Neurological Disorders: Cervical Spine Disorders

Cervical spine disorders are frequent. This part of the spine corresponds to the neck area, hence the above name is given.

Spine is the bone in the back region. It is also called as spinal column, back bone etc. It is not a single bone, actually made up of usually 33 individual bones called as vertebrae and they extend from the neck to lower back region. These vertebrae are held together firmly with various ligaments and disc material. The disc material is a semisolid soft substance found in between two successive vertebrae. It is present between the vertebrae from 2nd neck vertebra to 1st sacral vertebra, and not between the other vertebrae.

There is space inside the spine called as spinal canal and the spinal cord is housed and protected here. Various nerve roots emerge from the spinal cord called as spinal nerve roots. They are of 2 types; motor & sensory, and they unite to form a spinal nerve. Generally fibers from different spinal nerves unite to form a peripheral nerve (e.g. ulnar nerve).

Coming back to our main topic, in the neck area there are 7 vertebrae and 8 spinal nerves. Letter ‘C’ is used to indicate the cervical-spine area; accordingly the vertebrae in this area are labeled from C1 to C7 and the spinal nerve from C1 to C8. These spinal nerves supply the neck, arms, and part of the head area.

The cervical-spine is vulnerable for almost any kinds of injuries and pathologies. In fact some of the pathologies that affect the cervical-spine and also the lumbar spine are due to the increased mobility of these areas. And that explains why certain degenerative diseases are uncommon in the thoracic spine (which is less mobile).

• DDD (degenerative disc disease)
• Herniated disc (disc prolapse)
• Osteoarthritis
• Rheumatoid arthritis (of C1 & C2 joint)
• Tumors (both primary & secondary or metastatic)
• Fractures & dislocations (traumatic spine injuries)
• Spinal cord infarction, bleeding, contusion, transaction)
• Osteomyelitis (infection of bones of the spine
• Discitis (infection of the disc material)

The following manifestations are frequently seen;

• Neck pain
• Cervical Radiculopathy (neck pain shooting down to the arms)
• Swelling, growth in the spine/neck area
• Numb feeling of the arms
• Pins and needle feeling (tingling) of the arms
• Weakness of the arm muscles
• Muscle wasting (atrophy) of the arms
• Fasciculation (twitching) of the muscles in the arms etc

Once clnically a cervical spine pathology is suspected then investigations like CT and/or MRI is obtained. CT myelogram, EMG/NCS(electromyography and nerve conduction studies) may also be required. Blood tests like rheumatoid factor, ESR, CRP, ANA etc if rheumatoid arthritis of cervical spine is suspected. If a tumor is suspected a biopsy may be required.

The treatmen would depend upon what is the actual problem. They are cateorized as symptomatic (e.g. pain medications) and definitive. In the definitive category surgery, immunosuppressive therapy, radiotherapy, chemotherpy etc are some of the choices depending upon the pathology of the cervical spine disorders we are dealing with.