord and cause paralysis.
Other Causes
Less common causes of neck pain include tumors, infections, or congenital abnormalities of the vertebrae.
The spinal cord is the cable of nerves that send and receive signals from the body. When the spinal cord is slowly compressed, people may develop symptoms such as:
- Tingling and numbness
- Weakness: trouble lifting objects, dropping things
- Difficulty walking (loss of balance), wide-based gait
- Coordination problems/clumsiness: handwriting, buttoning clothes, and feeding oneself can become difficult
- Neck pain and stiffness
After discussing your symptoms and medical history, your doctor will examine your neck. He or she will look for:
- Abnormal reflexes: usually overactive (hyper-reflexia)
- Weakness: usually in the arms more than in the legs
- Numbness: mostly in the arms and hands
- Atrophy: muscles deteriorate and shrink
This MRI image shows bulging disks pressing on the spinal cord.
Other tests which may help your doctor confirm your diagnosis include:
X-rays
These studies are useful to look at the alignment of your neck.
Magnetic resonance imaging (MRI).
These studies can create better images of soft tissues. They can be used to look for compression of the spinal cord.
Myelogram
Your doctor may order this special type of computed tomography (CT) scan. CT scans allow better detailed cross-section images showing bone spurs and the size of the spinal canal. In a myelogram, color dye is injected before the scan to better outline the spinal cord.
Treatment
Nonsurgical Treatment
Some people get relief from symptoms without surgery. The most common nonsurgical treatment options include:
Soft Collars. Soft collars allow the muscles of the neck to rest and limit neck motion. This can help decrease pinching of nerve roots with movement. Soft collars should only be worn for short periods of time, because long-term wear can decrease the strength of neck muscles.Exercise. Improving neck strength and flexibility with simple exercises may lessen discomfort.
Nonsteroidal anti-inflammatory medications (NSAIDs). Drugs like aspirin and ibuprofen can reduce swelling and painful symptoms.
Epidural steroid injections. Cortisone is a powerful anti-inflammatory. Cortisone injections in the "epidural space" can decrease swelling as well as pain, although they are not often used in CSM.
Chiropractic manipulation. Manipulation is never used if a patient has spinal cord compression.
Surgical Treatment
Whether to have surgery or not is a complex decision made between you and your doctor.
Adapted from: American Academy of Orthopaedic Surgeons
