Neck Pain
 As a result of the natural wear
and tear that occurs with aging, certain parts of the cervical spine
start to degenerate and wear out, as we grow older. This process makes
some of the anatomic structures of the cervical spine, the bones,
intervertebral discs, ligaments, and muscles less flexible and less
resistant to injury.
Degenerative disc disease (DDD) is part of the natural process of
growing older. Unfortunately, as we age, our intervertebral discs
lose their flexibility, elasticity, and shock absorbing characteristics.
The ligaments that surround the disc, called the annulus fibrosis,
become brittle and they are more easily torn. At the same time,
the soft gel-like center of the disc, called the nucleus pulposus,
starts to dry out and shrink. Degenerative disc disease is as certain
as death and taxes, and to a certain degree this process happens
to everyone. However, not everyone who has degenerative changes
in their cervical spine has pain. Many people who have "normal"
necks have MRI's that show disc herniations, degenerative changes,
and narrowed spinal canals. Every patient is different, and it is
important to realize that not everyone develops symptoms as a result
of degenerative disc disease.
There are soft-tissue discs between the bony vertebral bodies in
your cervical spine that are called intervertebral discs. These
discs are composed of a soft gel-like center called the nucleus
pulposus, and a tough outer lining that surrounds the disc called
the annulus fibrosis. The intervertebral disc creates a joint between
each of the vertebral bodies that allows them to flex and extend,
rotate slightly, and move with respect to one another. When the
outer lining that surrounds the disc tears, the soft center squeezes
out through the opening, creating a "herniated", "slipped", or "ruptured
disc". Each of these terms describes the same process.
Myelopathy is a term that means that there is something wrong with
the spinal cord itself. This is usually a later stage of cervical
spine disease, and is often first detected as difficulty walking
due to generalized weakness or problems with balance and coordination.
This type of process occurs most commonly in the elderly, who can
have many reasons for having trouble walking or problems with gait
and balance. However, one of the more worrisome reasons that these
symptoms are occurring is that bone spurs and other degenerative
changes in the cervical spine are squeezing the spinal cord. Myelopathy
affects the entire spinal cord, and is very different from isolated
points of pressure on the individual nerve roots.
Doctors use the term radiculopathy to specifically describe pain,
and other symptoms like numbness, tingling, and weakness in your
arms or legs that are caused by a problem with your nerve roots.
The nerve roots are branches of the spinal cord that carry signals
out the rest of the body at each level along the spine. This term
comes from a combination of the Latin word radix, which means the
roots of a tree, and the Latin word pathos, which means a disease.
This disease is often caused by direct pressure from a herniated
disc or degenerative changes in the cervical spine that cause irritation
and inflammation of the nerve roots.
Cervical spondylolysis is a disorder that narrows the spinal canal
in the neck compressing the spinal cord or spinal nerve roots. It's
a fracture or defect in the pars anticulars (a portion of the bone
between each of the joints of the back), allowing one vertebral
body to slide forward on the next. Spondylolyosis is sometimes referred
to as pars interarticularis defect. It may be unilateral or bilateral
and is usually due to a developmental defect but may be secondary
to a fracture. Spondylolysis affects the area of the vertebra called
the pedicle. The pedicle is part of the bony ring that protects
the spinal nerves, and is the portion that connects the vertebral
body to the facet joints. It's a disease that often times affects
middle-aged and older adults who have degenerative discs and vertebrae
in their neck. When a spondylolysis is present, the back part of
the vertebra and the facet joints simply are not connected to the
body, except by soft tissue.
Stenosis is a term used to describe a narrowing of various parts
of the body. Cervical stenosis is a degenerative disease where the
spinal canal and neural foramina narrow and compress the spinal
cord and nerve roots. Stenosis occurs when pressure increases inflaming
the facet joints. The facet joints are overlapping arches that form
the spinal canal. These joints are covered with cartilage and a
membrane. Degenerative changes and wear and tear can cause the facet
joints to inflame. This disorder is most common in people over 50
years of age. However, genetics and congenital factors may predispose
a person for stenosis.
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