The cause of neck pain can usually be diagnosed with a detailed description of one’s symptoms, a medical history, as well as an evaluation and examination, (and possibly diagnostic testing), will lead to a diagnosis of a general cause (such as sprain or strain), or a specific condition (such as whiplash). Possible diagnoses for neck pain could include but are not limited to: cervical DDD or degenerative disc disease, herniated disc, osteoarthritis, spinal stenosis, myelopathy, foraminal stenosis, radiculopathy, spondylolisthesis, or spondylosis.
Causes of Chronic Neck Pain
Neck pain is considered chronic when it persists for more than 3 months. These conditions tend to stem from problems in the cervical spine either with a facet joint or disc. Common causes include:
Cervical degenerative disc disease: Everyone experiences wear and tear on the cervical spine over time. It’s natural for the discs to gradually lose hydration and the ability to cushion the spine’s vertebrae.
If a disc degenerates enough, it can lead to painful irritation of a cervical nerve in various ways, such as a herniated disc, pinched nerve, or changes in the facet joints that can cause arthritis.
Cervical herniated disc: A cervical disc is herniated when its jelly-like inner layer, the nucleus pulposus, leaks out through a tear in the disc’s protective outer layer. This could result from an injury or aging.
A herniated disc may press against or pinch a cervical nerve, or the nucleus pulposus may come close enough to a nerve to cause irritation.
Cervical osteoarthritis: When the cartilage in a cervical facet joint wears down enough, it can lead to cervical osteoarthritis, also known as cervical spondylosis.
Rather than having the facet joints move smoothly along cartilage as intended, they might grind bone on bone. The joint could become enlarged from inflammation and bone spur growth, causing a nearby nerve to become pinched or pressed.
Cervical spinal stenosis with myelopathy: Spinal stenosis occurs when the spine’s degeneration leads to a narrowing of the spinal canal, such as from a herniated disc that pushes into the spinal canal or bone spurs that grow into the canal.
When the spinal canal narrows enough to compress the spinal cord—a large bundle of nerves that runs inside the spinal canal—myelopathy can result. Myelopathy is when compression of the spinal cord starts causing symptoms, such as weakness or problems with coordination in the arms, hands, legs, or feet.
Cervical foraminal stenosis: This condition occurs when the foramina—the holes in the vertebral construct through which nerve roots that branch off from the spinal cord can exit the spinal canal—become narrowed. This narrowing of the hole can cause irritation for the nerve root that runs through it.
Foraminal stenosis: Associated with radiating pains in a pattern specific to the nerve that is pinched by the narrowing. In some situations, there is a combination of the cervical stenosis causing myelopathy, as well as the specific nerve pattern associated with a cervical foramen being narrowed.
Spondylolisthesis: This condition occurs when one vertebra slips over the one below it. It can be due to a tiny fracture in the vertebra, or possibly from advanced disc degeneration, or ligament laxity.
Ankylosing spondylitis: This progressive arthritis of the spine and pelvis can cause widespread inflammation, pain and stiffness throughout the spine, including the neck.
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