Neck Disorders and Injuries

The human neck is a very mobile and complex structure, and as such is prone to injury. Disorders of the neck are generally due to trauma or disease processes that lead to compression or other compromise of vital structures, especially the nerves and spinal cord.

Neck trauma with resulting damage to the spinal cord is not the most common neck injury, but it is one of the most serious because of the potentially devastating consequences. The flexibility of the cervical spine places it at an increased risk for potential injury. Dislocated or fractured vertebra may compress or sever the spinal cord and in extreme cases the resulting damage may cause quadriplegia (paralysis of all 4 limbs), with even an inability to breath without a respirator, or death.

In the United States, about 10,000 spinal cord injuries occur every year. About 80 percent occur in men under 35 years of age. Motor vehicle accidents cause 45 percent of theses injuries, 20 percent are from falls, 15 percent from sports injuries, and 15 percent from violence.

The fact that young men suffer the majority of spinal cord injuries and that risky behavior is often involved (unsafe driving, diving into shallow water, playing contact sports) emphasizes the importance of prevention in the management of spinal cord injury. Such preventive measures include safety belts, airbags and protective athletic equipment, but education is perhaps the simplest and most important. In fact, the first recommendation from a commission aimed at reducing football spinal cord injuries was teaching safe contact techniques.

Once a spinal cord injury has occurred, recognition is crucial. Prompt immobilization of the neck reduces the risk of further injury. Frequently, surgical intervention is necessary. In these cases the goal is to decompress the spinal cord, realign the cervical spine, and restore spinal stability. Depending on the location of the compression either an anterior procedure (i.e. discectomy) or a posterior procedure (i.e. laminectomy) may be necessary. Stabilization typically requires bone graft to achieve a fusion. Plates and screws may be necessary to provide initial stability.

Fortunately, traumatic spine injuries resulting in paralysis are uncommon, and injuries that result in pain, loss of range of motion, and varying neurologic symptoms are more typical. At any given time, 15 percent of adults suffer from neck pain. Whiplash injuries are typically the result of a strong extension and strong flexion of the cervical spine, as is the case when hit from behind in a car. Such a violent episode can result in a variety of soft-tissue injuries that may cause symptoms, such as neck, shoulder, or back pain, stiffness, headache, dizziness, and abnormal sensations such [Page 1213]as burning or prickling (paresthesias). Early mobilization is associated with better outcome, but persistent symptoms and resistance to treatment are common.

Herniated discs are rarely due to a single traumatic event but typically due to repetitive use injury, postural problems, and degenerative disease. The inner part of the disc (nucleus pulposus) bulges through the surrounding outer part of the disc (annulus fibrosus) and can compress a nerve root (“pinched nerve”) as it exits the spinal column.

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