Cervical Spine

The uppermost part of the spine. The cervical spine is made up of seven individual bones called vertebrae, separated by spongy disks that act as shock absorbers. The vertebrae are labeled, from top to bottom, C1 to C7. C1 and C2 are specially shaped to allow the head to swivel to the right and left. C7, the bottom cervical vertebra, is that bony “bump” one can feel at the bottom of the back of the neck.

Rheumatoid arthritis (RA) and other types of inflammatory arthritis can affect the cervical spine, making it unstable, but osteoarthritis (OA) in the cervical spine is much more common. In cervical OA, also known as cervical spondylosis, the cervical vertebrae and the disks between them gradually deteriorate, causing stiffness and pain. In some cases, bone spurs may develop.

It is estimated that most people over the age of 60 have at least some cervical OA, though they may not have any symptoms. The condition may develop over many years, starting with muscle pain and stiffness in the neck and shoulders and often involving headaches. Sometimes cervical OA causes the spinal cord or the nerves branching out from the spinal cord at the neck to become pinched. This condition, known as cervical spinal stenosis, can cause pain in the arms or shoulders or numbness or tingling in the hands.

To help diagnose cervical OA, doctors may use an x-ray, a magnetic resonance imaging (MRI) test, a computerized tomography (CT) scan, or a myelogram. (In a myelogram, dye is injected into a person’s spine and then x-rays or CT scans are taken of the spine. The dye makes parts of the spine more visible.) Doctors may also test the reflexes in a person’s arms and legs to determine whether there have been any changes to the nerves in the spine.

Cervical OA may be treated with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn), physical therapy, bed rest and traction, the wearing of a soft collar around the neck, moist heat, or gentle massage. In more severe cases, people with cervical OA may need shots of a corticosteroid drug such as prednisone, muscle relaxant drugs, or even surgery.

This column is edited by Robert S. Dinsmoor, a medical writer and editor based in Massachusetts.

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