Degenerative Cervical Spine Disorders

Introduction
At one time or another, most people have experienced neck pain. In the vast majority of cases, this is a benign, self-limited complaint. Symptoms are commonly described as a soreness or stiffness of the neck, which may or may not be associated with a minor injury. Patients often attribute this to a "cold wind" or "sleeping wrong" that may or may not be a factor. Most commonly, degenerative disorders of the spine are responsible. Degenerative "disease" is the changes associated with spinal wear and tear or age. Though among the most frequent causes of neck pain, it is the sometimes the most difficult to treat.

Chronic Pain May Affect Daily Activities Other possible disorders that can cause neck pain are rheumatoid arthritis (room-ah-toyed arth-rye-tis), infection, or cancer. It is rare that such conditions cause only neck pain, as they are usually associated with other warning signs such as profound or unintentional weight loss, fevers, or pain in other joints such as the hip or knee.
The focus of this chapter is a discussion of degenerative disorders of the cervical spine. These affect adult patients of any age, with a tendency for particular disorders to affect certain age groups. Cervical disk herniations are more characteristic in the young (less than forty-years old), while cervical spondylosis (spon-dee-low-sis) and stenosis (sten-oh-sis) are typically found in older patients. Treatments vary from observation, medications, and therapy to injections or operative intervention.
Definition: Degenerative Disease
As a patient, the first question is obvious. "What is degenerative disease of the spine?" In all honesty, the academic leaders of the spine world are currently pondering this same question. What we mean is that spine doctors can recognize and treat degenerative disorders of the spine but are often unclear how the disorder actually arises except to attribute it to age. To date, most theories about how the spine degenerates remain just that-theories. Although these theories are often well thought out and reasonable, it is exceedingly difficult to prove them. Regardless, it is worthwhile trying to understand them, as http://www.lansi.org/our-team.php.they are the best explanation we have to explain degenerative disease of the spine at this time.
Degenerative disease of the spine refers to a breakdown of the normal architecture of the various components of the cervical spine. Normally, the neck is very flexible. As you may demonstrate on yourself, the neck allows the head to rotate from side to side nearly 180 degrees, to flex forward to touch your chin to your chest, and extend backwards to almost touch the back of the head to your upper back, as well as bend your head toward your shoulder (and all ranges in between these basic motions). These motions are afforded by the various joints of the cervical spine.
There are seven cervical bones in the spine. Known as vertebrae (ver-ta-bray), they can be likened to the cars of a passenger train. The cars of the train, by themselves, are stiff with no ability to bend. Each car (i.e. vertebra) is joined to its neighbor by a joint. The joint allows motion between the cars. As in the spine, joining a number of cars together can allow overall motion. The more joints and vertebrae (the plural of vertebra), the more motion is allowed. In contrast to the joints of the car, the cervical vertebrae are connected by three joints. This gives the spine more stability, while still allowing motion. The extremes of motion must be limited because of the fragile "freight" that the vertebrae hold-the spinal cord. Like the people in the cars of the train, the spinal cord is located in the center of the vertebrae.
At this point, clarification of terms is important. "Spine" refers to the bony parts. These are the vertebrae that were described above. "Spinal cord" is the nerve elements that travel within the spine from the brain down to the rest of the body. The spinal cord transmits signals (bioelectrical and biochemical) that control all the functions (muscles and sensation) below that level. The function of the spine is to protect the spinal cord from injury during motion and activity.
Joints are comprised of two opposing surfaces of bone. Some joints are covered with smooth, glistening cartilage. The slippery properties of cartilage (car-til-ledge) make the two surfaces move easily in relation to each other. The facet joints of the cervical spine have these properties.
Figure 5: Facet Joints In contrast, the main joint between two cervical vertebrae is made up by a large spongy mass, the intervertebral disc. This disc sits between the two broad flat surfaces of the vertebral bodies. The disc is made up of specialized materials that act as a soft "glue" between the bones, while still allowing them to move. The disc is extremely important to spinal stability. However, it is a frequent site of degeneration or breakdown.

Figure 3: Vertebral Segment In another way the disc can be considered as a pillow in between two bones. The pillows can softly resist the downward forces placed on the vertebrae from the weight and movement of the head. A good pillow is thick and soft and functions best. It allows some movement between the vertebrae. Because the pillow is well fixed to both bones, it resists the tendency of the bones to become misaligned. With time and use the pillow can become flattened.
In this state the disc no longer provides adequate cushioning between the vertebrae. The bones then come closer and closer together. Because the disc is no longer sustaining the forces that it usually does, the other joints of the spine are forced to take on these extra loads. The two smaller sliding joints (facet joints, fah-set) have greater demands placed on them.
Since they were designed to sustain only a small portion of the forces of the spine, the previously glistening, healthy cartilage starts to breakdown. As the cartilage degenerates, the underlying bone becomes exposed and an inflammatory reaction begins. This causes irritation of the joint, which can lead to pain. This sets up a vicious cycle of events. The more the facet joints become degenerated, the less they are able to tolerate the increased demands. Thus, greater demands will then be placed on the intervertebral disc, causing it to further degenerate (or breakdown) as well. The changes in the intervertebral disc and facet joints are not reversible at this time.
This article is an excerpt from Dr. Stewart G. Eidelson's book, Advanced Technologies to Treat Neck and Back Pain, A Patient's Guide (March 2005).