Cervical Spine Pain
Conditions involving the cervical discs can produce several clinical syndromes or groups of symptoms.
The annulus can tear.
This may be a silent event or it can produce pain, usually referred to the posterior neck, occipital region, or between the shoulder blades. No radiculopathy or myelopathy occurs because there is no neurologic compromise.
Sometimes along with an annular tear the inner disc gel can herniated or ooze outward. This can be asymptomatic, or it can produce pain, pressure on a nerve (radiculopathy), pressure on the spinal cord (myelopathy), or a combination of neurologic findings.
A radiculopathy involves nerve roots and may produce muscle weakness, abnormal sensations such as numbness or tingling, or pain along a particular nerve pathway. Remember, the nerves of the upper extremity are composed of fibers from several different nerve roots. A radiculopathy may develop when the disc material herniates posterolaterally toward the nerve root.
A disc herniation may also produce myelopathy. This occurs when the herniation occurs directly posteriorly, compressing the spinal cord directly. This causes spinal cord malfunction below the level of the herniation. Your spinal physician will look for signs of this while examining you. Several signs include the Hoffman’s sign, Babinski’s sign, the scapulohumeral reflex, the inverted radial reflex, and clonus. Some of these are difficult to perform or to detect and may not be present in all cases. In addition, acute bowel or bladder deficits may occur.
Another form of disc pathology involves degeneration. As the disc degenerates or wears out, it begins to bulge. Anterior bulge is insignificant. A posterior bulge gradually decreases space for the spinal cord. In addition as the disc height decreases, the pathway for the nerve roots decreases. After continued disc degeneration, osteophytes (bone spurs) may begin to form. These spurs may also compress nerve roots or the cord. A “disc-osteophyte complex” develops. Cervical disc degeneration may cause neck pain, referred pain, radiculopathy, or myelopathy, but tends to develop slowly. Often patients may have slight difficulty with activities such as knitting, buttoning shirts, handling coins, or they may notice a change in the way they walk (wider shorter steps). Sometimes these changes are difficult to detect, but your spinal physician has the skills and training to recognize these signs.