Do You Have Neck Pain? What Causes It?

Neck Pain 

By Stephen Ducker, MD with Chambers Medical Group

Neck pain can be from a multitude of causes such as acute trauma, disease, or chronic degenerative changes such as osteoarthritis.  To fully understand the causes of neck pain, it is important to have some basic understanding of the anatomy of the cervical spine, the surrounding connective tissue, and the associated musculature. Each of the anatomic entities of the neck can be a source of disease and pain either independently or in conjunction with other structures.

The cervical (C) spine is composed of 7 vertebrae (C1-C7), with an intervening disc in between each vertebral body.  The cervical vertebrae are much smaller and more fragile than the remainder of the spinal column for various functional and anatomic reasons.  Functionally, the cervical spine has greater range of motion than the remainder spinal column and structurally it is required to support less weight than the lumbar spine by comparison. Overall, the neck is responsible for support and movement of the head throughout rotation, flexion, extension, and lateral bending.  As a result of these functional and structural attributes, the cervical spine is often the source of injury during even relatively minor trauma.

The first two cervical vertebrae (C1 and C2) are also referred to as the Atlas and Axis, respectively and function primarily to support and rotate the head. As the spinal cord emerges from the skull, it passes downward through a canal created by the 7 cervical vertebrae.  This canal is referred to as the cervical vertebral canal or central canal and serves to protect the spinal cord.  Emerging from each level of the cervical spine are spinal nerves exiting from the vertebral foramen which are openings at each side of the vertebral column, created by the alignment of the vertebral bodies and their bony extensions.  In addition, connecting each of the vertebrae are multiple ligaments helping to stabilize the cervical spine and maintain proper alignment.  These entities will be discussed in more detail below.

The cervical facet joints are joints created by the articulation (joining) of the superior and inferior (upper and lower) cervical vertebrae. They function to prevent slippage of the vertebrae and guide the movements of the vertebrae relative to each other.  Most of the facet joints in the cervical spine are true joints in that they are like the other joints in the body with a joint capsule, cartilage, and a lining.

There is a strong flexible disc in between each of the vertebral bodies which serves two main functions.  The first function is absorbing mechanical impact and stress on the cervical spine and the second is to assist in movement of the spine, helping to prevent the compression of nerves and blood vessels.  The disc is a closed fluid filled container encased in a tough fibrous cartilage.  The side of the container consists of crisscrossing fibers referred to as the annulus.  In the very center of the disc, much like a jelly filled doughnut, is a water containing gel-like substance called the nucleus pulposus.  It is the nucleus pulposus that is primarily responsible for maintaining the space between adjacent vertebrae.  This in turn serves to help protect spinal cord and nerve roots exiting through the vertebral foramen mentioned above.

The cervical facet joints are joints created by the articulation (joining) of the superior and inferior (upper and lower) cervical vertebrae. They function to prevent slippage of the vertebrae and guide the movements of the vertebrae relative to each other.  Most of the facet joints in the cervical spine are true joints in that they are like the other joints in the body with a joint capsule, cartilage, and a lining.

There is a strong flexible disc in between each of the vertebral bodies which serves two main functions.  The first function is absorbing mechanical impact and stress on the cervical spine and the second is to assist in movement of the spine, helping to prevent the compression of nerves and blood vessels.  The disc is a closed fluid filled container encased in a tough fibrous cartilage.  The side of the container consists of crisscrossing fibers referred to as the annulus.  In the very center of the disc, much like a jelly filled doughnut, is a water containing gel-like substance called the nucleus pulposus.  It is the nucleus pulposus that is primarily responsible for maintaining the space between adjacent vertebrae.  This in turn serves to help protect spinal cord and nerve roots exiting through the vertebral foramen mentioned above.

Surrounding the central nervous system including the brain and spinal cord are the meninges which consists of 3 layers of connective tissues.  The dura mater is the tough band like tissue that is the outermost layer, lining the spinal canal.  Just inside the dura mater is the arachnoid mater, under which the cerebrospinal fluid is contained.  Finally, there is a very thin delicate vascular lining covering the spinal cord called the pia mater.

The cervical spine has a complex system of ligaments for stabilization and maintenance of alignment of the vertebrae. More precisely, the ligaments serve to provide stable rotation of the head relative to the neck as well as preventing excessive flexion, extension, and mobility of the cervical spine. For instance, the anterior and posterior longitudinal ligaments run along the anterior (front) and posterior (back) portions of each cervical vertebrae, serving to limit excess flexion, extension, and mobility of the vertebral bodies which are located anteriorly in the spinal column. Whereas the supraspinous, interspinous and ligamentum flavum located more posteriorly within the spinal column serve to stabilize the more posterior elements of the cervical vertebrae.

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