By the age of 50, 80-90% of people have evidence of wear and tear of the discs in the neck on an x-ray, but that doesn’t mean that they are in pain. Pain in the neck is most typically from the discs or the facet joints, but sometimes nerves are pinched and rarely the spinal cord itself can be compressed.
The discs
The disc consists of two parts. The outer part is the tougher ‘annulus fibrosus’ while the inner part is the ‘nucleus pulposus’. The disc is an interesting structure. It has no blood vessels and receives nutrients from the adjacent bones.
The causes of damage to the disc cells are not entirely clear. When disc cells are damaged the disc becomes more fractured and the load is transferred from the nucleus pulposus in the centre to the surrounding annulus fibrosus. The annulus fibrosus is liable to crack and fissure, and the nucleus pulposus squeezes out through the hole, a ‘herniated disc’.
As the disc becomes less spongy and watery, it dehydrates and loses height. This is why people ‘shrink’ as they get older. An additional effect of loss of height is that the nerves exiting on either side of the disc are more likely to get squashed, causing nerve pain (radiculopathy).
Nerve fibres within the annulus and nucleus pulposus can also signal pain. Pain can also be caused by a distortion of the surrounding muscles and ligaments.
Facet joint arthritis
The facet joints are two small joints at the back and slightly to the left and right, of each bone in the spine. Wear and tear in these joints causes pain, particularly with bending of the spine, and can also contribute to the compression of nerve roots.
Rarely, cervical arthritis can cause compression of the spinal cord (myelopathy) and this is a serious complication. It can present with weakness and difficulty walking and changes in the hands and feet.
Neck pain
Neck pain is common, affecting about 15% of the population at any one time. Patients with ‘red flags’ need urgent investigation. This includes patients with a history of cancer, becoming unstable when walking, or loss of sensation in the arms or legs, or fever with pain at night.
Patients with numbness, tingling, or pain shooting down an arm may have a compressed nerve root.
Neck arthritis treatment
Treatment is often challenging and unsatisfactory. There are lots of possible interventions including simple painkillers, epidural steroid injections, physiotherapy, osteopathy, and massage.
In more difficult cases, a chronic pain management team can be involved and treatment of any anxiety or depression may also help. It’s uncommon to require surgery but it can be helpful in selected cases.
How can we prevent it? Staying physically active, maintaining good posture, and preventing neck injuries are all sensible approaches. It’s best to avoid smoking and obesity has also been associated with neck arthritis. There are no good quality studies showing that any specific treatments are particularly recommended in this context.. so it remains a bit of a pain in the neck!
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