Causes and Treatmentsof Neck and Arm Pain

Brian T. Ragel, MD

Department of Neurosurgery

Introduction

• Anatomy

• Definitions• Cervical spondylosis• Herniated disc

• Dx / Tx• Axial neck pain• Radiculopathy• Myelopathy

Cervical Spondylosis

• degenerative aging process from wear and tear

• “bone spurs”

• loss of disc height

• Osteophytes

• Mineral deposition in ligaments and discs

Degenerative changes that contribute to spinal cord/nerve root compression

Axial Neck Pain

• Sx– Neck pain (poorly understood)– Nerve endings in discs and facets– musculoskeletal

• Dx– ?

• Tx– NSAID and physical therapy

Natural History of Axial Neck Pain

• Notes:• 66% of all adults will have neck pain• Rothman, no difference b/w op and non-op• Gore, no correlation b/w neck pain and x-ray

Author Relief Partial No Relief

Depalma 21% 49% 22%

Rothman 23%

Leees 45% 55% -

Gore 43% 25% 32%

Cervical Radiculopathy

• Sx– Sx’s in dermatomal distribution from

compressed nerve root• Example: C6 radiculopathy will produce

pain/numbness in lateral biceps -> lateral forearm -> thumb

• Dx – sx / exam / MRI• Tx

– ACDF / disc arthroplasty– Posterior foraminotomy

Cervical Myelopathy

• Sx– Sx’s N/T, clumsy hands, spastic gait, leg

weakness due to spinal cord compression

• Dx – sx / exam / MRI• Tx

– ACDF (usually > 1 level)– Posterior decompression

Natural History of Cervical Myelopathy

• Lees and Turners– usually stable nonprogressive disability– progressive deterioration exception

• Symon et al, 67% steady decline• Nonrandomized MCT in 2000

– 20 surgery with improved function– 23 non-op with decline in ADL

Summary

• Cervical spondylosis (degeneration)

• Dx / Tx• Axial neck pain• Radiculopathy• Myelopathy