What happens during instability
Each segment of the spine is supported by a disc, joints, and ligaments; The deep muscles of the neck work as an active stabilizer. If these structures are damaged or stretched, when bending forward and backward, the vertebra moves more than permissible. On a functional x-ray this can be seen as excessive sliding and a change in the angle between the vertebrae. The body responds with protective muscle tension, hence the pain, stiffness and fatigue of the neck. Gradually, degenerative changes develop at an unstable level, and over time, the segment may, on the contrary, become rigid due to the proliferation of bone tissue.
- Displacement of the vertebra during flexion and extension is greater than normal
- Damage to ligaments and intervertebral disc
- Protective spasm of the neck muscles
- Accelerated degenerative changes in the segment
- Possible compression of a nerve root or spinal cord
Causes and risk factors
The most obvious cause is injury: whiplash during sudden braking, a fall, a sports impact. Degenerative instability develops slowly as the disc height decreases and the ligaments lose tension, most often after age 40. Postoperative complications occur if part of the stabilizing structures had to be removed during the intervention. A separate group is systemic diseases: rheumatoid arthritis affects the ligaments of the upper cervical vertebrae; in connective tissue dysplasia syndromes, the ligaments are initially more extensible. Congenital and post-traumatic instability occurs in children, but such a diagnosis is made carefully and only based on objective data.
- Trauma and whiplash injuries to the neck
- Intervertebral disc degeneration
- Consequences of operations on the cervical spine
- Rheumatoid arthritis and other systemic diseases
- Connective tissue dysplasia
- Prolonged static load and weak neck muscles
Symptoms
Most often, patients describe a dull pain and a feeling of heaviness in the neck, which intensifies at the end of the day and after working at the computer. Characteristic is the feeling that there is “nothing to hold your head up with,” the desire to prop it up with your hand, and the need to frequently change position. There are crunching and clicking noises when turning, headaches in the back of the head, dizziness and tinnitus. If the displacement affects the nerve root, lumbago, numbness and weakness in the arm appear. Signs of spinal cord compression - clumsiness of the hands, unsteady gait, weakness in the legs - require immediate medical attention.
- Neck muscle pain and fatigue
- Feeling of head instability
- Crunching and clicking noises when turning
- Headache in the back of the head, dizziness
- Shooting, numbness and weakness in the arm
- Clumsiness in the hands and unsteadiness of gait with myelopathy
Diagnostics
The examination begins with an assessment of range of motion, pain, strength and sensitivity in the hands, and reflexes. The key study is an X-ray of the cervical spine with functional tests: pictures are taken in the position of maximum flexion and extension and measure the displacement of the vertebra and the angle between the endplates. MRI is needed to see the disc, ligaments, spinal cord and roots, especially for neurological complaints. CT scans better show bone structures and the effects of injury. After an accident or fall, the examination is carried out urgently; before this, the neck is not loaded.
- Examination by a neurologist or vertebrologist
- X-ray of the cervical spine with functional tests
- MRI of the cervical spine
- CT scan for trauma and suspected fracture
- ENMG for persistent numbness and weakness in the hand
Treatment and prevention
The basis of treatment is strengthening of the deep muscles of the neck and upper back under the supervision of a physical therapist. Exercises are selected individually and performed regularly, without sudden rotations or throwing back the head. In the acute period, a soft collar is used, but only for a short course: prolonged wearing weakens the muscles. Painkillers and anti-inflammatory drugs are prescribed by the doctor for a limited time, physiotherapy and gentle massage help. Rigid manipulations with jerks in case of instability are contraindicated. Surgery to stabilize the segment is considered in cases of severe displacement, persistent pain, and signs of compression of nerve structures.
- Physical therapy for the deep muscles of the neck
- Soft collar short course in the acute period
- Physiotherapy and gentle massage of the cervicothoracic region
- Painkillers as prescribed by a doctor
- Avoid sudden head rotations and manual jerks
- Organize your workplace: screen at eye level, breaks every hour
- Surgical stabilization for neurological disorders