Pain emanating from the cervical spine may be localized to the back of the neck radiating into the intercapsular region or be diffusely referred to the shoulder girdle. Radiculopathy implies damage to the nerve root exiting from the spinal cord. It may be secondary to compression or inflammation. Myelopathy implies damage to the spinal cord itself and one can use symptoms and signs to localize the level of myelo-pathy. Radicular pain follows a typical nerve root distribution and is easy to discern by careful history taking. Very commonly, rather diffuse pain is difficult to isolate to any one particular structure in the cervical spine, be it a disc, facet joint or ligament. To assess these patients accurately, a good working knowledge of the anatomy of the cervical spine is needed as well as of the myotomal and dermatomal distribution of the cervical nerve roots to the upper limbs. There may be confusion as to whether the pain emanates from structures within the cervical spine or shoulder joints. However, careful clinical assessment should help to elucidate this.
A simple pathological classification of diseases involving the cervical spine is:
• Congenital spinal dysraphysm:
- spinal dysraphysm
• Klippel Feil syndrome.
- Degenerative: cervical spondylosis (Fig. 22.33), prolapsed cervical intervertebral disc, facet joint arthro-pathy, foraminal stenosis.
- Neoplastic: primary bone tumours, metastatic tumour, primary intradural/extradural tumour.
- Inflammatory: rheumatoid arthritis, HLAB 27 spondyloarthropathy.
- Infective: bacterial vertebral osteomyelitis, infective discitis + epidural abscess.
- Post-traumatic: traumatic cervical disc prolapse, cervical instability.
- Miscellaneous: diffuse idiopathic skeletal hyperostosis, anterior longitudinal ligament calcification.
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