Let's get to know your neck better. What is the cervical spine?

Today we are going to talk about a very important part of our body, and one that causes a lot of trouble for many people from time to time. That is our neck, or as doctors call it , the cervical spine ( Cervical Spine (a region of the spine) . Perhaps you've also experienced a little pain, stiffness, or a tingling sensation in your neck, right? Even if you haven't, it's worth knowing exactly what this part of our body is that supports our head and carries important messages from the brain.

So what is this cervical spine?

Simply put, your cervical spine is the part of your spine in your neck. It's made up of seven pieces of bone stacked on top of each other. We call these pieces of bone vertebrae . They're like the floors of a building.

Of these seven vertebrae (C1 to C7), the first two are a bit special, both in shape and in the function they perform.

• First vertebra (C1) : This is also called Atlas . Just like Atlas in Greek mythology, who held up the world on his shoulders, this Atlas vertebra is the one that holds up your head. It is shaped like a ring, and it is your This is located right where the skull begins.
• Second vertebra (C2) : This is also called the axis . This is where the atlas (C1) vertebra rotates. When you turn your head from side to side and say "no," this is the axis that helps with that movement.

These seven vertebrae are connected at the back of the bones by a type of joint called the facet joints . These joints allow you to bend your neck forward, backward, and turn it from side to side.

There are many things around your cervical vertebrae, such as muscles, nerves, tendons, and ligaments. Between each vertebrae, like shock absorbers in a car, are parts called intervertebral disks . These are what absorb the shocks that come to your neck. The spinal cord runs down the middle of your entire spine . This spinal cord is what sends and receives messages from the brain to all parts of your body. This means that it is involved in controlling every action in your body.

What are the main functions of the cervical spine?

This part of the spine in our neck performs several very important functions.

• Protecting the spinal cord: The nerves in your spinal cord run through a large hole in the middle of each vertebra (called the vertebral foramen ). This way, they start at the base of your skull, go through your cervical vertebrae, your thoracic vertebrae (those in your middle back), and end between the first and second lumbar vertebrae (those in your lower back). The spinal cord is contained within a protective tube that is made up of all these vertebrae.
• Supporting the head and allowing movement: This is the vertebra that supports the weight of your head (usually about 10-13 pounds). It is the vertebrae . It is also the reason why you can bend your head and neck forward ( flexion ), backward ( extension ), turn it from side to side ( rotation ), or bend it to one side like your ear to your shoulder ( lateral flexion ).
• Providing a safe passage for the vertebral arteries: The vertebral arteries, which carry blood to your brain, pass through small holes in the vertebrae between C1 and C6 in the cervical spine. This is the only part of the entire spine that has holes in the bones for arteries to pass through in this way.

Think of it this cervical vertebra is like a main highway leading to the control room (the brain) of our body. It is very important to protect it.

What other muscles and soft tissues are in the neck?

There are many other important parts around the cervical vertebrae.

Major muscles associated with the cervical spine

• Sternocleidomastoid: This is a muscle on either side of your neck. It starts behind your ear and runs down the front of your neck, connecting to your breastbone ( sternum ) and collarbone. It helps you turn your head from side to side and lift your chin.
• Trapezius: These are two triangular muscles. They run from the base of your skull, down your cervical and thoracic spine, and attach to your shoulder blades. These muscles help you lift your head up/back, turn your head left and right, and elevate your shoulder blades.
• Levator scapulae: This muscle is attached to your first four cervical vertebrae and the top of your shoulder blade (scapula). It helps you lift your shoulder blade, tilt your head to the side, and rotate your head.
• Erector spinae: This is a group of muscles. In the cervical spine, these muscles help you maintain your posture , rotate your neck, and bend your neck backward.
• Deep cervical flexors: These muscles run down the front of the cervical spine. They help you bend your neck forward, and they also help keep the cervical spine stable.
• Suboccipital muscles: These are four pairs of muscles that connect the top of the cervical vertebrae to the base of the skull. They help you tilt your head back and rotate it.

Ligaments of the cervical vertebrae

The ligaments in the cervical spine are band-like structures that connect the bones together and help keep the cervical spine stable. There are three main ligaments:

• Anterior longitudinal ligament: This runs from the base of the skull down the front of the cervical vertebrae. It stretches to stop the neck from moving backward.
• Posterior longitudinal ligament: This starts at the C2 vertebra and runs down the back of the cervical vertebrae. It stretches to stop the neck from moving forward.
• Ligamentum flava: This ligament is located at the back of the opening inside each vertebra that houses the spinal cord. It covers and protects the spinal cord from behind.

Cervical Discs

Cervical discs are like "shock absorber cushions" between each vertebra. There are six discs between each of the seven vertebrae (one between two vertebrae). In addition to absorbing pressure and shock to your neck, these discs also help you bend and turn your head easily when you do any activity.

