As it runs from the brain down the back, the spinal cord is protected by bones, the vertebrae, and shock absorbers, discs, made up of a
tough, fibrous outer layer with an inner core of elastic tissue. During a lifetime we generally lose 20 mm of length due to shrinking of
the discs in the spine. Spondylosis or spondylarthrosis is the general term for this progressive loss of the normal stability of spinal discs,
or disc degeneration. All of these pathologies can result in narrowing, stenosis of the nerve foramina or the spinal canal. Compression
of the spinal cord, spinal stenosis, can develop difficulty with walking and loss of hand function, myelopathy. You may experience leg
numbness and an inability to make the legs move properly, cramping, muscle spasms, and easy fatigueability. Other symptoms,
radiculopathy, can include clumsiness and weakness in the hands, difficulty in fine activities such as buttoning clothes or writing. The
hands may feel cold or diffusely painful.
Careful clinical and neurological examination by a spine surgeon can help determine which nerve roots are involved. Plain X-rays
reveal the presence of osteophytes, constricted space and misalignment in the cervical spine. In earlier days, a cervical myelography
was needed for confirming the diagnosis. MRI (magnetic resonance imaging) is now preferred, because it is a noninvasive procedure.
MRI also has greater sensitivity for visualization of the soft tissue structures and can show disc ruptures, spurs, narrowing of the nerve
root or spinal canals and compression of the nerves and spinal cord.
Conservative treatment with rest for a couple of days may reveal the acute symptoms. A cervical collar may help to relax the muscles.
Cervical traction or manipulation and acupuncture by a physical therapist is sometimes beneficial. Pain is treated with nonsteroidal
anti-inflammatory drugs, NSAID such as Ibuprofen. Once the pain is resolved, exercises to strengthen neck muscle and stretching are
If pain is continuous and does not respond to conservative treatment for 3-6 months, surgery can be suggested. Surgery is usually not
recommended for neck pain alone, but it may be necessary to adress radiculopathy and myelopathy. Surgical procedures include
anterior cervical discectomy with fusion or a posterior cervical laminotomy. For disease involving multiple levels, your spinal surgeon
may recommend multiple subtotal vertebrectomies and fusions or multiple posterior cervical laminectomies. A new revolutionary
method is arthroplasty with artificial joints, which can preserve mobility and function in the spine.
Modern minimal invasive surgical procedures permit early return to normal activities. Titanium screws and plates, preformed disc
spacers made of titanium or carbone give excellent anatomical alignment and stability. There is no need for extended rest and
immobilization in a cervical collar. The hospital stay is only a few days. You should discuss the possible benefits and risks of surgery
with your surgeon. For further insight you can ask him to review the x-ray and MRI images with you. The more you know, the more
aware you will be about your problem and your options.