Cervical Spine Disorders

The neck carries the weight of the head through seven small vertebrae and moves further than any other part of the spine. The discs between them dry out and lose height with age, and the joints at the back and the small joints at the sides of the vertebrae enlarge with arthritis.

That wear narrows two spaces. The tunnels the nerve roots leave through close down, which affects one arm along the territory of that root. And the central canal, which carries the spinal cord itself, can be narrowed by a bulging disc, a bony ridge or a thickened ligament behind.

The two problems are different in seriousness. Pressure on a nerve root is painful and usually settles. Pressure on the cord is a different matter, since the cord does not tolerate compression, and the changes it produces in the hands and in walking do not reliably reverse once they are established.

Your doctor establishes first whether the trouble is confined to the neck, involves a single arm along a defined territory, or affects the hands and the legs together, since that separates a local problem from root compression and from pressure on the cord.

The examination covers the range of neck movement, the power, reflexes and sensation in both arms, and then the legs. Brisk reflexes in the legs, an unsteady gait and difficulty with fine tasks such as buttons are the findings that point to the cord and change the urgency entirely.

X-rays show the disc heights, the alignment and the bony spurs. An MRI is the investigation that shows the cord, the roots and the discs, and it is requested when a nerve is involved, when the cord is suspected, or before any surgery. A CT scan is added where the detail of the bone matters.

Most necks are managed without surgery. Physiotherapy aimed at posture and the deep neck muscles, workstation adjustment, medication and time settle the majority of episodes over six to twelve weeks, and a collar is used briefly if at all, since prolonged use weakens the muscles.

After surgery from the front of the neck, swallowing feels awkward and the voice can be hoarse for a few weeks as the tissues settle. The wound sits in a skin crease and fades well. Most people go home after one or two nights.

Where a level has been fused, the bone unites over three months and heavy lifting waits until then. Arm pain usually improves quickly. Recovery of hand function and steadiness where the cord was compressed is slower, continuing for a year, and the aim of surgery there is to stop further loss as much as to regain what has gone.