Spine Conditions: Cervical Spine Conditions

There are a variety of causes of neck pain, including trauma and degenerative changes. The history of onset helps to direct evaluation, including the need for imaging or ancillary testing. Patterns of pain, weakness, and other specific physical examination findings also aid in diagnosis. Management of most soft tissue injuries involves early mobilization, whereas fractures are managed based on patterns of instability. Acute spinal cord injury requires emergent care, to include possible decompressive surgery. The role of hypothermia and corticosteroids in these patients remains unclear. Cervical radiculopathy (eg, disk herniation, arthritic changes) can be managed conservatively in most patients. Central cord compression, or myelopathy, often is overlooked but is a common condition among older patients. Although certain patients may benefit from surgery, many have a stable course or slow progression that can be managed nonsurgically. Rheumatoid arthritis can have significant effects on the cervical spine. Patients with inflammatory conditions may improve with steroids, nonsteroidal anti-inflammatory drugs, or biologic drugs, but these drugs rarely have lasting benefit in degenerative conditions. Stretching, strengthening, and other physical therapy modalities have been shown to be helpful for patients with chronic and acute but stable neck conditions.