Neck Disorders - Types, Diagnosis, and Treatment

What Are Neck Disorders?

The neck contains important structures like the cervical spine (comprised of the cervical vertebrae, intervertebral discs, the spinal cord, etc.), jugular veins, the carotid arteries, part of the esophagus (food pipe), the larynx, vocal cords, muscles (like the sternocleidomastoid, the hyoid, the trapezius, and the nuchal).

Any abnormalities in these structures automatically come under neck disorder (also known as cervical disorder). The frequently seen cervical disorders are in the cervical spine; they are typically caused due to injury or degeneration in the spinal structures.

One of the main symptoms of a cervical disorder is neck pain, which may also extend to the head, jaw, shoulders, arms, or legs. Other problems include impaired coordination, difficulty breathing, loss of bowel and bladder control, etc. Symptoms vary with the type of cervical disorder.

Most abnormalities can be diagnosed with routine imaging techniques like an ultrasound or an MRI (magnetic resonance imaging). Treatment involves addressing the underlying conditions with either surgical or non-surgical approaches, depending on the nature of the anomaly.

What Are the Different Types of Cervical Disorders?

The structural complexity of the neck makes it vulnerable to various congenital and acquired abnormalities. For easy understanding, they can be divided into the following categories.

Neuromusculoskeletal Disorders: These are the disorders that affect the bones, muscles, and nerves in the neck and can be symptomatic in several ways; the most commonly seen cervical neuromusculoskeletal disorders are as follows:

1. Cervical Spondylosis - It is a condition caused by abnormal wear and tear (known as degenerative changes) of the cervical spine. This leads to the gradual narrowing of the disc space (space between the adjacent cervical vertebrae), loss of normal shape (square shape) of the bone, and bone spurs (growths at the edges of the bone). The newly formed bone spurs can increase pressure on the surrounding tissues leading to nerve pinching. This causes neck pain, weakness, numbness, abnormal sensation in the arms or shoulders, or limitations in the neck movement.
2. Fibromyalgia - It is a systemic disorder characterized by widespread musculoskeletal pain followed by fatigue, sleep, memory, and mood issues. The signs and symptoms may vary greatly from individual to individual, but neck pain is common.
3. Cervical Radiculopathy - It occurs when a nerve root is irritated by something pressing on it (a protruding disc, arthritis of the spine, a mass, or a cyst). Symptoms of radiculopathy can include pain, weakness, or changes in sensation (such as numbness or tingling) in the arms. The most common causes of cervical radiculopathy are degenerative changes (related to aging or injury) or herniation of the cervical disc.
4. Whiplash-Associated Disorders (WADs) - Whiplash is a term used to describe injury caused by a traumatic event in a motor vehicle accident. It can affect many structures in the neck, including the muscles, ligaments, and joints. Symptoms of whiplash include severe pain, spasm, headaches, ear pain, jaw pain, and loss of range of motion in the neck. A similar type of injury called basilar invagination can occur in sports leading to the upward movement of the axis (second cervical vertebra) towards the skull’s base. Symptoms include dizziness, tingling, weakness, and numbness.

Autoimmune Disorders: Autoimmune disorders are conditions that happen when the body’s immune system cannot tell the difference between its cells and foreign cells, causing the body to attack its healthy cells mistakenly. They can target any system in the body, and the cervical spine is no exception. The most common autoimmune disorders that also affect the neck are as follows:

1. Rheumatoid Arthritis - Chronic inflammation of the cervical spine is the second most common feature of rheumatoid arthritis. Symptoms include pain and occipital headaches.
2. Polymyalgia Rheumatic - It is a chronic inflammatory disorder characterized by aches and stiffness of the neck, shoulder, and hip.
3. Multiple Sclerosis (MS) - It is a multifocal autoimmune condition that has a distinctive neck symptom known as the Lhermitte’s sign - It is a transient uncomfortable sensation that travels from the neck to the spine during neck flexion.

A few uncommon autoimmune conditions affecting the neck are systemic lupus erythematosus (SLE), ankylosing spondylitis, psoriatic arthritis, and myositis.

Genetic: Also known as congenital (present since birth) disorders, these disorders are caused due to mutations (alterations) in the genetic material; the alterations can be spontaneous or inherited. A few commonly seen congenital cervical disorders are as follows:

1. Platybasia - It is a congenital disorder characterized by abnormal flattening at the base of the skull. Symptoms include pain, dysphagia (difficulty in swallowing), and coughing.
2. Atlantoaxial Instability - It is defined as excessive movement (caused by a bone or a ligament) between the first two bones (atlas and axis) of the cervical spine. Excessive movement can lead to the dislocation or subluxation of the pivot joint leading to the impingement of the nearby nerves; symptoms include pain and numbness.
3. Atlas Hypoplasia - It is a condition caused due to incomplete development of the atlas (first vertebra in the cervical spine).
4. Klippel-Feil Malformation - Also known as Klippel-Feil syndrome, it occurs when the bones in the neck fail to segment properly before birth. Reduced range of motion is the obvious sign, but other tell-tale signs include low hairline and short neck.
5. Chiari Malformation and Syringomyelia - It occurs when the bottom part of the cerebellum moves outside of its normal location by dipping through the opening in the occipital bone and entering the top part of the spinal canal. Some people with Chiari malformation also experience syringomyelia, a fluid-filled cyst called syrinx that forms within the spinal cord. If the syrinx grows, it can cause damage to the cervical spinal cord and cause painful neurological symptoms throughout the body, including numbness and weakness.
6. Os Odontoideum - It is a condition where a portion of the odontoid process is missing from the rest of the axis (second cervical vertebra). This leads to excess movement between the atlas and the axis, causing symptoms like neck pain, headache, balance problems, and occasionally paralysis.
7. Achondroplasia - It is a bone growth disorder caused due to mutations in the FGFR3 gene - A gene that makes proteins integral for bone growth. In relation to the neck, achondroplasia is associated with the narrowing of the foramen magnum (a hole in the base of the skull through which the spinal cord, brain stem, and other key structures pass through the head and neck).This narrowing is known as cervical medullary stenosis, which is a serious condition and has been known to cause infant death occasionally.

A few less common cervical disorders are pseudogout (caused due to deposition of calcium crystals in the joints), cervical tumors, cervical dystonia, etc.

How Are Neck Disorders Diagnosed?

Diagnosing cervical disorders is done with the help of clinical manifestations, medical history, and necessary investigations. Investigations typically include imaging studies like an x-ray, CT (computed tomography) scan, or MRI (magnetic resonance imaging).

How Are Neck Disorders Treated?

Given the broad spectrum of morphological and physiological variations in neck disorders, treating them with a one-size-fits-all approach is impossible. Treatment depends on the type and severity of the conditions. Some of the frequently suggested treatment options are-

1. Medication.

2. Osteopathic manipulation.

3. Rest.

4. Physical therapy.

5. Neck brace or immobilization.

6. Exercise.

7. Massage therapy.

8. Surgery.

Conclusion:

Given the detailed anatomy of the neck, it is understandable that any complication or anomaly can be extremely painful and occasionally life-threatening. Diagnosis and prompt treatment play a vital role in treating neck disorders. Advancement in imaging techniques (like discography) and treatment approaches (like ultrasound-guided injections and radiofrequency ablation) has improved the prognosis for neck disorders.