The Causes of Severe Neck Pain Resulting from a Cervical Radiculopathy
Posted Nov 17 2008 10:27am
Depending on the cervical nerve root that is affected in a radiculopathy, a patient will notice neck pain that radiates into a certain area, weakness in certain muscles, or other neurological deficits. What causes irritation or compression to the cervical nerve roots in the first place? Well there are three causes that I am going to discuss today:
The most common cause of a cervical radiculopathy is a herniated disc in the neck. This is more common in younger people. In between the bones of the cervical spine are cervical discs- they act like sponges. Sometimes with a whiplash injury or trauma t o the neck, this sponge material can move out of place putting pressure on nerves. This type of injury can occur as a result of a sudden trauma that puts extra pressure on the disc, such a whiplash type injury following a motor vehicle accident. Some patients may even state that their pain started after a seemingly simple event like a violent sneeze to turning to look around or they have no idea how it started. Although the process of a how cervical disc herniation develops has not been studied as extensively as it has been in the lower back, there are some theories similar to the lumbar spine. As a result of recurring flexion of the head (bringing the chin to the chest), loading and rotational strains, little tears can develop in the outside ring of the disc (the annulus fibrosus). Over time, these tears can become larger (radial tears) and may go from the inside of the disc to the outside of the disc. The material inside the disc can then travel through these tears and ultimately press on the sensitive cervical nerves. If the movement of the disc material occurs gradually the whole process can occur without the patient feeling anything. When the tear becomes nearly complete, it may only require a mild force to break through the remaining outside fibers and allow the nuclear material to enter the canal and thus cause a radiculopathy. This is the reason why some people with severe neck pain may note that their pain began after a seemingly unsuspecting event like turning their head to check their blind spot. The nerve root affected will be determined by the disc level involved. The most commonly involved discs are C5-6 and C6-7.
The second most common is degeneration of the cervical spine. This is also called lateral canal stenosis, and cervical spondylosis. Changes occur to the bone that involves bony outgrowths, spurs, and certain ligaments swell and englarge. In most cases this may not cause symptoms right away. But if spurs extend into the canal where nerve roots sit, they can cause more irritation and compression, resulting in cervical radiculopathy. If there is a misalignment in the cervical spine at the same level, it can cause a decrease in range of motion which puts further pressure on the nerve root. This degeneration in the cervical spine often occurs in patients who are older.
A lesser common cause of radiculopathy, although just as serious, is infection and certain types of cancer. In the next blog post we will effective treatment options for a cervical radiculopathy