Q: I have had problems with my neck (diagnosed as cervical spondylosis) for about 10 years. The condition has grown worse over the years. While massage and physical therapy have been useful to eliminate the pain, their effect is short-lived and the pain usually returns after one or two days. Is there any medication you would recommend? Otherwise, any special treatment that will last longer than the one or two days?
A: There are many reasons for a pain in the neck, and cervical spondylosis is one of the more serious. Neck pain can be caused by congenital abnormalities, trauma, degenerative diseases, infection and tumors.
Cervical spondylosis is one of the degenerative diseases and is most commonly seen in middle-aged and older adults. It is also called degenerative arthritis and is characterized by gradual disintegration of the disks between the vertebrae in the neck and upper spine, and the formation of bony outgrowths in the area.
This degeneration can result in the narrowing of the spinal canal in the vertebrae of the neck and compression of the spinal cord and spinal nerve roots. As you might expect, this problem is potentially very serious.
When one or more of the nerve roots in the cervical area, most commonly C5 and C6 (for cervical vertebrae numbers 5 and 6), become compressed or stretched, damage can result in the muscles supplied by those nerves. In fact, cervical spondylosis is suspected when an exam reveals weakness of the muscles supplied by cervical nerves.
Symptoms include neck pain, restricted neck movement, headaches and/or tingling and weakness in the shoulder and arms.
To aid in making a diagnosis, X-rays can show some narrowing and disintegration, but it's often inconclusive for cervical spondylosis. Computed tomography (CT) scans and magnetic resonance imaging (MRIs) can confirm the diagnosis.
Cervical spondylosis may improve or stabilize without treatment, but it may also be a chronic and progressive disease.
There may be no way, including surgery, to reverse the problems associated with the deterioration, because some of the spinal cord nerves may have been permanently damaged. However, there is treatment for symptoms of cervical spondylosis.
Surgery to prevent further deterioration may be required in cases of serious nerve damage or severe and persistent pain. Such surgery may include stabilization of the cervical spine.
Anti-inflammatory drugs, mild analgesics and muscle relaxants are often recommended for control of pain. A cervical collar can restrict head and neck movement and thereby relieve pain. Neck traction can also help.
If you are not wearing a brace whenever possible, I would recommend increasing its use. Increased dosage of pain medication may be considered.
Otherwise, you may want to get another opinion from an orthopedic or neurosurgeon and learn of the risks and benefits of surgical intervention for you.
Update on mammography: For many years, I and many others have been urging women to get mammograms on a regular basis in order to detect breast cancer as early as possible. The earlier the cancer is detected, the less surgery is required to remove it and the less likely it will have spread beyond the breast.
But there remains some debate about how frequently a woman should be tested. The American Cancer Society, for example, recommends once a year, starting at age 40. Because the risk of developing breast cancer increases with age, it made sense that mammograms continue on a regular basis throughout life.
However, a study just reported in the Journal of the American Medical Association calls this into question. This study found that continuing to get mammograms every two years after the age of 69 prevented one death from breast cancer for every 10,000 mammograms done, but only increased life expectancy by one day overall.
You must factor your personal situation (both increased risk and needs) into making decisions about this and any other medical procedure.
Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is DRFamily@aol.com.
This column is for informational and educational purposes only.