Q: For a couple of years I have suffered from an arthritic neck, which is now so bad I struggle to turn my head and am in constant pain.
My doctor sent me to a physiotherapist, who tried giving me traction, but I was in so much pain afterwards I was unable to get out of bed for a week.I paid to have an MRI scan, which revealed that a bony spur, a growth of bone, is pressing on the right side of my head. Would you help me please? – Victoria Sharpe Westgate, Kent.
A: The type of pain you are experiencing is, as you are fully aware, grim. This is because it is caused by pressure on a nerve, which is rarely eased by painkillers. However, do not despair, as it is likely that you can be relieved of this.
I congratulate you on taking the initiative and having an MRI scan (though it saddens me that you were forced to pay for this privately), as this showed what precisely is causing your pain.
You have a diagnosis, and the next stage is to decide what can be done and whether it is likely to be effective, safe and free from complications.
As I often say to patients, the human neck is one of nature’s more troubled pieces of design. For though our neck gives us the flexibility to look around us and use our eyes and ears to best purpose, this comes at a price.
The problem is that the delicate structure of the neck, which is made up of the top seven bones, or vertebrae, of the spine, has to carry the 8kg weight of the head, which makes it prone to damage. The areas often affected are the tiny joints between the bones of the neck, called facet joints.
These enable the neck to move freely when we move our head up and down or turn from side to side, but they wear out as the years go by – hence your diagnosis of arthritis of the neck.
There may also be thinning or even rupture of the shock-absorbing discs between the vertebrae, commonly known as a slipped disc, which complicates the picture.
What has happened in your case is that your body has tried to repair this wear and tear on the facet joints by starting to produce new bone at the site of the damage, resulting in the formation of small outgrowths called osteophytes.
However, instead of fixing the problem, this repair simply makes it worse. Each facet joint has windows through which the nerves of the spine leave the spinal cord and travel to the head and neck.
The new bone formation blocks these windows, narrowing the space for the nerves to travel through.
In your case, an osteophyte, described by the radiologist interpreting your MRI as a bony spur, is pressing on a nerve and causing your severe pain.
The solution to this is an operation to remove this spur: your age of 72 and the fact you also have diabetes should not exclude this possibility. No amount of physical therapies will help – in fact, they will only flare up the symptoms, as you have found.
You must speak to your doctor about referral to a spinal unit. A spinal surgeon, or a neurosurgeon with an interest in the neck, will, on the basis of the story, the physical examination, and the MRI images be able to reach a decision about what is possible.
The surgery is skilled and delicate, but not dangerous. It would be carried out under general anaesthetic and you would need two or three nights in hospital – but would wake pain-free.
I have three sons in their mid-40s, and all have different doctors.