Cervical nerves

Eight pairs of nerves exit through small openings (foramen) between each vertebra in the cervical spine. They are labeled C1 through C8. These nerves stimulate muscle movement and provide sensation in your neck, shoulder, arm, and hand.

• C1, C2, C3 nerves: Control forward, backward, and side-to-side movements of your head and neck. The C2 nerve provides sensation to the top of the head; the C3 nerve provides sensation to the side of the face and back of the head.
• C4 nerve: Controls the upward movement of your shoulder. It is also one of the nerves that controls your diaphragm (the muscle under your chest that helps you breathe). The C4 nerve provides sensation to parts of your neck, shoulders, and upper arms.
• C5 nerve: Controls the deltoid and biceps muscles in your shoulders. The C5 nerve provides sensation from the top of your upper arm to the elbow.
• C6 nerve: Controls the extensor muscles of your wrist and is also involved in controlling the biceps muscle. The C6 nerve provides sensation to your forearm and the thumb side of your hand.
• C7 nerve: Controls your triceps muscles and the extensor muscles of your wrist. The C7 nerve provides sensation from the back of your hand to your middle finger.
• C8 nerve: Controls your hands, and provides sensation to the little finger side of the hand and forearm.

Spinal Cord

Your spinal cord is a bundle of nerve tissue that runs from the base of your brain down through your body. It is what carries messages between the muscles mentioned above and your brain.

What diseases and disorders affect the cervical spine?

Problems with the soft tissues and nerves in and around the cervical spine can lead to a variety of diseases and conditions. Some of these include:

• Cervical Radiculopathy: This is when a nerve in the neck is compressed by a cervical vertebra. You may experience numbness, loss of sensation, weakness, and pain. These symptoms may be limited to the neck, or they may spread to the entire arm, hand, or fingers. This is also called a "pinched nerve" or "cervical nerve compression."
• Neck Pain: Neck pain is a common symptom that can be caused by a variety of injuries and medical conditions. It can be caused by degenerative conditions (e.g., osteoarthritis , spinal stenosis , herniated disc , pinched nerve ), whiplash , stress, physical exertion, poor posture, tumors, cysts, bone spurs, meningitis , rheumatoid arthritis, and cancer.
• Cervical Degenerative Disk Disease: This is the degeneration of the discs in the cervical vertebrae.
• Herniated Disk: A tear or leak in the cushion-like discs between your vertebrae. These intervertebral discs are what allow you to bend and move easily.
• Cervical Osteophytes / Bone Spurs: These are bony growths that can develop on any of the seven vertebrae in the cervical spine.
• Cervical Spondylosis: Also called "neck arthritis," this is the gradual deterioration of the discs and joints in the cervical spine with age.
• Cervical Spinal Cord Injury: An injury to the cervical vertebrae. Most spinal cord injuries are caused by a sudden, severe blow to the vertebrae.
• Cervical Spinal Fracture: A fracture in the spine can be caused by compression (often from a minor accident in someone with osteoporosis) , a "burst fracture" (where the vertebrae are crushed in all directions), or a "fracture-dislocation" (often from a car accident or fall).
• Cervical Spondylotic Myelopathy: This is a condition in which there is pressure on the spinal cord in the cervical region. The main cause of this is the degeneration of the bones of the spine, which is osteoarthritis .
• Cervical Stenosis: This is a narrowing of the spinal canal in the cervical region. This reduces the space available for the spinal cord and the nerves that come out of it. When this space is reduced, the spinal cord or nerves can become compressed or pinched.
• Cervical Spinal Tumors and Cancer: Tumors are abnormal tissue growths that form inside the spinal canal. They can be non-cancerous (benign) or cancerous (malignant).
• Meningitis: Meningitis is an infection of the meninges, the protective covering that surrounds your brain and spinal cord.
• Osteomyelitis: This is a bacterial or fungal infection of the bones, in this case the vertebrae of the spine. If left untreated, the vertebrae can die.

How are cervical spine diseases and conditions diagnosed?

First, your doctor will ask about your medical history, the medications you are taking, ask about your symptoms, perform a physical exam, and then order tests and imaging studies .

Tests and imaging may include:

• Computed Tomography (CT) scan: This uses X-rays and a computer to take very thin "slice" pictures of the area being examined. A CT scan shows the shape, size, contents of your spinal canal, and the bones around it. It can help detect bone spurs, osteophytes, bone fusion, and bone destruction caused by infection or tumors.
• Magnetic Resonance Imaging (MRI): This test uses a large magnet, radio waves, and a computer to take detailed pictures of your spinal cord and the nerves that come out of your spine. This scan can reveal problems with your spinal cord and the nerves that come out of your spine, such as spinal degeneration, herniated discs, infections, and tumors.
• X-rays: X-rays use a small amount of radiation to take pictures of your bones and soft tissues. X-rays can show fractures, disc problems, spinal alignment problems, and arthritis.
• Electromyogram (EMG) and Nerve conduction studies: An EMG helps assess the health and function of nerves and muscles. A nerve conduction study measures how quickly an electrical impulse travels through a nerve. These tests can help identify nerve damage and areas of nerve compression.
• Myelogram: This imaging test shows the connections between your vertebrae and discs, your spinal cord, and the nerves that exit your spine. It can show if something, such as a tumor, bone spur, or herniated disc, is pressing on your spinal cord, nerves, or nerve roots, causing pain, numbness, or weakness.

