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Cervical Arthritis

Introduction

Arthritis affecting the neck is a condition that occurs with advance in years.

As patients get older, the intervertebral discs start to become less resilient and extra bone starts to form around the edge of the disc and also within the joints of the back of the neck known as the facet joints.

For many people arthritis of the neck occurs without any symptoms and may be noticed when an x-ray is taken for some other reason such as following a road traffic accident.

The arthritic changes within the neck, which are also known as spondyloarthropathy and spondylitis progress but at a variable rate.

In some patients they are known to have had arthritis affecting the neck for many years without symptoms while others develop the degeneration that is rapidly progressive requiring treatment.

Arthritis affecting the neck produces two principal symptoms. The first is that of neck pain and a restricted range of movements. The second is compression of the spinal cord and this is dealt with in the section on myelopathy.

When arthritis of the neck causes pain the pain is often within the neck but can radiate into the shoulders and can on occasions give pins and needles in the arms although this should not be confused with cervical disc prolapses that have been dealt with in the separate section on disc prolapses of the cervical spine.

The pain is often activity related but may be present at rest.

The pain may vary throughout the day and throughout the days of the year.

History

Patients often start with a gradual reduction in the range of movements of the neck and occasional pain.

The pain may remain episodic and not have a great influence in lifestyle but may become more and more progressive with time.

Examination

Examination may reveal no obvious abnormality or it may reveal a restricted range of movements with pain.

A neurological examination will be performed by your doctor to confirm that there is no compression of the nerves as they leave the spinal canal.

Special Investigations

Although plain radiographs may be used to confirm the diagnosis as they are a cheap and easily available form of investigation, an MRI scan is more useful as it will show whether the spinal cord itself is being compressed, it will show the state of the discs and also the degree of compression as the nerves themselves exit the spinal canal.

Often access to MRI scans is limited and general practitioners may be able to request them.

The cost of an MRI scan privately can vary depending upon the unit that is used. If patients pay for their own MRI scans then physiotherapists, chiropractors, osteopaths, general practitioners and consultants can refer them for MRI scans.

If an MRI scan is to be funded by an insurance company, great care should be taken that the insurance company are going to fund the MRI scan and often the scans can only be requested by a specialist or hospital consultant.

For MRI scans provided by the National Health Service provision has been made with some general practitioners to refer for them directly but others prefer for a consultant to request these scans.

Other Conditions

There are other conditions that come under the heading of arthritis of the neck. These include rheumatoid arthritis and ankylosing spondylitis.

These are different conditions requiring different treatments and causing a different set of symptoms.

In rheumatoid arthritis other areas of the spine are frequently involved. The condition causes instability of the spine and careful assessment by a specialist either a rheumatologist or a spinal surgeon is required to assess the treatment that might be required with regard to the cervical spine.

In ankylosing spondylitis the condition causes marked stiffness within the neck and can cause an increase susceptibility to fractures as well as pain, which is often worse at night.

This condition also needs to be carefully monitored and treated by a rheumatologist or a spinal orthopaedic surgeon.

Non-surgical Treatments

The non-surgical treatments that are available for neck pain due to underlying arthritis depend upon the degree of symptoms.

If the symptoms are mild and episodic, patients often resort to simple oral analgesics that can be purchased over-the-counter from supermarkets and from chemist.

If these medications fail to improve the pain, the patient may wish to participate in physical therapy. Physiotherapists provide treatment for neck pain as do chiropractors and osteopaths.

Pain management techniques including acupuncture, dry needling, manipulation and massage may also be of assistance.

Surgery

If the pain is particularly severe and is found to affect either one or two levels of the spine then a surgeon may elect to perform surgery.

The least invasive form of surgery is injection type treatment under x-ray control where either steroids are injected into the facet joints and around the painful areas of the spine or the nerves causing the pain are disrupted either electrically using radiofrequency techniques or thermally using heating probes.

If all of these treatments fail, the patient may wish to avail themselves to surgical stabilisation in the forms of either an anterior cervical fusion or a posterior fusion depending upon the extent of the disease and the surgeon's preference.

These procedures are dealt with in the common procedures involving the spine section of this website.

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