CERVICAL INSTABILITY

Cervical Instability

Instability in the Neck and Cervical Nerve Compression

Cervical Instability as a result of displacement of the cervical vertebrae or spondylolisthesis is usually a result of traumatic injury or the gradual development of small fractures within the vertebrae. Vertebral slippage is much more common in the lumbar (lower back) region of the spine, than in the cervical (neck) region. However, fractures to the pars interarticularis (a bony segment adjacent to vertebral joints) can cause one vertebra to slip out of place on top of another, which can produce symptoms that include neck stiffness, focal pain, and – in cases of spinal nerve compression – radiating pain, tingling, numbness, and muscle weakness in the upper body.

How Spinal Instability in the Neck Can Affect the Central Nervous System

The central nervous system (CNS) consists of the brain, the spinal cord, and nerve roots that exit the spinal cord in pairs along the length of the spine. The spinal cord and nerve roots are conduits for motor and sensory messages that travel between the body’s extremities and the brain. If a cervical vertebrae slips out of place, the nerve roots located in the neck region can become vulnerable to compression.

Although there are seven cervical vertebrae, there are eight pairs of cervical nerve roots, denoted C1-C8. Each set of cervical nerves is responsible for transmitting a range of signals that trigger voluntary and involuntary responses in the body. Here are the functions associated with each of the eight sets of cervical nerves:

• C1 – breathing, blood supply to the head

• C2 – breathing, head and neck movement, eyesight

• C3 – breathing, facial movement

• C4 – breathing, heart rate, facial movement

• C5 – heart rate, wrist and elbow movement

• C6 – heart rate, neck and shoulder movement

• C7 – arm, hand and finger movement

• C8 – arm, elbow, hand and finger movement

Compression of any of these nerves caused by spondylolisthesis in the neck can interfere with the body’s ability to carry out the respective function. In most cases, cervical nerve compression symptoms can be managed using a regimen of conservative, nonsurgical treatment methods such as exercise, stretching, behavior modification, and others. Surgery usually becomes an option only if conservative treatment proves ineffective after several weeks or months.

How Can I Avoid Spinal Instability Surgery?

Spinal Instability (Fusion) surgery typically is not necessary for about 80 percent of people who suffer from painful vertebral slippage. In most cases, pain, stiffness, and other symptoms associated with spondylolisthesis can be managed conservatively. Noninvasive treatment methods can include pain medication, strengthening and stretching exercises, behavior modification, back bracing, and others. The type of treatment prescribed will depend on the severity of the slippage, the patient’s overall health, and other factors.

Is Spinal Instability Preventable?

Spinal Instability or vertebral slippage can be caused by age-related anatomical deterioration, by a congenital condition, or by small stress fractures in the vertebrae. It’s a common cause of back pain among teens, often related to a pre-teen growth spurt or sports injury. These conditions may not be preventable, per se, but associated symptoms usually are manageable with conservative treatment methods.

Sometimes no amount of conservative treatment, regardless of what combination is used, is enough to provide relief or spinal stability. In about 20 percent of cases, spondylolisthesis surgery may become necessary. But what sets those who don’t require surgery apart from those who do? A number of steps can be taken to try to mitigate the symptoms, including:

• Maintaining strong back and abdominal muscles to help support and stabilize the lower back.

• Avoiding contact sports like football and hockey, focusing instead on low-impact sports such as swimming and bicycling.

• Maintaining a healthy body weight to reduce excess stress on the lower back.

• Keeping bones and other tissues healthy by maintaining a well-balanced diet.

What If I Can’t Avoid Stabilization Surgery?

Surgery may become necessary if the vertebral displacement is a Grade III (50 percent slippage) or worse, especially if adjacent neural structures become compressed and radiculopathic symptoms of pain, tingling, numbness, and muscle weakness become chronic and debilitating. The two main procedures used to correct spondylolisthesis are the laminectomy (removal of a portion of bone pressing on nerves), and spinal fusion. Although these highly invasive procedures carry their own risks and potential side effects, adequate symptom relief and spinal stability are achieved through surgery about 85 percent of the time.

Patience and Common Sense are Key

If you are an avid golfer, hiker, bicyclist, or jogger, or if you lead an otherwise active lifestyle, chances are your doctor will ask you to curtail your physical activity during the initial stages of spondylolisthesis treatment. The one thing you’ll want to avoid as you recover from painful symptoms associated with vertebral slippage is exacerbating your condition. That might mean leaving the golf clubs in the closet for a while, or foregoing that routine morning hike for a few weeks. Rest is necessary to combat any swelling, along with nonsteroidal anti-inflammatory drugs (NSAIDs), hot or cold applications, and other conservative methods of treatment. Once your symptoms have stabilized, your doctor might suggest a gradual increase in your physical activity, starting with low-impact exercise such as walking or swimming. The important thing is to remain patient and use common sense as you gradually regain mobility.

Will I Ever Be Symptom-Free?

No two cases are alike, and no two patients respond in exactly the same way to spondylolisthesis treatment. Some patients find temporary relief with epidural steroid injections, which can reduce swelling around the compressed nerve, which in turn can decrease pain for weeks or months. Others require surgery to relieve any associated nerve compression and to regain stability within the affected vertebral segment. Talk to your doctor about a common-sense approach to working through symptoms associated with vertebral slippage. It also may help to set treatment goals related to your favorite physical activity, and adjust those goals accordingly as you become more familiar with the physical limitations associated with spondylolisthesis.

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