Common Conditions

Back Conditions

The healthy spine and motion unit concept

Before discussing how the spinal disc can cause back pain and/or leg pain (sciatica), or neck pain with or without down the arm irradiating pain, it is useful to first understand the role of a healthy disc in the spine and its anatomy.

The intervertebral disc is the so called anterior column of the spine and has several important functions, including functioning as a spacer, as a shock absorber, and as a part of the motion unit or functional spinal unit (FSU).

The intervertebral discs, joint capsules and ligaments hold the vertebrae together and control the range of segmental motion. The posterior wall of the vertebra, the bony arch and the yellow ligament extending from one arch to the next form a tube (spinal canal) containing the end of the spinal cord and the spinal nerves. Each segment has two lateral openings through which the corresponding nerve roots exit to the periphery.

 

functions-of-the-spine-disc

Functions of the spine disc.

 

  • Spacer. The height of the disc maintains the separation distance between the adjacent vertebral bodies. This allows biomechanics of motion to occur, with the cumulative effect of each spinal segment yielding the total range of motion of the spine in any of several directions. Proper spacing is also important because it allows the intervertebral foramen to maintain its height, which it allows the segmental nerve roots room to exit each spinal level without compression (e.g. a pinched nerve).
  • Shock absorber. Shock absorption allows the spine to compress and rebound when the vertebrae is axially loaded during such activities as jumping and running. Importantly, it also resists the downward pull of gravity on the head and trunk during prolonged sitting and standing. When we are born, the disc is comprised of about 80% water, which gives it its spongy quality and allows it to function as a shock absorber. As we age, the water content decreases and the disc becomes less capable of acting as a shock absorber.
  • Motion unit. Motion is possible between two adjacent vertebrae. The intervertebral disc in front, a pair of so-called facet joints (small joints that connect two vertebrae) posteriorly and various ligaments and muscles form a functional spinal unit (FSU). The lumbar spine has five FSUs. These provide stability and motion in the lumbar spine.

The average range of motion of a lumbar FSU is around 10 degrees flexion and 5 degrees extension, 5 degrees lateral bending and around 3 degrees rotation. The sum of these ranges of motion provides the total flexibility of this anatomical structure.

The elasticity of the disc allows motion coupling, so that the spinal segment may flex, rotate, and bend to the side all at the same time during a particular activity. This would be impossible if each spinal segment were locked into a single axis of motion. There are other components in this motion unit, posterior facet joints and segmental muscles as the motor part of the unit.

The gelatinous central portion of the disc is called the Nucleus Pulposus. It is composed of 80 – 90% water. The solid portion of the nucleus is Type II collagen and non-aggregated proteoglycans. 
 The nucleus pulposus contains a great deal of very inflammatory proteins. If this inner disc material comes in contact with a nerve root, it will inflame the nerve root and create pain down the leg sciatica or down the arm (radiculopathy). In the same manner, if any of the inflammatory proteins within the disc space leak out to the outer annulus and touch the pain fibers in this area, it can create a lot of low back pain or neck pain.

As the disc is not directly connected to the body’s vascular system, the nutrition of the disc is only secured by perfusion through the cartilaginous and bony endplates of the adjacent vertebral bodies. This makes the disc susceptible to degeneration. There is minimal blood supply to the disc, and blood is what brings healing nutrients and oxygen to damaged structures in the body. This means that the spinal disc lacks any significant reparative powers. Unlike muscles, which have good blood supply, once a spinal disc is injured it cannot repair itself.

The outer ligamentous ring around the nucleus pulposus is called the Annulus Fibrosus, which hydraulically seals the nucleus, and allows intradiscal pressures to rise as the disc is loaded. The annulus has overlapping radial bands, not unlike the plies of a radial tire, and this allows torsional stresses to be distributed through the annulus under normal loading without rupture. The vertebral body itself can transiently be deformed by the axial loading, recovering it shape after this loading have finished.

