Neck Pain Causes
1. Inflammatory and Infectious Disorders
Though infections and inflammation of the cervical spine are rare, if they are neglected for a period of time, or if there is a delay in diagnosis, they can become a significant source of pain and disability. Inflammatory spinal disorders include arthritis where inflammation is behind the cause of pain in the joints of the spine. Inflammation is a body’s natural response to tissue irritation or damage, and it can cause swelling, redness, heat, and loss of function. Inflammation of a joint is called arthritis, and it can be confined to a single joint, or it may be wide-spread, as in rheumatoid arthritis. Figure 2 illustrates the “crooked” or kyphotic cervical spine in a patient with rheumatoid arthritis causing compression on the spinal cord.
Cervical spine injuries can range from mild cases of neck pain, called whiplash, to injuries that can cause paralysis of the rest of the body below the level of injury.
Whiplash is the common term used for a hyperextension injury to the neck. Though the neck is a very flexible structure, it can be injured when the weight of the head exceeds the neck’s ability to control its motion. This commonly occurs when the patient traveling in a motor vehicle is hit from behind. Sometimes, the symptoms may be chronic.
The discs that act as shock absorbers between the vertebrae of the cervical spine can be damaged during an accident. When this happens, the material in the center of the disc can be pushed out from where it normally is, a process called disc herniation.
Fractures with or without dislocations of the cervical spine demand early and accurate diagnosis, otherwise this may lead to worsening of the spinal cord function. Figure 3 illustrates a spinal injury case of fracture of the odontoid (second cervical vertebra) confirmed on CT scan.
Spinal cord tumors can be either primary (originating in the spinal cord), or secondary (metastases or spread of cancer that originated elsewhere in the body). Pain that continue to get worse despite treatment, or associated with other symptoms such as fatigue or weight loss, may suggest that a tumor is responsible. The pain may be worse at night. Pressure on the spinal cord and/or nerve roots that exit the spinal cord can cause pain, numbness, tingling, and weakness. Be aware of other physical symptoms, such as lumps and bumps, moles on your skin, and any other findings that might suggest that you have a tumor somewhere else in your body. Figure 4 shows destruction of the odontoid (second cervical vertebra) on CT scan due to nasal cancer.
4. Mechanical Problems
Mechanical problems are the most frequently encountered causes for neck pain. As a result of the natural degeneration conditions of the neck that occurs with aging, certain parts of the cervical spine start to degenerate and wear out. This process makes some of the structures of the cervical spine less flexible and less resistant to injury. Pain can be due to the loss of normal surface cartilage in the joints of the cervical spine, tears in the ligaments that surround the intervertebral discs, herniated intervertebral discs, and bone spurs that may be pressing on nerve roots or the spinal cord. These changes can create a variety of symptoms, ranging from sharp neck pain, arm and shoulder pain, arm numbness and tingling, to difficulty walking. Common mechanical problems are herniated disc and cervical spinal stenosis.