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Spinal Cord Disorders Message Board

Spinal Cord Disorders Board Index

Hi Heather....let's start with an anatomy's the best way for you to understand what is going on in your neck. If you know this stuff already, please forgive me but others may learn from it.

Your spinal cord descends out of the base of the brain and into the spinal canal. The spinal canal is inside the vertebrae of the spine at the back of the bone.The much maligned disks are in the front of the vertebrae and in between them as well. That is why they list the areas as 2 vertebrae with their disk in between as that is where the most problems lie.

So the first vertebra is C1 and it's a simple circle with a hole in the middle and no disk below it. It gives you the rotation of your head. C2 is a regular vertebra with a bone sticking up on top that C1 sits on. So at C2, nerves peel off the sides of the spinal cord and go out to the body. They serve the back/sides/top of the scalp and wraps around the neck. It MAY have a branch that serves the lower sides of the face and overlaps with the facial nerves that come directly from the brain. There is a disk between C2 and C3. At C3, another pair of nerves peels off and goes out to the body and serves the back of the neck and wraps around to the collar bone area. C4 has nerves that go to the shoulder area. C5 serves the upper part of the outer arm. C6 serves the lower arm on the outside down to the thumb and index finger. C7 shows up on the skin only at the middle finger. And C8...the nerve that comes out between C7 and T1 serves the ring and little fingers.

So as you look at the spine from the back, if cut in half, you'd see all these vertebrae. At the front is the disk and behind it is the open canal for the spinal cord. The canal holds the cord and the cord is covered with a lining that holds spinal fluid in around it. They call this lining, the thecal sac. And at each vertebra, a pair of nerves peels off the cord and goes out from the thecal sac and then out through holes on either side of the bone called the neural foramina. Most of our pain comes from bone spurs or bits of herniated disks that hit these exiting nerves. When something hits the cord, it really doesn't hurt as like the brain, the spinal cord itself has no nerve endings but it can cause problems below, in your legs. Yes, you can have numb toes from a problem in your neck...the pressure on the cord transfers inward to affect the inner most nerves that serve the lower part of the body.

If you look a the spine from the side, it has multiple curves. At the neck, the spine curves inward toward the throat, known as lordosis, the curves outward at the chest, called kyphosis, then back in again at the waist, called lordosis again and then it actually curves back out at the sacral area for the final kyphotic curve. As we age, we naturally start to lose the normal lordotic curves in both the neck and the lumbar regions. Injury, arthritis and congenital problems can all make it happen faster. When the curve in your neck goes the opposite way(kyphosis), you end up not being able to lift your head.

So that is basic anatomy. Terminology.....spondylosis is a fancy word for arthritis of the spine. Osteophytes are bone spurs caused by arthritis. Stenosis is a fancy word for "closing up" whether it be the spinal canal or a heart valve. Physiatrist...a doctor who specializes in physical rehabilitation.

So here is what your docs have found: C1 and 2...fine. C2 is slightly(3mms) forward where it sits on C3. Inside of C3-4, there is severe impingement of the nerves that leave the cord to the body.....according to spine clinic but not reported elsewhere. As noted above, this would cause pain at the back of your neck and wrap around to the collarbones. Probably what is causing the muscle spasms in your neck and the vast majority of your problems. have that congenital fusion which means you may have been born with this or it happened on it's own during your lifetime. At C6-7 the same thing is are fusing naturally. Natural fusions happen when bone spurs from arthritis build up and form solid bone connecting across the bones surfaces.

You have a narrowed spinal canal with these natural/congenital fusions as it builds bone and not always where we want it to. It shows that bone spurs and some disk material have pushed up against the thecal sac and as a result, filled up the spinal canal. HOWEVER, and this is a big one, you can have your spinal cord compressed down to half thickness before it causes problems or needs to be fixed. You only have stuff touching the sac and possibly the cord was flat as a pancake(instead of oval) and compressed to the point where you couldn't see any spinal fluid around it. A normal spinal cord in women is 10-12mms and I was crushed down to 5-6mms. So you have a way to go before it needs fixing. I suspect the doc made a big deal about it as it was something he could show off and so he did. You should see my MRI.

He also made a big thing about the loss of lordotic curve and that is something that happens naturally but in your case, was sped up by that natural fusion. And since they are already fused naturally, it can't be fixed. But the good news is, it won't get any worse and shouldn't really cause that much pain unless you spend a lot of time looking up at the sky.

So the bottom line is that your neck is not that bad with the exception of the closed up foramina at C3-4 that is pressing on the nerves to your neck muscles. This produces severe spasms and the more you try not to move your neck to avoid the spasms, the worse they actually get. After a while, the muscles freeze in place.....what I suspect has happened to you.

Which of your symptoms does this explain? The headaches which can trigger migraines. Loss of neck mobility and spasms. And that is about it.

Surgery to fuse C3-4 and remove the disk and bone spurs would probably help a lot but then you are looking at man-made and congenital fusions from C3 to C7 and you'd lose a lot of head movement but you've lost that from the spasms anyhow. But I would see the physiatrist first. I see one and she is great. Has me doing all sorts of physical therapy to keep my muscles loose so I don't spasm like you do. And I take the same muscle relaxer that the doc suggested...Soma.....quite strong. I doubt they'll do surgery until you get the muscles moving. Home traction units can be very helpful to relieve the pressure on your nerves as well and should give pain relief as well.

As for all the other symptoms, I suspect your GP needs to keep looking. Have they done a brain MRI or MRA?

One of the secrets I use for pain relief is therapy....not physical therapy but the emotional type. Chronic pain can drive you to suicide. I don't know of anyone who doesn't battle depression and anxiety from chronic pain. Psychotherapists who specialize in treating chronic pain can teach you a lot of ways to deal with it and it has paid off tremendously for me. I cannot suggest a better thing to do for yourself.

So now that I've done my usual anatomy class and terminology class and looked at your records, I hope this doesn't upset you. Your neck is really not bad but you have a big problem in one spot that no one is addressing very well. If you could read some of the MRIs we have here!

Anyhow, I'm here for questions and I bet you have a ton of them.

hugs.......Jenny(fused C3 to T1)

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