The disc functions as a hydraulic cylinder. The annulus interacts with the nucleus. As the nucleus is pressurized, the annular fibers serve a containment function to prevent the nucleus from bulging or herniating. The gelatinous nuclear material directs the forces of axial loading outward, and the hoops of annular fibers help distribute that force without injury in a uniform way. 
Nerves to the disc space only penetrate into the very outer portion of the annulus fibrosus. Even though there is little innervation to the disc, it can become a significant source of back or neck pain if a tear in the annulus reaches the outer portion and the nerves become sensitized. With continued degeneration, the nerves on the periphery of the disc will actually grow further into the disc space and become a source of pain.

The lumbar disc is a unique and well-designed structure in the spine. It is strong enough to resist terrific forces in multiple different planes of motion, yet it is still very mobile.

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Degenerative Disc Disease (DDD)

Disc degeneration known as spondylosis is a natural part of aging and over time all people will exhibit changes in their discs consistent with a greater or lesser degree of degeneration. However, not all people will develop symptoms of the so called, degenerative disc disease a pathological process related to genetics and unknown causes. The differentiation between spondylosis as an age related natural process and degenerative disc disease is some time difficult to achieve in the clinical setting.

This complex process is usually addressed as Degenerative Disc Disease (DDD), one of the most common causes of low back or neck pain. The disc, the facet joints  and the muscles can generate pain:

  1. Pain caused by the Ruptured Disc. Pain caused by a ruptured disc inner nucleus dehydrates, the disc space narrows, and redundant annular ligaments bulge (bulging disc). With progressive nuclear dehydration, the annular fibers can crack and tear (annular tear). Loss of normal soft tissue tension may allow the spinal segment to sublux (e.g. partial dislocation of the joint), leading to osteophyte formation (bone spurs), leading to a collapsed disc foraminal narrowing, mechanical instability, and pain. Degenerative disc disease can cause pain and other symptoms in two ways:
    • Herniated disc. If the annular fibers stretch or rupture, allowing the pressurized nuclear material to bulge or herniate and compress neural tissues, leg pain(sciatica) or pain down the arm, and associated weakness may result. This is the condition called a pinched nerve, slipped disc, or herniated disc. This condition will typically cause g pain as a result of mechanical and/or chemical irritation against the nerve root.
    • Mechanical dysfunction may also cause disc degeneration and pain. This is a motion unit dysfunction.
  2. Pain caused by the Facet Joint degeneration. Similar to the intervertebral disc, the posterior elements – mainly the facets – are subject to degeneration and can become potential sources of pain. They form the posterior column of the spine, facet joint degeneration and disc degeneration frequently occur together, although one may be the primary problem and the other a secondary phenomenon due to altered mechanics of the spine. The degenerative changes also involve the facet joints. Similar to other joints in the body, the facets are covered with a layer of cartilage. This ensures a harmonious, pain-free motion between the two bony articular masses. Continuous load and motion cause erosion of this cartilage, direct bony contact and finally painful osteoarthritis. Central and lateral spinal stenosis, and degenerative spondylolisthesis may all result from the abnormal mechanical relationship between the anterior and posterior column structures. This mechanical pain syndrome, unresponsive to nonsurgical treatment, and disabling to the individual’s way of life, was generally addressed by spinal fusion. The introduction of motion-preserving techniques open a new alternative treatment that can stop o even reverse this process. Currently, the dynamic stabilization with pedicle screws is widely applied in Europe. By restabilizing the motion and unloading the facets, pain is expected to decrease, while maintaining a close to normal range of spinal motion.
  3. The spinal motion unit needs the attached muscles to maintain a normal function in the same manner that anterior and posterior column integrity is necessary. When atrophy or permanent damage of the muscle exits there could be the source of substantial pain as a secondary pain generator added to the primary source in the disc or facet joints.

Degenerative disc disease in the lumbar spine, or lower back, refers to a syndrome in which a compromised motion unit level or several levels causes low back pain.

Lumbar degenerative disc disease usually starts with a torsional (twisting) injury to the lower back, such as when a person rotates to put something on a shelf or swing a golf club. However, the pain is also frequently caused by simple wear and tear on the spine. The way we call the lumbar degenerative disease is emphasizing the importance of the disc in front of the facet joints and the clinical symptomatology is frequently originated in both structures. This fact is sometimes under-recognized in the literature.

