The vertebral column, also known as the spinal column or simply the spine, is a column of 26 bones in an adult body (24 vertebrae interspaced with cartilage in addition to the sacrum and coccyx). In adolescents, the column consists of 33 bones as the sacrum's five bones and the coccyx's four do not fuse together until after adolescence. The spine is further divided into regions: cervical (the neck), thoracic (upper and mid back), lumbar (lower back), sacral, and coccygeal. In between the vertebrae are thin regions of cartilage known as intervertebral discs, which are made of a fibrous outer shell (annulus fibrosus) and a pulpy center (nucleus pulposus).
The cervical spine, commonly referred to as the neck, is a delicate, but yet flexible and well-engineered structure of bones, muscles, nerves, tendons and ligaments. The cervical spine houses the spinal cord which sends messages from the brain to control all aspects of the body. The neck connects the base of the skull to the thoracic spine, which is the mid back, through a series of seven vertebral segments. The cervical spine is at risk for developing a number of painful conditions due to the complicated structure and the amount of stress and pressure placed on the neck through a traumatic event or even the day-to-day demands.
Sometimes, people have pain in the neck that radiates into the shoulder or arm. This type of pain is often caused by cervical radiculopathy, commonly referred to as a pinched nerve, which is an injury near the root of a spinal nerve in the cervical spine. A pinched nerve occurs when there is tremendous pressure applied on a nerve by surrounding disc or bone, which disrupts the nerve’s function causing pain and at times, weakness.
Common symptoms of cervical radiculopathy are:
- Pain in the neck that travels down the shoulder or arm
- Numbness or a tingling (“pins-and-needles”) feeling
- Occasional weakness in the muscle(s) that the pinched nerve travels to
Diagnosis of cervical radiculopathy will consist of a combination of a patient history, physical examination, and a series of tests. After discussing the medical history of the individual, the physician will examine the neck and instruct the individual to move the neck in certain ways that may recreate the symptoms. The physician may order additional imaging studies such as a CT or MRI scan to rule out other abnormalities, as well as conduct a nerve function test called electromyography (EMG), where he or she will be able to see the electrical activity in the nerves and muscles to determine the extent of the nerve injury
Some of the individuals with cervical radiculopathy improve over time without any treatment. In some patients, the pain will go away sooner than others and the symptoms might return at a later date, but once again. However, some patients develop symptoms that do not go away and might require some treatment for the pain and weakness.
Medication - Over-the-counter NSAID’s mayhelp reduce pain and swelling. If these are deemed insufficient by the physician, he or she might prescribe stronger pain relief medication. Additionally, the physician may also prescribe oral corticosteroids for a short time to help reduce pain and swelling.
Physical Therapy - Early treatment can often help improve symptoms. With the help of a therapist, exercises may be given to work on helping improve posture and reducing pain. Traction, weather mechanical or manual, may also be helpful and can be instituted with proper guidance from a trained individual.
Epidural Steroid Injections - Injecting the area around the spinal nerves with cortisone, a powerful anti-inflammatory medicine, might aide in decreasing pain. This is done using real-time x-ray imaging (fluoroscopy). Oral or IV sedation may be offered to keep the patient comfortable during this procedure.
Surgery - If the non-operative treatments have been exhausted and have failed to relieve symptoms, the physician may recommend operative treatment. There are a number of surgical procedures for cervical radiculopathy, but the exact procedure will depend on the location and source of pain as well as several other factors. Options must be discussed with the physician to determine the appropriate course of treatment.
Recovery will depend on the treatment option chosen by the individual as well as the physician. Each patient is unique, so the recovery process will vary based on his/her level of pain, extent of damage, and desired level of activity they would like to return to.
CALL 911 IMMEDIATELY IF YOU ARE HAVING A MEDICAL EMERGENCY!
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