Cervical spine: when neck pain is more than muscle tension

Neck pain is one of the most common reasons people see a doctor. It is almost always muscular or postural and improves with general measures. But when symptoms reach the arms, the hands or even the legs, the source may be the cervical spine.

When does neck pain come from the spine?

When, in addition to the pain, there are symptoms in the arms or hands (tingling, numbness, weakness) or changes in walking. The cervical spine has seven vertebrae that protect the spinal cord and the nerves to the arms; wear of the discs and joints or bone spurs can compress them.

What is cervical radiculopathy?

It is compression of a nerve in the neck. It causes pain that runs from the neck to the shoulder, arm and hand along the nerve's path, with tingling, numbness or an electric feeling in the fingers. There may also be weakness when gripping objects, writing or lifting the arm.

What is cervical myelopathy and why is it more serious?

It is compression of the spinal cord in the neck. Unlike radiculopathy, it can affect all four limbs:

• Trouble walking or a feeling of unsteadiness.
• Clumsiness in the hands with fine movements, such as buttoning or writing.
• In advanced cases, changes in bladder or bowel control.

It can progress silently, and sometimes needs surgery to prevent permanent neurological damage.

How is it diagnosed?

An MRI is the main study: it shows the condition of the discs, how much the nerves and spinal cord are compressed and how extensive the wear is. Electromyography helps measure how much the nerve is affected.

Does neck pain need surgery?

Most of the time, no. Many cases of radiculopathy improve with well-directed conservative treatment. Cervical myelopathy is different: surgery may be needed to stop the damage and, in many patients, recover function.

When should I see a neurosurgeon?

If neck pain comes with symptoms in the arms or hands, weakness that is progressing, problems with walking or coordination, or if it does not improve after several weeks of treatment. The evaluation determines whether the problem is muscular or structural and what the best plan is.

In summary

Neck pain on its own is usually muscular. When it runs down the arms or affects the way you walk or how well you use your hands, have it checked soon.

This article is for information only and does not replace a medical visit. If you have warning signs, go to the emergency room.