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Lumbar Degenerative Disc Disease Symptoms

Most patients with lumbar degenerative disc disease will experience low-grade continuous but tolerable pain that will occasionally flare (intensify) for a few days or more. Symptoms can vary, but the general characteristics usually include:

  • Pain that is centered on the lower back, although it can radiate to the hips and legs.
  • Pain that is frequently worse when standing, when the discs experience a heavier load than when patients are walking getting better by laying down.
  • Pain that is exacerbated by certain movements, particularly bending, twisting or lifting.
  • Walking, and even running, may actually feel better than prolonged sitting or standing.
  • Patients will generally feel better if they can change positions frequently, and lying down is usually the best position since this relieves stress on the disc space and facet joints.
  • Typically spine specialist attribute the pain exacerbated by bending forward as originated in the disc and when bending backwards is the predominant maneuver that elicits pain they consider the facet joint complex as the main source of pain.

Most patients with degenerative disc disease will have some underlying chronic low back pain, with intermittent episodes of severe low back pain. The exact cause of these severe episodes of pain is not known, but it has been theorized that it is due to abnormal micro-motion in the degenerated disc that spurs an inflammatory reaction. In an attempt to stabilize the spine and decrease the micro-motion, the body reacts to the disc pain with muscle spasms. This provides us with a protective reflex, such as the reflex to remove your hand immediately if you put it on something hot. The reactive spasms are what make patients feel like their back has “gone out”. The severe episodes of low back pain from degenerative disc disease will generally last from a few days to a few months before the patient goes back to their baseline level of chronic pain. The amount of chronic pain is quite variable and can range from a nagging level of irritation to severe and disabling pain.

In addition to low back pain from degenerative disc disease, there may be leg pain, numbness and tingling. Even without pressure on the nerve root (a “pinched nerve”), other structures in the back can refer pain down the rear and into the legs. The nerves can become sensitized with inflammation from the proteins within the disc space and produce the sensation of numbness/tingling. Generally, the pain does not go below the knee. These sensations, although worrisome and annoying, rarely indicate that there is any ongoing nerve root damage. However, any weakness in the leg and feet muscles (such as foot drop)is an indicator of some nerve root damage.

One very important tenet in chronic pain is that the level and extent of pain does not equal tissue damage. Severely degenerated discs may not produce much pain at all, and discs with little degeneration can produce severe pain.

The low back pain associated with lumbar degenerative disc disease is usually generated from one or both of two sources disc and facet joints through mechanism like:

  • Inflammation, as the proteins in the disc space irritate the surrounding nerves, and/or synovial cyst develop in the facet joint
  • Abnormal micro-motion instability, when the outer rings of the disc, called the annulus fibrous, are worn down and cannot absorb stress on the spine effectively, resulting in abnormal movement along the vertebral segment as a whole motion unit (disc+facet joints). Axial forces are unequally distributes or not absorb at all. In functional flexion-extension X-ray we can see retrolistesis as a sign of this instability, progression of it produces degenerative spondylolisthesis. More difficult to diagnose is the rotational instability that represent the failure of the facet joint as the main structure in the spine that is acting in the rotation of the motion unit.
  • Compression of surrounding structures

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Spinal canal stenosis

Narrowing of the spinal canal is produce by the following mechanism:

Motion and load create adaptive tissue changes during life. These changes include loss of tissue elasticity, growth of osteophytes and calcification of ligaments. As a result, the structures around the spinal canal increase in volume, thereby reducing the available space for the nerve roots in the canal or the outlets for the roots. This effect is sometimes emphasized by anterior vertebral slippage (degenerative spondylolisthesis) due to insufficiency by wear and tear of the vertebral facets.

The narrowing of the spinal canal is referred to as spinal stenosis.

Symptoms of a narrow spinal canal:

The predominant symptom of a narrow spinal canal is the so-called neurogenic claudication. This is a painful sensation occurring after a certain walking distance, or during a certain period of standing in an upright position. Typically, the pain disappears in a bending-forward position of the body, e.g. in the sitting position. Even if the most common symptom is leg pain (often in a specific area), other typical symptoms include weakness or unsteadiness in the legs after a certain walking distance. In severe cases, the patient may hardly be able to walk a few meters and is literally immobilized by this condition.

