What are the symptoms?
Degeneration alone can lead to mechanical neck pain and stiffness radiating across the shoulders and into the head causing headaches. If a nerve is pinched pain may radiate or ‘shoot’ down the arm to the fingers, with pins and needles and numbness; this is called brachialgia. This may be aggravated by work and lifestyle.
Pressure on the spinal cord ‘myelopathy’ can lead to a progressive loss of balance, when walking resulting in falls. Fine tasks such as writing, doing up buttons and shoelaces may become impaired and, rarely, bladder control is affected.
What is the prognosis and treatment options?
Referral to the clinic leads to careful history taking, examination, and appropriate imaging – usually x-rays and MRI – and a diagnosis.
Mechanical neck pain and stiffness, without significant arm symptoms is best managed conservatively with a combination of physiotherapy (specifically neck stretching and strengthening exercises), lifestyle modification and simple analgesia as required. Cervical facet joint injections, selective nerve root blocks or rhizolysis are simple techniques, which can settle a refractory episode of pain either temporarily or for a prolonged period. A pain management Consultant may be involved if symptoms remain severe. With good quality conservative treatment most patients do well with more manageable symptoms and longer periods when their neck feels better.
Significant arm symptoms, which have not responded to conservative treatment, including a cervical nerve root block, are best managed with surgery.
Symptomatic cord compression or myelopathy usually progresses with time. Surgery is primarily aimed at preventing further progression of symptoms, but can lead to significant improvement and recovery of independence.
Depending on the problem surgery is performed either anteriorly – anterior cervical decompression and fusion or cervical disc replacement – or less commonly posteriorly – foraminotomy, laminectomy or laminoplasty – if multiple levels are affected.