الفهرس 
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Abstract
Recent studies have elucidated which tissues within cervical
spine when irritated or inflamed are capable of eliciting pain.
Nerve fiber endings have been identified within the outer
annular layers of the intervertebral disc capable of transmitting
painful sensations. They are considered to be a neurologic basis of
diskogenic pain. The anterior longitudinal ligament is considered to
be the nociceptive site and is innervated by the sinu vertebral nerve.
The posterior longitudinal ligament is innervated by the recurrent
sinu vertebral nerve and is considered to be a site of noceception.
Irritation of the cervical nerve roots within the region of
intervertebral foraminae results in radicular pain. The dura is
innervated by the sinu vertebral nerve and considered to be the site
of pain. The zygapophyseal joints are innervated by somato
sympathetic fibers of the posterior primary division of the nerve
root and are defined as a source of pain. The neck muscles are also a .
site of nociperception.
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The causes of neck pain include cervical spondylosis,
subluxations of cervical spme (The Whiplash syndrome),
inflammation (rheumatoid arthritis), muscle disorder (muscle
hyperactivity), neoplastic conditions, infections and Pancoast
tumors.
Cervical spondylosis is the term used to describe degeneration
of the cervical spine. Primarily it is a process that involves the
intervertebral disc. It progresses with age and often develops at
multiple interspaces. The pathophysiolgy of cervical spondylosis is
multifactorial including anatomic, biomechanical and
electrophysiological factors .
Cervical spondylosis can be divided into three primary groups
of clinical manifestations. The first group of patients includes those
that have radicular complaints. The second group presents with
myelopathy secondary to cervical spondylosis. The third group
presents primarily with neck pain without a true radicular or
myelopathic component. Cervical spondylotic myelopathy is the
most senous consequency of cervical intervertebral disc
degeneration.
Imaging modalities play a major role in the diagnosis and
management of patients with cervical spondylotic myelopathy.
Electrodiagnostic studies play a limited role in the evaluation of
cervical spondylotic myelopathy.
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Clinical conditions that should be considered in the
differential diagnosis of cervical spondylosis are divided into two
major subheadings: intrinsic and extrinsic condition. Intrinsic
cervical conditions include, inflammation (Rheumatoid arthritis),
neoplastic conditions, infections, multiple hyperextension /
hyperflexion injuries of the cervical spine (whiplash syndrome),
Pancoast tumors and syringomyelia. Extrinsic conditions include
tendinitis in the shoulder (frozen shoulder), rotator cuff tendinitis,
brachial plexitis, compressive neuropathies (thoracic outlet
syndrome, median, nerve compression) and shoulder hand
syndrome.
Treatments of cervical spondylosis include non- surgical and
surgical treatments. The non- surgical treatments include
medication with non steroidal anti-inflammatory drags, physical
therapy (transcutaneous electrical nerve stimulation, ultrasound,
neuroprobe, aryl cervical traction) & cervical epidural steroid
injections. Chemonucleolysis IS extremely controversial and
certainly the experience in the lumber spine has been associated
with significant neurological risk.
Surgical treatments include the posterior. and anterior
approaches. The posterior approaches include hemilaminectomy and
foraminotomy for the management of cervical radiculopathy, and
Laminectomy with flavectomy and laminoplasty for the
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management of cervical myelopathy. The anterior approaches
include anterior diskectomy with or without bone graft. The
anterior approach to the surgical management of a central cervical
soft disc herniation has been shown to be superior to that of the
posterior laminectomy approach.
The Whiplash syndrome is considered to be an injury of soft
tissue from acceleration - deceleation, essentially a strain - sprain
type of injury. A wide variety of clinical problems occurring
following acceleration injury have been reported. These include
spinal symptoms, central nervous system symptoms and psychiatric
symptoms.
The spinal symptoms include diffuse neck pain with or without
radicular, radiation, cervical radiculopathy, cervical myelopathy and
symptoms of lumber pain syndromes including herniated nucleus
pulposus.
The central nervous system symptoms are those of cerebral
concussion, the Barre syndrome (sympathetic dysfunction), multiple
cranial nerve dysfunction & chronic headache.
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The psychiatric symptoms are mood and personality change,
sleep disturbance, psychoneurotic reaction, depression and litigation
neurosis.
In treatment, conservative measures of orthopedics and
neurosurgery are indicated, and include the use of cervical collars,
physical therapy modalities, and the use of anti - inflammatory,
and muscles relaxant. Surgery is reserved to the more severe and
intractable cases.