There are three major types of stenosis and accurate identification is vital to stenosis treatment:

  • Lateral stenosis. The most common type of spinal stenosis, lateral stenosis occurs when a nerve root that has left the spinal canal is compressed by either a bulging disc, herniated disc or bone protrusion beyond the foramen (a bony, hollow archway through which all spinal nerve roots run).
  • Central stenosis. Occurring when the central canal in the lower back is choked, central stenosis may lead to compression of the cauda equina nerve roots (the bundle of roots that branch off at the bottom of the spinal cord like a horse’s tail).
  • Foraminal stenosis. When a nerve root in the lower back is pressed on and trapped by a bone spur in the foramen, or the opening where the nerve root leaves the spinal canal.

The most important clue to diagnosis is the patient’s history, as the physical examination may not reveal conclusive findings. Imaging confirms the suspected narrowing and defines the extent of the stenosis. Magnetic resonance and sometimes computer tomography are the most commonly used techniques.

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Degenerative Spondylolisthesis

Degenerative spondylolisthesis is Latin for “slipped vertebral body”, and it is diagnosed when one vertebra slips forward over the one below it. This condition occurs as a consequence of the general aging process in which the bones, joints, and ligaments in the spine become weak and less able to hold the spinal column in alignment.

Degenerative spondylolisthesis is more common in people over age 50, and far more common in individuals older than 65. It is also more common in females than males by a 3:1 margin.

A degenerative spondylolisthesis typically occurs at one of two levels of the lumbar spine:

  • The L4-L5 level of the lower spine (most common location)
  • The L3-L4 level.

Degenerate spondylolisthesis is relatively rare at other levels of the spine, but may occur at two levels or even three levels simultaneously. While not as common as lumbar spondylolisthesis, cervical spondylolisthesis (in the neck) can occur. When degenerative spondylolisthesis does occur in the neck, it is usually a secondary issue to arthritis in the facet joints.

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Degenerative Spondylolisthesis Causes

Every level of the spine is composed of a disc in the front and paired facet joints in the back. The disc acts as a shock absorber in between the vertebrae, whereas the paired facet joints restrain motion. They allow the spine to bend forwards (flexion) and backwards (extension) but do not allow for a lot of rotation.

As the facet joints age, they can become incompetent and allow too much flexion, allowing one vertebral body to slip forward on the other.

In cases of degenerative spondylolisthesis, the degenerated facet joints tend to increase in size, and enlarged facet joints then encroach upon the spinal canal that runs down the middle of the spinal column, causing canal stenosis.

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Isthmic spondylolisthesis

The spine condition called isthmic spondylolisthesis occurs when one vertebral body slips forward on the one below it because of a small fracture in a piece of bone that connects the two joints on the back side of the spinal segment.

The fracture in this small piece of bone, called the pars interarticularis, is caused by stress to the bone. While the fracture tends to occur most commonly when an individual is young (around 5 to 7 years old), for most people symptoms typically do not develop until adulthood. There is another spike in occurrence of lower back pain from spondylolisthesis in adolescence.

It is estimated that 5 to 7% of the population has either a fracture in this small piece of bone (a fracture of the pars interarticularis) or a spondylolisthesis (slipped vertebral body), but in most cases there are no symptoms. It has been estimated that 80% of people with a spondylolisthesis will never have symptoms, and if it does become symptomatic, only 15 to 20% will ever need surgical correction.

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Isthmic Spondylolisthesis Causes

The pars interarticularis (Latin for “bridge between two joints”) connects the facet joint above to the one below. It is a thin piece of bone with a poor blood supply, which makes it susceptible to stress fractures. There also can be a fracture of the pars interarticularis without a vertebral slip. The fracture itself is known as a spondylolysis. The pars interarticularis may also be referred to as the isthmus.

When this small bone fractures it usually does not cause pain or other symptoms. Trauma is not a common reason for fracturing. The fracture is usually due to cumulative stress, analogous to taking a paper clip and bending it multiple times. It will eventually break apart after enough stress.

Isthmic spondylolisthesis occurs most commonly in the L5-S1 level of the spine, the lowest level of the lumbar spine. It does happen rarely above this level, at L4-L5 or L3-L4, but at these levels trauma (rather than cumulative stress) is a more common cause of the fracture.

