Congenital Malformations And Neck Pain

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[edit] Congenital Malformations And Neck Pain

Apart from trauma there can be congenital abnormalities of the cervical spine. The lower end of the cervical spine may have some cervical ribs in the lowest two levels (C6 and C7 levels). This in turn can put pressure onto the brachial plexus injury, which can mimic a herniated disc in the neck. However, the real diagnosis in such a congenital cervical rib case with nerve root irritation is thoracic outlet syndrome. There are other malformations such as spondylolisthesis, where one vertebral body is overriding the one of the next level due to a malformation of a bony part, called "pars interarticularis". Most of these malformations are harmless and need observation only. A minority of these cases in turn will need surgical attention after a careful work-up by a neurosurgeon. The type of cases that need to be investigated further are the ones where the patient experiences pain that is radiating into an arm (this is called cervicala radiculopathy).

Most of the neck pains can be managed by the patient at home. Remobilisation with physiotherapy, acupuncture treatment, chiropractic treatment (manipulation) and professional massage (Ref.2) helps as well.

The physician likely will recommend one modality over another depending on what the preferences of the patient are and depending on what the clinical presentation is. For instance, if it appears that there is a locking of one of the facet joints along the back of the cervical spine, a gentle manipulation by an experienced chiropractor might give the quickest response. However, if there is a lot of muscle spasm, physiotherapy, massage therapy or acupuncture might be more beneficial.

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References:

1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 2.

2. D Irnich et al. BMJ 2001 Jun 30;322(7302):1574.

3. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 140.

4. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders

5. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

6. Rakel: Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier