Neck Pain 

Most patients who present with neck pain have "non-specific (simple) neck pain," where symptoms have a postural or mechanical basis. Aetiological factors are poorly understood and are usually multifactorial, including poor posture, anxiety, depression, neck strain, and sporting or occupational activities. Neck pain after whiplash injury also fits into this category, provided no bony injury or neurological deficit is present. When mechanical factors are prominent, the condition is often referred to as "cervical spondylosis," although the term is often applied to all non-specific neck pain. Mechanical and degenerative factors are more likely to be present in chronic neck pain.

In cervical spondylosis, degenerative changes start in the intervertebral discs with osteophyte formation and involvement of adjacent soft tissue structures. Many people over 30 show similar abnormalities on plain radiographs of the cervical spine, however, so the boundary between normal ageing and disease is difficult to define. Even severe degenerative changes are often asymptomatic, but can lead to neck pain, stiffness, or neurological complications.

Summary points

The diagnosis of cervical spondylosis is usually based on clinical symptoms

Patients need detailed neurological assessment of upper and lower limbs as cervical degeneration is often asymptomatic, but can lead to pain, myelopathy, or radiculopathy

"Red flag" symptoms identify the small number of patients who need magnetic resonance imaging, blood tests, and other investigations

The best treatments are exercise, manipulation, and mobilisation, or combinations thereof

Radiculopathy has a good prognosis and may respond to conservative measures

Results of neck surgery for myelopathy or intractable pain are often disappointing

 

Who gets neck pain?

About two thirds of the population have neck pain at some time in their lives, and prevalence is highest in middle age. In a general practice survey of adults in the United Kingdom, 25% of women and 20% of men reported current neck pain. In a Norwegian survey of 10 000 adults, 34% of responders had experienced neck pain in the previous year. is the most frequent musculoskeletal cause of consultation in primary care worldwide. In the UK about 15% of hospital based physiotherapy and in Canada 30% of chiropractic referrals are for neck pain. mostly based on questionnaire or population surveys and may overestimate the frequency of the condition. Despite these methodological difficulties, they do provide evidence that neck pain places a heavy burden on individuals, employers, and healthcare services. After back pain, neck pain Epidemiological studies of neck pain are

 

What is the natural history of neck pain?

The outcome of neck pain depends on the underlying cause, but acute neck pain usually resolves within days or weeks, although it can recur or become chronic (more than three months' duration). A UK survey of 7669 adults found that 18% had neck pain at the time of the survey, and half of those (58% of the symptomatic patients responded) still had pain when asked one year later. Outcome is unpredictable once pain becomes chronic, and prognosis and the factors that influence it vary greatly. Reports on the importance of factors like age, sex, occupation, psychological factors, and radiological findings are conflicting, but the quality of most studies is poor. Three recent studies (1535 patients) found that the best predictors of an unfavourable outcome one year after presentation with neck pain were severity of the initial pain and concomitant back pain. At least 10% of affected people develop chronic neck pain, although this figure is much higher in some studies. In some industries, neck related disorders account for as much time off work as low back pain. Neck pain causes severe disability in 5% of affected people.

 

How is cervical spondylosis diagnosed?

Cervical spondylosis is usually diagnosed on clinical grounds alone. Although pain is predominantly in the cervical region, it can be referred to a wide area, and is characteristically exacerbated by neck movement. Neurological change should always be sought in the upper and lower limbs, but objective changes occur only when spondylosis is complicated by myelopathy or radiculopathy, or when unrelated causes like disc prolapse, thoracic outlet obstruction, brachial plexus disease, malignancy, or primary neurological disease are present.