Back Pain Neurosurgeon
Dr W Adriaan Liebenberg
FC Neurosurgery (SA)
MMed Neurochirurgie (Stellenbosch)
MB. ChB (Stellenbosch)
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neck pain
Spinal Conditions and treatments
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Neck Pain

Neck pain is a very common complaint among people of all age groups. It is, however, more commonplace among people in their thirties and onwards. Neck pain is mainly due to degenerative or wear and tear changes in the spine and is most often part of a progressive disease. It means that the underlying problem responsible for neck pain will slowly but surely get worse in time.

It is therefore of paramount importance that treatment focuses on supporting the structures of the neck and to prevent excessive stress on the spine.

There are three types of neck pain: mechanical neck pain, referred pain and radicular pain

Mechanical neck pain

This is pain that is caused, as the name suggests, by the mechanics of movement. There are muscles, tendons, vertebrae, discs and joints between the vertebrae, nerves and other structures that can cause pain. Mechanical pain is based on inflammation of these structures and the aggravation of this inflammation by movement.

The main source of mechanical neck pain is, however, the joints between the vertebrae called the facet joints. This pain is typically increased by certain movements. Turning and bending the neck is uncomfortable and frequently associated with crunching sounds and a feeling of stiffness. It is often worse on the one side. It is frequently associated with referred pain.

There are a great number of people suffering from mechanical neck pain who have associated headaches. This is most frequently caused by inflamed joints which in turn cause the muscles of the neck to go into spasm. These muscles are attached to the head and cause headaches by pulling on the head. This is the same way that stress headaches are caused. There are other causes of mechanical neck pain as well. The treatment of mechanical neck pain focuses mainly on treatment of the facet joints and the inflammation located in these joints as well as the effects of that inflammation, such as muscle spasm.

Medical treatment would include the use of anti-inflammatory medication, pain medication and muscle relaxants. Manual treatment would include pressure point therapy, massage therapy, physiotherapy and chiropractic therapy. Non-surgical management would include radiofrequency rhizotomies, local blocks and facet blocks. Mechanical neck pain that is associated with spinal instability may be treated by performing a  posterior neck fusion.




This image demonstrates the dermatomes.

Radicular pain is due to nerve compression. Dermatomes are skin maps that indicate which area of the skin is being supplied with sensation by a specific spinal nerve. This will allow your specialist to have a reasonable suspicion about which nerve is being compressed if you have radicular pain. The fifth cervical nerve root (leaving the spinal canal between the fourth and fifth cervical vertebrae), for instance, is called C5 and extends from the shoulder to the wrist on the inside of the arm, as demonstrated in the diagram. When there is compression of this nerve root, you will experience pain over the area supplied by that nerve.

Referred pain is not due to nerve compression and is a more vague and non-specific pain which spreads to the head, shoulders, between the shoulder blades and even behind the eyes.


Referred pain

This is pain that spreads from the inflamed tissue in the neck along nerves to other parts of the body. This would frequently be the head, shoulders, between the shoulder blades and even behind the eyes. This is directly associated with mechanical neck pain. It should not be confused with radicular pain.

Referred pain is a frequent cause of headaches. The nerves that supply the skin of the head come directly from the neck and pain can spread along these nerves. The treatment for referred pain is the same as for mechanical neck pain, since the cause is the same in both cases and based on inflammation of tissue.

Radicular pain

This is pain that is caused by a pinched nerve and the pain will travel down the length of the nerve and be most severe at the distal point of the nerve, but can manifest at any point along the length of the nerve.

When the nerve, for instance, between the fifth neck vertebra and the sixth neck vertebra is being pinched, the pain will be experienced at the thumb and index finger as this is where the nerve ends up. Both the physical compression of the nerve root and the inflammatory changes in and around the nerve root are responsible for the pain.
A pinched nerve may require surgery. Although surgery is very effective in loosening nerves that are being pinched and fixing unstable areas of the spine, it almost always leads to increased stress on the spine and is believed to speed up the wear and tear of the spine.

The main aim of treating spinal pain should always be to support the normal biological recovery processes of the body. Surgery is always the last option and the aim of surgery would be to relieve the symptoms and to maintain the normal biomechanical stability of the spine.


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