Tservikalgiya (neck pain)
Contents:
Description:
Tservikalgiya is a pain syndrome which is characterized by neck pain and tension which is often accompanying it, morbidity of cervical muscles, restriction of mobility of cervical department, and also dizziness, vegetative dysfunction, a sight illegibility.
Distinguish a vertebrogenny tservikalgiya which is connected with pathology of cervical department of a backbone (a protruded disk, a spondylosis, a pseudorheumatism and other inflammatory spondiloartropatiya, an injury, a tumor, a spondylitis, osteoporosis of vertebrae) and a nevertebrogenny tservikalgiya which can arise because of a miositis, a muscle strain and sheaves, a myofascial pain syndrome, fibromyalgia, neuralgia of an occipital nerve, besides, to have psychogenic genesis.
Also epidural abscess, meningitis, retropharyngeal abscess, subarachnoidal hemorrhage, thrombosis or stratification of a vertebral or carotid artery can be the cause of a nevertebrogenny tservikalgiya.
To establish the tservikalgiya reason, use a backbone X-ray analysis, computer or magnetic and resonant tomographies. Detection of symptoms of osteochondrosis at a X-ray analysis is not clinically important – it can be revealed at persons of mature or advanced age in the majority.
In general the forecast rather favorable, at treatment is in most cases reached a complete recovery.
Tservikalgiya reasons:
Are the reasons of a tservikalgiya:
overcooling
during sleep uncomfortable position of the head
long forced stay in the same situation, sedentary work
performance of physical exercises in gym or the exercise stresses leading to an overload of muscles in a cervical and collar zone
injuries of cervical department of a backbone as a result of accidents, an unsuccessful diving the head down
tumors or infections of tissues of backbone.
Tservikalgiya symptoms:
Neck pain can have the shooting, pricking, pulsing character. At the slightest movement, cough or physical tension pain becomes aggravated.
Generally patients address with the following complaints:
impossibility of turn or ducking aside, for a turn the patient is forced all case to turn or incline
nape pain
dizziness
numbness in a nape or in hands
sonitus, etc.
Existence of pain at turn of the head, and also long pains in a nape, a neck and shoulders can indicate existence of a chronic disease of a backbone in an initial stage. As a rule, in such cases it is about development of cervical osteochondrosis or a spondylosis. At these diseases vertebrae and intervertebral disks undergo degenerative and dystrophic changes which easily come to light by means of modern diagnostic methods.
Diagnosis:
First of all success of diagnosis depends carrying out the competent clinical analysis of pain and careful collecting the anamnesis.
It is necessary to pay special attention to the analysis of conditions under which pain for the first time arose. It can be a long anti-physiological pose, in particular that which is connected with professional activity (stomatologists, drivers, office workers), and also after a dream in an inconvenient pose, at unsuccessful turn, carrying weights, at local or general cooling.
Diagnosis of a tservikalgiya includes radiological survey of cervical department of a backbone (usual projections and with functional trials), MPT, KT. The panmiyelografiya and KT – a miyelografiya is in certain cases carried out. This research is important in postoperative diagnosis. Methods of functional diagnosis include EMG, an elektroneyrografiya, motor and somatosensory evoked potentials.
The cervical department represents very mobile part of a rachis. Therefore cervical vertebrae are most predisposed to degenerative changes which serve as the most frequent reason of a tservikalgiya.
Treatment of a tservikalgiya:
Treatment of a tservikalgiya can be conservative or surgical
Conservative treatment
First of all carry out conservative treatment:
Anesthetics, first of all non-steroidal anti-inflammatory drugs. The course of treatment drugs NPVS should not be long as sushchestvt risk of complications from a GIT.
Muscle relaxants.
At the expressed tension of juxtaspinal muscles injections of local anesthetics, for example, of Procainum (novocaine) are reasonable.
Perhaps temporary carrying a cervical collar within 1 – 3 weeks. Attention: individual selection of a collar as at too wide collar perhaps excess extension of a neck is necessary.
In certain cases for reduction of pains recommend traction treatment.
Remedial gymnastics: is of especially great importance. When determining intensity of loading it is necessary to consider sharpness of pain.
Physical therapy: local thermal procedures (mud baths, compresses), massage (begin only at reduction of pains), maintenance of a correct posture.
Use of a special orthopedic pillow.
Hiropraktichesky manipulations on cervical department of a backbone are not recommended as can lead to crushing ischemic defeat of a brainstem.
Surgical treatment
Serve as the indication to an immediate surgery: 1) acute or subacute damage of a spinal cord at the cervical level which is shown by pelvic disturbances, the central paresis dissociated by sensitivity disturbance; 2) increase of paresis in a zone of an innervation of a spinal root with threat of a necrosis of a root (at the same time reduction of pains despite weakness increase is characteristic).
Methods of operational treatment:
Diskektomiya with a ventral spondylodesis (on Cloward).
Back access with a laminectomy and a decompression of the vertebral channel throughout several segments.
Foraminotomy on purpose decompression of a spinal root.
Surgical treatment
Operational treatment is applied only as a last resort – in the presence of signs of damage of a spinal cord. At the expressed pain syndrome steady against conservative treatment, or weakness of the muscles innervated by the corresponding root indications to operation are regarded as relative.
Methods of surgical treatment:
The ventral diskektomiya isolated or in combination with an interkorporalny spondylodesis.
Dorsolateral foraminotomy and resection of a facet joint (it is shown, first of all, at lateral hernia of a disk).
Treatment of a tservikalgiya in our clinic is carried out by conservative methods. An important role is played by time of an initiation of treatment as at timely begun treatment secondary neurologic disturbances are not so significant. Treatment is carried out by reflex techniques, but if there is a need, then also medicamentous means are applied. The course of treatment usually consists of 10 – 15 sessions. The medical session can include such procedures as acupuncture, vacuum therapy, pharmapplikation, soft technicians of manual therapy.
