AP X-ray of severe degenerative facet disease that leads to instability. The white arrows point to the worn facets.
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Lateral X-Ray of the neck with a forward bend (flexion). Note the vertebra slipping forward. The black arrows point to the forward slide and forward angulation of the vertebra.
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Lateral X-ray of backwards bending of the neck (extension). The same vertebra have some correction of their slip and angulation.
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Painful excessive motion of the vertebral bodies within the cervical spine in relation to one another is considered cervical spine instability. Instability in this region will make a patient feel as if the neck and upper spine are moving at a greater movement than what the bone, muscle and ligament can hold. The feeling is that a patient must be careful with head motion or a sharp pain and “catch” will occur. The motion must be reproducible with the same motion at most times to be considered instability. That is, if it occurs only one a week, it would not be considered unstable but if it occurs 5-8 times a day, instability would be considered as a diagnosis.
The cause of cervical spine instability is normally the result of the degenerative process (such as wear and tear or arthritis), as well as a previous injury or congenital condition. The entire motion unit (both disc and facet) must wear in a manner that the normal restraining structures become deficient. The resultant instability causes the patient to forego activities that would put their neck at risk.
Symptoms
Symptoms of cervical spine instability within the cervical spine include sharp neck pain with motion or position, upper back pain, and an acute, on-going unstable sensation within the region. Muscle spasms are also a common occurrence for patients experiencing instability as the muscles work overtime to try and prevent the painful motion.
Treatment
Non-surgical
Non-surgical treatments are typically enough to restrain the symptoms of cervical spine instability. Non-steroidal, anti-inflammatory medication along with physical therapy and prescribed exercises typically work well. Ergonomics are important to prevent putting the neck in a position of instability (typically a flexion and twisting motion). Adjusting the stem height on a bicycle seat and adjusting the golf swing are good examples. Chiropractic manipulation is not recommended as these segments move too much and manipulation would increase the motion.
Surgical
If these non-surgical remedies do not work, then a surgery involving stabilization and fusion will most likely be the next course of treatment. This would be an ACDF of the involved unstable segment.
For more information on cervical spine instability or other related neck and back conditions, please contact Dr. Donald Corenman, MD at 970-479-5895.