A fracture has not ever been found in a newborn so it is not considered a congenital problem. The slip that results from having the fracture is most likely to progress in juvenile or adolescent individuals. Progression of the slippage in adulthood is rare.

At L5-S1 there is not usually a lot of instability associated with the condition because there is a large ligament (the sacral alar ligament) that connects the L5 vertebral body to the sacrum, preventing the progression of slippage of L5 on the sacrum.

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Spondylolisthesis Grading

The severity of the slippage is usually measured after taking a side-view X-ray, and then graded on a scale of 1 to 4. The slippage is measured from the amount the upper vertebral body slips forward on the lower vertebral body.

Grade 1 25% or less of vertebral body has slipped forward
Grade 2 26% – 50%
Grade 3 51% – 75%
Grade 4 76% – 100%

 

Although very rare, a condition called spondyloptosis can occur, whereby the L5 vertebral body slips off the sacrum and into the pelvis. Fortunately, most slips are grade one or grade two, and if they become symptomatic they can be treated without surgery.

Unlike Isthmic spondylolisthesis, the degree of the slip of a degenerative spondylolisthesis is typically graded 1 or 2.

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When Consider Surgery

No one looks forward to surgery, but sometimes it is the right treatment. A key question to ask yourself (expect your doctor to ask you too) is: are you making concessions in how you do – or whether you do – everyday activities because of the pain? The ability to do such everyday tasks as shopping for groceries and putting them away, picking up children, or driving to or sitting comfortably at work significantly impact an individual’s quality of life. Not being able to do them may mean that it’s time to consider surgery as a treatment option if patients meet the following criteria:

  • They have conscientiously engaged in at least six months of non-surgical pain treatment and active exercise-based physical rehabilitation for core strengthening. For people with ongoing severe, disabling pain and associated symptoms (e.g., numbness, tingling, difficulty sitting) it is sometimes not possible to wait for a full six months of non-surgical care to work. Consequently, surgery – either the more standard fusion surgery or the newer motion preservation surgery including artificial disc replacement – may be warranted.
  • If back pain causes one to make concessions to his or her normal lifestyle on a daily basis, despite adequate non-operative treatments, then a surgical consultation is warranted.
  • Their pain is still significant, both in terms of magnitude and its inability to be controlled with acceptable doses of medication or treatment.

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Exploring Your Surgical Options

Beside discectomy and spinal decompressive surgery, there are two main types of surgery used to treat pain and symptoms from lumbar degenerated disc: lumbar fusion surgery and motion preservation techniques; artificial disc replacement and posterior dynamic stabilization. A surgeon’s clinical experience, judgment, and interpersonal skills are also important parts of the decision process.

There is strong scientific evidence in the form of prospective randomized multi-center studies that shows less pain and improved function in appropriately selected patients after either lumbar fusion surgery, artificial disc replacement surgery and other posterior motion preservation technologies. An appropriately trained spine surgeon should be able to ensure that non-operative care has been maximized, that the pain generator has been correctly defined, and that surgical options have been clearly presented so that an educated decision can be made by the patient.

The hospital stay can range anywhere from an outpatient procedure, in which case the patient may go home the same day of surgery, to a 3 to 4 day hospital stay. Either way, the patient generally has some activity restrictions for at least 3 to 4 weeks following surgery, followed by up to 3 to 6 months of post-surgical rehabilitation.

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Neck conditions

The healthy spine

Before discussing how the spinal disc can cause neck pain with or without down the arm irradiating pain, it is useful to first understand the role of a healthy disc in the spine and its anatomy.

The cervical spine is comprised of seven vertebrae – C1, C2, C3, C4, C5, C6, C7 (often noted as C1-C7) – that begin at the base of the skull and extend down to the thoracic spine. The cervical vertebrae are composed of cylindrical bones (vertebral bodies) that lie in front of the spinal cord, and work with the muscles, joints, ligaments and tendons to provide support, structure and stabilization to the neck.

The first cervical vertebra is unique in that it is a ring that rotates around the second vertebral body (the odontoid). The cervical vertebrae closest to the skull are the smallest.