How are cervical spine health problems treated?

There are both non-surgical and surgical treatment options for most conditions affecting the cervical spine. The treatment you choose will depend on the cause of your cervical spine problem and its severity.

What are the non-surgical treatment options for cervical spine conditions?

Your doctor may initially recommend less invasive methods for neck pain that is not caused by an accident or tumor. Some common non-surgical treatment options include:

• Rest.
• Ice or hot compress.
• A soft cervical collar. A collar helps to support and immobilize your neck.
• Avoiding physical activities that are strenuous or aggravate the disease.
• Physical therapy.
• Medications, such as muscle relaxants, pain relievers (e.g. , acetaminophen ), and anti-inflammatories (e.g. , ibuprofen and naproxen ).
• Steroid injections: Two types of steroid injections may be considered for specific neck and/or arm pain.
• Cervical epidural block: In this, the steroid is injected into the epidural space (the space outside the covering of your spinal cord).
• Cervical facet joint block: In this, the steroid is injected into the capsule (connective tissue covering) of the facet joint (the small joint at the top and bottom of each vertebra that connects the vertebrae for movement).
• Medical branch block and radiofrequency ablation: This procedure is considered for some cases of chronic neck pain. First, a local anesthetic is injected into the nerve that supplies the facet joint of the spine. If your pain decreases, the next step is to stabilize the pain. This is done by damaging your nerve with a technique called radiofrequency ablation . The pain relief lasts for months. If your nerve regenerates, the pain may return.

How do I know if I am suitable for cervical spine surgery?

You may be a candidate for cervical spine surgery if:

• If other treatments don't help.
• If your symptoms related to your spine, arms and/or legs get worse.
• If you are healthy enough to have surgery.

What are the surgical options for cervical spine conditions?

There are several commonly performed surgical procedures:

Cervical Spinal Decompression Surgery

This is a general term for a variety of procedures used to relieve symptoms caused by pressure or compression on your spinal cord or nerve roots. A nerve root is the first part of a nerve that exits your spinal cord through the small openings between the vertebrae. Common surgical techniques used to relieve pressure include:

• Cervical Diskectomy: In this, your surgeon removes part of a disk to relieve pressure on nearby nerve roots.
• Cervical Laminotomy or Laminectomy: In these procedures, your surgeon removes a small section of the bony arches of the spinal canal, called the lamina . In a laminotomy, only a small portion of the lamina is removed. In a laminectomy, the entire lamina is removed, along with any bone spurs, disc fragments, and thickened ligaments, if necessary. Removing the lamina increases the size of the spinal canal, which reduces pressure.
• Cervical Foraminotomy or Foraminectomy: Both of these procedures involve removing some of the bone in the area where the nerve roots exit your spinal cord and making it larger. In a foraminectomy, a larger amount of bone is removed.
• Cervical Corpectomy: In this surgery, your surgeon removes the vertebral body (the large front part of the vertebra) and the disc to relieve pressure on the spinal cord. In some cases, they then perform a fusion of the vertebrae (the permanent joining of two or more vertebrae) to stabilize your cervical spine.

Cervical Disk Replacement Surgery

In this, a diseased cervical disc is removed and replaced with an artificial disc. The main reason for this is cervical disc degeneration.

Cervical Spinal Fusion

This is a surgical procedure that permanently fuses one or more cervical vertebrae. This surgery eliminates movement between the vertebrae.

Functional Electrical Stimulation for Spinal Cord Injury

This procedure uses small electrical impulses to activate specific muscles and nerves, restoring function to the muscles of your upper body controlled by the cervical nerves.

Is it possible to perform minimally invasive cervical spine surgery?

Talk to your surgeon. In many cases, minimally invasive spine surgery is an option. Instead of making one large incision in the skin like traditional open surgery, minimally invasive surgery is done through one or more small incisions. Because the procedure is done through small incisions, there is less damage to the muscles and soft tissues than with one large incision.

Take-Home Message

Your cervical vertebrae are the neck region of your spine. They are made up of your first seven vertebrae (C1-C7). Other structures within or around your cervical vertebrae include the intervertebral discs, the spinal cord and nerves, muscles, tendons, and ligaments. Your cervical vertebrae support the weight of your head and allow it to move through a wide range of motion. They are also protected by a round bony shell that surrounds your spinal cord.

Many diseases and disorders can affect your cervical spine. But the good news is that there are many non-surgical and surgical options to treat these conditions. If you are experiencing any discomfort related to your neck, it is best to see a doctor for advice.

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