Cervical Spine Conditions
Understanding neck pain, arm symptoms, and spinal cord compression
Your cervical spine—the seven vertebrae in your neck—supports your head, protects your spinal cord, and allows for a wide range of motion. When problems develop in this region, they can cause neck pain, arm pain, numbness, weakness, or even difficulty with balance and coordination. This chapter covers the three most common cervical conditions Dr. Greenberg treats in Fort Wayne.
Cervical Radiculopathy (Pinched Nerve)
Quick Overview: Cervical radiculopathy occurs when a nerve root in the neck is compressed or irritated, causing pain, numbness, tingling, or weakness that radiates into the shoulder, arm, or hand.
What Causes a Pinched Nerve?
Several conditions can compress cervical nerve roots:
- Herniated disc: Most common cause in younger patients (30s-50s)
- Bone spurs: Arthritis-related overgrowth narrows nerve openings
- Foraminal stenosis: Narrowing of the holes where nerves exit
- Degenerative changes: Age-related wear and tear
Recognizing the Symptoms
Symptoms depend on which nerve root is affected:
- Sharp, shooting pain: From neck into shoulder, arm, or hand
- Numbness or tingling: Often in specific fingers (thumb, index, middle, or ring/pinky)
- Weakness: Difficulty gripping, lifting, or raising the arm
- Pain worsens: With certain neck positions, coughing, or sneezing
- Relief: Often improves by placing hand on top of head (Spurling's relief sign)
Diagnosis
Dr. Greenberg uses a comprehensive approach:
- Physical examination: Tests for nerve function, reflexes, and strength in specific muscle groups
- Spurling's test: Reproduces symptoms by compressing the nerve
- MRI: Shows disc herniations, bone spurs, and nerve compression
- EMG/NCS: Confirms nerve damage and identifies affected nerve root
Treatment Options
Most cervical radiculopathy improves with conservative care over 6-12 weeks:
- Physical therapy focusing on neck strengthening and posture
- Anti-inflammatory medications and nerve pain medications
- Cervical epidural steroid injections
- Soft cervical collar for short-term use
When symptoms persist or worsen, surgical options include minimally invasive foraminotomy, ACDF, or cervical disc replacement to decompress the nerve.
Learn More: Read the complete guide to cervical radiculopathy treatment.
Cervical Myelopathy (Spinal Cord Compression)
Quick Overview: Cervical myelopathy is compression of the spinal cord in the neck, causing problems with balance, coordination, hand function, and walking. This is a more serious condition than radiculopathy and often requires surgical treatment.
What Causes Myelopathy?
Myelopathy develops when the spinal canal narrows and compresses the spinal cord:
- Cervical stenosis: Age-related narrowing of the spinal canal
- Disc herniations: Large herniations pressing on the cord
- Bone spurs: Arthritis causing cord compression
- Ligament thickening: Ossification of posterior longitudinal ligament (OPLL)
Warning Signs and Symptoms
Myelopathy symptoms are often subtle at first but progressively worsen:
- Hand clumsiness: Difficulty with buttons, writing, or fine motor tasks
- Gait problems: Unsteady walking, feeling like legs are stiff or heavy
- Balance issues: Increased risk of falls
- Numbness: In hands, arms, or legs (often both sides)
- Weakness: Progressive loss of strength in arms or legs
- Bowel/bladder changes: Urgency or difficulty (in severe cases)
⚠️ Important: Myelopathy can cause permanent spinal cord damage if left untreated. If you experience progressive weakness, balance problems, or hand clumsiness, seek evaluation promptly.
Diagnosis
Diagnosing myelopathy requires careful evaluation:
- Neurological exam: Tests for hyperreflexia, Hoffman's sign, and Babinski reflex
- Gait assessment: Observing walking pattern and balance
- MRI: Shows spinal cord compression and signal changes within the cord
- CT scan: Evaluates bone anatomy and calcification
Treatment Approach
Unlike radiculopathy, myelopathy typically requires surgical treatment:
- Conservative care: May be appropriate for very mild cases with close monitoring
- Surgery: Recommended for moderate to severe myelopathy to prevent progression
- Surgical options: ACDF, cervical disc replacement, or laminoplasty depending on compression location
The goal of surgery is to decompress the spinal cord and prevent further neurological decline. While surgery can stop progression, recovery of lost function varies—early treatment offers the best outcomes.
Learn More: Explore the detailed cervical myelopathy guide.
Neck and Back Strain
Quick Overview: Neck strain (also called cervical strain or whiplash) involves injury to the muscles, ligaments, or tendons in the neck, typically from sudden movement, poor posture, or overuse.
Common Causes
- Whiplash: Sudden acceleration-deceleration injury (car accidents)
- Poor posture: "Text neck" from prolonged phone or computer use
- Sleeping position: Awkward neck position during sleep
- Repetitive strain: Work-related activities or sports
- Sudden movements: Quick turning or lifting
Typical Symptoms
- Neck pain and stiffness: Worsens with movement
- Reduced range of motion: Difficulty turning head
- Muscle spasms: Tight, tender muscles
- Headaches: Often starting at the base of the skull
- Shoulder pain: May radiate into upper back
When to Seek Specialist Care
Most neck strains resolve within days to weeks, but see a specialist if you experience:
- Pain lasting more than 2-3 weeks
- Numbness, tingling, or weakness in arms or hands
- Severe pain that doesn't improve with rest
- Balance problems or difficulty walking
- Bowel or bladder changes
Treatment and Recovery
Most neck strains respond well to conservative treatment:
- Rest and activity modification: Avoid aggravating activities
- Ice/heat therapy: Ice first 48 hours, then heat
- Medications: Over-the-counter anti-inflammatories and muscle relaxants
- Physical therapy: Gentle stretching and strengthening
- Posture correction: Ergonomic adjustments at work and home
Prevention Tips
- Maintain good posture, especially during phone and computer use
- Take frequent breaks to stretch and move
- Use proper lifting techniques
- Sleep with proper neck support
- Strengthen neck and upper back muscles
Learn More: Read the complete neck and back strain guide.
Key Takeaways
- Radiculopathy affects nerve roots (arm pain, numbness), while myelopathy affects the spinal cord (balance, coordination, hand function).
- Myelopathy is more serious and typically requires surgery to prevent permanent spinal cord damage.
- Most neck strains resolve with conservative care, but persistent symptoms warrant specialist evaluation.
- Early diagnosis and treatment of cervical conditions leads to better outcomes, especially for myelopathy.
Medical Disclaimer: This chapter provides educational information only and is not intended as personal medical advice. Every patient's condition is unique. Consult with Dr. Greenberg or another qualified spine specialist for an accurate diagnosis and personalized treatment plan.