Cervical Vertebrae Functionalities

Stacked on top of each other with a cervical disc in between them, the cervical vertebrae provide strength and structure to the cervical spine and support the head. The cervical vertebrae also provide for structure and control of certain types of movement in the neck (with the movement described in terms of the two vertebral bodies that are connected), including:

  • Rotation (rotating the head from side to side and back and forward). Most rotation of the neck takes place in the first two segments of the cervical spine, specifically the atlas (C1) and the axis (C2).
  • Lateral (moving the head from side to side).
  • Flexion (moving the head forward) and extension (moving the head backward). Most flexion and extension movements in the neck are controlled by the C5-C6 and C6-C7 segments of the spine. Unlike the first two cervical vertebrae, the remaining five cervical vertebrae, C3 through C7, are constructed more similarly to the rest of the spine, with three joints making up each vertebral segment (a disc in the front and two facets joints in the back).

The uncovertebral joints are peculiar but clinically important anatomical structures of the cervical vertebrae. In the aged or degenerative cervical spine, osteophytes arising from an uncovertebral joint can cause cervical radiculopathy, often necessitating decompression surgery.

Cervical Spine Degenerative Disease Symptoms

There are several symptoms that may indicate the presence of a degenerative condition in the cervical spine. Symptoms include neck pain, pain around the back of the shoulder blades, arm complaints (pain, numbness, or weakness), and rarely, difficulty with hand dexterity or walking.

The degenerative process may begin in any of the joints in the cervical spine, and over time it may also cause secondary changes in the other joints. For example, an intervertebral disc may be primarily affected. As the disc narrows, the normal movement of that segment is altered, and the adjacent joints (also called ‘osteoarthritis’ or ‘degenerative joint disease’) are subjected to abnormal forces and pressures, leading to degenerative arthritis (ie, inflammation of a joint).

Neck pain as a result of spondylosis (eg, a degenerative change) is relatively common. The pain may radiate, or spread, into the shoulder blade or down the arm. Patients may have an arm complaint (such as pain or weakness) as the result of nerve root compression from a bone spur.

 

herniated-disc

 

Neck anatomy is a well-engineered structure of bones, nerves, muscles, ligaments and tendons. The cervical spine (neck) is delicate – housing the spinal cord that sends messages from the brain to control all aspects of the body – while also remarkably flexible, allowing movement in all directions, and strong.

The neck begins at the base of the skull and through a series of seven vertebral segments connects to the thoracic spine (the upper back). With its complex and intricate construct, and the many stresses and force that can be placed on it through a trauma or even just daily activities, the cervical spine is at risk for developing a number of painful conditions, such as:

  • Cervical degenerative disc disease
  • Cervical herniated disc
  • Cervical stenosis
  • Osteoarthritis
  • Simple muscle strain resulting in a painful neck.

The Cervical Spine Roles

The cervical spine maintains several crucial roles, including:

  • Housing and protecting the spinal cord. A bundle of nerves that extends from the brain and runs through the cervical spine and thoracic spine (upper and middle back) prior to ending just before the lumbar spine (lower back), the spinal cord relays messages from the brain to the rest of the body.
  • Supporting the head and its movement. The cervical spine literally shoulders a big load, as the head weighs on average between 10 and 13 pounds. In addition to supporting the head, the cervical spine allows for the head’s flexibility, including rotational, flexion/extension and lateral bending motions.
  • Facilitating flow of blood to the brain. Vertebral openings (vertebral foramen) in the cervical spine provide a passageway for vertebral arteries to pass and ensure proper blood flow to the brain. These openings are present only in the vertebrae of the cervical spine.

The cervical vertebrae play a key role in maintaining these functions in the neck.

Degenerative Disc Disease (DDD)

Cervical Degeneration: Bone Spurs and Cervical Osteoarthritis

A bone spur (medically known as an osteophyte) describes an enlargement of the facet joints, the small stabilizing joints that are located between and behind the adjacent cervical vertebrae. Bone spurs are smooth structures that can grow on the bones and tend to occur in adults over 60 years of age.

Patients with cervical bone spurs may or may not have symptoms, which could include neck pain and/or referred pain and weakness in the arms and the legs. For example, patients with cervical bone spurs may experience dull neck pain that occurs when standing. In some instances, the pain may be referred to the shoulders or prompt headaches.

