Our guest author today is Orthopaedic & Spine Center’s Managing Partner, Dr Jeffrey R. Carlson, MD. Dr Carlson is a Harvard trained spine surgeon and in addition to his duties with OSC, he is also Chief of Surgery at Bon Secours Mary Immaculate Hospital in Newport News, VA.
As an Orthopaedic Specialist, I treat people with Arthritis every day. However, Arthritis in the neck has some very unique properties. There are 2 specific places in the neck that have cartilage which can degenerate with arthritis. One of those places is in the small joints in the back of the neck called “facet joints”. These small joints act as stabilizers in the spine when the bones move. They control the movement of the neck, so that the bones do not come apart. The facet joint is made of 2 bones which are covered in cartilage. The cartilage allows the bones to move smoothly and without pain. When arthritis begins to affect the surface of the cartilage, the once smooth motion becomes rough and painful. This pain will cause the patient to want to limit the motion in the neck. The second place that arthritis of the neck can be a problem is in the spinal discs. These discs are composed of cartilage, provide the separation between the vertebral bones and allow some cushioning between the spine bones or vertebrae. As these discs wear out, the “cushion” is degraded and the motion in the neck can become painful. The discs are also closely associated with the nerves. As the disc loses its height, a bulge of the disc may develop. This bulge can pinch the nerves that affect the arms or the press on the spinal cord that can affect the nerves to the rest of the body, causing pain, weakness or numbness.
Specific compression of the spinal cord is called myelopathy. The spinal cord is the extension of the nerves from the brain to the rest of the body. These nerves are very sensitive when they are still part of the spinal cord as in the neck and upper back. This compression is not found in the lower back when disc herniations occur because the spinal cord does not extend all the way through the length of the spine. Because the spinal cord carries all of these more central nerves, compression of the spinal cord can lead to global difficulties. There may be difficulty with fastening buttons, handwriting and ultimately walking. Some extreme pressure on the spine cord can lead to paralysis.
Spinal cord compression in the cervical spine can have significant implications on a patient’s function. This has been shown in many studies, that spinal cord compression will continue to cause difficulties until the compression is relieved. Unfortunately, surgery is the only way to relieve this pressure. In general , patients and surgeons try to use surgery as the last resort, but with compression on the spinal cord the best treatment is surgery.
A recent study looked at the outcomes of surgical intervention in patients with spinal cord compression. The CSM-North America trial looked at the surgical treatment in patients with spinal cord compression from arthritis. It has shown that patients with spinal cord compression are best-treated early in the disease process. Those patients that had difficulty walking from long-standing disease were less likely to get better. Those patients that were older and were smokers also had less improvement in their symptoms. The best treatment is surgery to remove the pressure on the spinal cord before permanent damage is done. Surgery will also prevent worsening of the disease which will protect patients from having spinal cord injury later. Spinal cord injury related to arthritic compression may not be reversible, but without surgery there is no chance for it to improve, so it is best to remove the pressure from the nerve roots and spinal cord to allow them the optimal environment to heal.
Dr. Jeffrey R. Carlson is a Harvard Orthopaedic/Neurosurgical Spine Fellow and is Chief-of-Surgery at Bon Secours Mary Immaculate Hospital in Newport News, VA. He is the Managing Partner of Orthopaedic and Spine Center in Newport News, VA. For more information or for an appointment, contact OSC at 757-596-1900 or go to www.osc-ortho.com.