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Neck Disorders

Kyphosis is a forward rounding of your upper back of more than 50 degrees. Kyphosis can occur as a result of degenerative diseases such as arthritis of the spine; osteoporosis with compression fractures of the vertebrae or trauma to the spine.

Severe Kyphosis can affect the lungs, nerves and other tissues and organs, causing pain and other problems.

Symptoms of Kyphosis I include slouching posture or hunchback; back pain; spinal stiffness; and fatigue.

Causes in adults include: osteoporosis; degenerative arthritis of the spine; ankylosing spondylitis; and connective tissue disorders.

Kyphosis may cause deformity of the back; back pain; breathing difficulties; and neurological signs and symptoms.

Treatment

Treatment depends on the cause of the disorder:

  1. Congenital kyphosis requires corrective surgery at an early age.
  2. Scheuermann’s disease is treated with a brace and physical therapy. Occasionally surgery is needed for large (greater than 60 degrees), painful curves.
  3. Multiple compression fractures from osteoporosis can be left alone if there are no nervous system problems or pain. However, the osteoporosis needs to be treated to help prevent future fractures. For debilitating deformity or pain, surgery is an option.
  4. Kyphosis caused by infection or tumor needs to be treated more aggressively, often with surgery and medications.

Treatment for other types of kyphosis depends on the cause. Surgery may be necessary if neurological symptoms or persistent pain develop.

Cervical Spondylosis

Cervical spondylosis is a term used for abnormal wear and tear affecting the joints in the neck with degeneration and mineral deposits in the cushions between the vertebrae.

Extreme cases of cervical spondylisis may compress one or more of the spinal nerves branching out of the cervical vertebrae. This is called cervical radiculopathy. The bone spurs may also reduce the diameter of the canal that houses the spinal cord resulting in cervical myelopathy

Symptoms of cervical spondylosis include, stiff painful neck, shoulder, arm, chest pain, tingling and pinprick sensations in the arms, hands, legs and feet, numbness and weakness in the arms, hands, legs or feet, difficulty walking, abnormal reflexes, loss of bladder or bowel control.

Treatment

Even if your neck pain does not go away completely, or it gets more painful at times, learning to take care of your neck and back at home and prevent repeat episodes of your pain can help you avoid surgery.

Your doctor and other health professionals can help you manage your pain and keep you as active as possible.

  1. Your doctor may refer you for physical therapy. The physical therapist will help you reduce your pain using stretches. The therapist will show you how to do exercises that make your neck muscles stronger.
  2. You may also see a massage therapist, someone who performs acupuncture, or someone who does spinal manipulation (a chiropractor, osteopathic doctor, or physical therapist). Sometimes a few visits will help with neck pain.
  3. Cold packs and heat therapy may help your pain during flare-ups.

A type of talk therapy called cognitive behavioral therapy may be helpful if the pain is having a serious impact on your life. This technique helps you better understand your pain and teaches you how to manage it.

A number of different medications can help with your back pain.

  1. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, naproxen sodium (Aleve), and ibuprofen (Advil) can help with the pain. Always talk with your doctor if you need to take these drugs every day. Side effects may include stomach ulcers or bleeding, and liver or kidney damage.
  2. Low doses of prescription medicines used to treat seizures (called anticonvulsants) or depression (antidepressants) may help some patients whose long-term back pain has made it hard for them to work or interferes with daily activities.
  3. Your doctor may give you pain medicines called narcotics or opioids to use when the pain is very severe. These medicines are rarely, if ever, used to treat neck pain on a daily basis.

If the pain does not respond to these treatments, or you have a loss of movement or feeling, surgery is considered. Surgery is done to relieve the pressure on the nerves or spinal cord.

Herniated Discs

The spine is made up of bones that are cushioned by small oval discs. A herniated disc occurs when a small portion of the nucleus of the disc pushes through a tear in the annulus into the spinal canal. This can irritate a nerve and result in pain, numbness or weakness in the back as well as the leg or arm.

There are some people with herniated discs that are asymptomatic. However, some herniated discs are painful. Common symptoms include:

Sciatica – radiating, aching pain, sometimes with tingling and numbness that starts at the buttock and extends down the back or side of one leg.

  1. Pain, numbness or weakness in the lower back and one leg, or in the neck, shoulder, chest or arm.
  2. Low back pain or leg pain that worsens when sitting, coughing or sneezing.

Disc herniation is most often the result of gradual, aging-related wear and tear called degeneration of the discs. Normally a specific event is not linked to a herniated disc.

Complications of herniated discs include:

Significant or increasing pain, numbness or weakness spreading to one or both legs.

  1. Bladder or bowel dysfunction.
  2. Progressive loss of sensation in areas that touch a saddle (inner thighs, back of legs and area around rectum).

Treatments include:

  1. Conservative treatment – avoiding painful positions and following a planned exercise and pain-medication regimen.
  2. Modified activity.
  3. Physical therapy.
  4. Heat or cold applications.
  5. Pain medication.
  6. Bed rest.
  7. Surgery. About 10% of people with herniated discs eventually need surgery.

Cervical Radiculopathy

Cervical radiculopathy is a dysfunction of a nerve root of the cervical spine, normally affecting the C7 and C6 nerve roots the most. It occurs much less than lumbar radiculopathy, affecting about 85 out of 100,000 people per year.

Symptoms include:

  1. Pain;
  2. Numbness;
  3. Weakness.

Range of motion is usually reduced with increased pain with lateral bending away from the affected side. Muscle tenderness is usually note along the cervical paraspinal muscles, and is usually more pronounced along the ipsilateral side of the affected nerve root. Letchuman et al showed that cervical radiculopathy is associated with increased tender spots (both trigger and tender points) on the side of the radiculopathy, with predilection toward the muscles innervated by the nerve root. This study revealed that not only pain, but also tenderness, may be referred in radiculopathy.

Treatment

  1. physical
  2. therapy
  3. steroid injections
  4. surgery
  5. medication.

Useful Links:

http://www.mayoclinic.com/health/kyphosis/DS00681/
http://www.mayoclinic.com/health/cervical-spondylosis/DS00697/
http://orthoinfo.aaos.org/topic.cfm?topic=A00332

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