However, it must be emphasized that the presence of bone spurs does not necessarily mean this is what is generating a patient’s pain. Most bones spurs are simply radiographic findings indicating a patient has degeneration in the neck.

Bone spurs may form as the result of cervical osteoarthritis, a condition marked by degeneration and breakdown of the cartilage between the facet joints in the cervical spine. With cervical osteoarthritis (also known as cervical arthritis), different symptoms may occur, such as pain that:

  • Refers to the shoulder or between the shoulder blades
  • Feels worse at certain times of the day (early in the morning, late at night)
  • Calms with rest

Rarely requiring surgery (such as when there is a vertebral fracture in the neck), cervical osteoarthritis is typically treated via rest, pain medications, chiropractic and/or traction.

Cervical Symptoms from Degenerative Disc Disease

Cervical degenerative disc disease refers to when a cervical disc is the actual source of pain in the neck, possibly from twisting or falling on the neck but more likely from day-to-day wear and tear on the cervical spine.

Cervical symptoms related to a degenerative cervical disc may include a stiff neck and/or numbness, tingling and weakness in the neck, arms and shoulders as a result of a cervical nerve that has been irritated or pinched by the degeneration. Such cervical symptoms may persist for several months and fluctuate in terms of intensity.

This complex process is usually addressed as Degenerative Disc Disease (DDD), one of the most common causes of neck pain.

Disc degeneration known as spondylosis is a natural part of aging and over time all people will exhibit changes in their discs consistent with a greater or lesser degree of degeneration. However, not all people will develop symptoms of the so called, degenerative disc disease a pathological process related to genetics and unknown causes. The differentiation between spondylosis as an age related natural process and degenerative disc disease is some time difficult to achieve in the clinical setting.

Symptoms of Spinal Cord Compression and Dysfunction

It’s important to know that in many cases cervical stenosis is asymptomatic, meaning that the spinal cord is compressed but the patient is not experiencing any of the common symptoms. In these cases, the patient may simply be monitored to ensure that the spinal cord continues to function normally and that myelopathy (i.e. spinal cord dysfunction) does not develop as a result of the compression.

In other situations, cervical stenosis with myelopathy may present itself in symptoms that include a heavy feeling in the arms and legs, cervical pain that is referred to the arm, shooting pains in the arms and legs, and/or difficulty walking and performing activities involving fine motor skills (handwriting, buttoning a shirt, etc.)

When cervical stenosis with myelopathy is present, the spinal cord – specifically the long tracts that run inside it – is affected, possibly leading to impaired or abnormal functioning that may be observed during a physical examination, including:

  • Increased muscular tone in the legs. Muscle tone refers to the amount of tension or resistance to movement in a muscle; increased muscle tone may make it difficult to make certain movements, like walking and moving one foot in front of the other (tandem walking).
  • Hyperreflexia. Heightened deep tendon reflexes in the knee and ankle are potential indicators of spinal cord compression and dysfunction.
  • Clonus. Upon forcing the ankle to extend, the patient’s foot rapidly beats up and down.
  • Babinski reflex. When scratching the sole of the foot, the big toe moves up rather than down (the normal movement), most often prompting a closer examination of the spinal cord.
  • Hoffman’s reflex. Upon flicking the middle finger, the thumb and middle finger flex.

Since cervical stenosis with myelopathy is typically related to some sort of spinal cord instability, various diagnostic tests may be conducted to get a closer examination of the spine.

Arm Pain with Lack of Coordination

Pain that radiates down the arm, along with symptoms such as lack of coordination in the arms and legs, difficulty with fine motor skills, and occasional intermittent shooting pains, is commonly caused by cervical spinal stenosis with myelopathy.

These symptoms, which are caused by either a cervical herniated disc or degenerative changes in the joints that can cause pressure on the spinal cord, generally develop slowly. Symptoms may not progress for years, and then the patient may notice progression of the coordination difficulties, only to be followed by another long period where there is no progression.

Conservative treatments may help relieve the chronic arm pain, but the definitive treatment option for the spinal cord compression (which causes the coordination difficulties) is surgery to decompress the spinal canal.

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