What types of spine conditions are the most painful?

CERVICAL SPONDYLOTIC MYELOPATHY (Spinal Cord Compression)

One of the most common neck conditions that occurs with age is cervical spondylotic myelopathy (CSM). Over time, the normal wear-and-tear effects of aging can lead to a narrowing of the spinal canal. This compresses — or squeezes — the spinal cord. CSM can cause a variety of symptoms, including pain, numbness, and weakness (AAOS, 2015).

Symptoms usually begin after the age of 50, but can occur earlier if there was an injury to the spine at a younger age. Many people with CSM will have steady progression of their disease. Once symptoms start, they tend to continue. Typically, the disease progresses slowly over several years. In about 5% to 20% of people, CSM worsens more rapidly.

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SYMPTOMS

The spinal cord is the cable of nerves that send and receive signals from the body. When the spinal cord is slowly compressed, people may develop symptoms such as:

  • Tingling and numbness
  • Weakness: trouble lifting objects, dropping things
  • Difficulty walking (loss of balance), wide-based gait
  • Coordination problems/clumsiness: handwriting, buttoning clothes, and feeding oneself can become difficult
  • Neck pain and stiffness

TREATMENT

Nonsurgical Treatment
Some people get relief from symptoms of CSM without surgery. The most common nonsurgical treatment options include:

  • Soft Collars. Soft collars allow the muscles of the neck to rest by limiting neck motion. This can help decrease pinching of nerve roots with movement. Soft collars should only be worn for short periods of time, because long-term wear can decrease the strength of neck muscles.
  • Exercise. Improving neck strength and flexibility with simple exercises may lessen discomfort.
  • Nonsteroidal anti-inflammatory medications (NSAIDs). Drugs like aspirin and ibuprofen can reduce swelling and painful symptoms of spinal cord compression.
  • Epidural steroid injections. Cortisone is a powerful anti-inflammatory. Cortisone injections in the “epidural space” can decrease swelling as well as pain, although they are not often used in CSM.
  • Chiropractic manipulation. Manipulation is never used if a patient has spinal cord compression.

Surgical Treatment
Whether to have surgery or not is a complex decision made between you and your doctor. Learn more about surgical options for cervical spondylotic myelopathy.

RISK FACTORS

Risk factors for CSM include:

  • Normal age-dependent changes of the intervertebral discs, most commonly manifested as cervical osteophytes (bone spurs) at the margins of the vertebrae.
  • Arthritis in the spine leading to facet hypertrophy i.e. enlargement of the facet joints.
  • Thickening of the ligaments surrounding the spinal canal, especially the ligamentum flavum, which parallels loss of disc height.
  • Translational mechanical instability resulting in subluxation (or partial dislocation) of the vertebral bodies.
  • Congenitally small spinal canal, which renders the patient’s spinal cord more susceptible to compression.
  • Repetitive wear and/or trauma leading to degenerative changes affecting the disc spaces and vertebral endplates.

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