Whiplash injury, contusion of the neck and back of the head, cervicocranial syndrome

Editor - Harutyunyan Mariam Harutyunovna

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Last updated date: 11/16/2021

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Up to 72% of the working-age population experience neck pain - cervicalgia - at least once a year, and in 1.7-11.5% this problem becomes a cause of disability1.

With age, the number of people experiencing discomfort in the neck area increases; women are more likely to experience this symptom2.

In most cases, cervicalgia is not associated with serious illnesses and, with proper treatment, ends in complete recovery. However, in 10% of cases, neck pain becomes chronic and requires long-term therapy2.

The information presented in this article is strictly for informational purposes only. Keep in mind that if you have a very sore neck, you should under no circumstances engage in self-diagnosis or self-medication. If signs of illness appear, you should consult a doctor.

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Classification of subaxial injuries of the cervical spine

Clinical classification of subaxial ( C3 - C7 vertebrae) injuries of the cervical spine includes the following types of injuries:

• compression fracture,
• burst fracture,
• flexion-distraction injury of the neck,
• dislocation of the articular processes (unilateral or bilateral),
• fracture of the articular processes.

There is also a classification by Allen and Ferguson for injuries of the cervical spine, which is used in specialized literature and in scientific research. This classification of subaxial ( C3 - C7 vertebrae) injuries of the cervical spine is based on radiographic data and the mechanism of injury:

• flexion-compression,
• vertical compression,
• flexion-distraction: subluxation of the articular process,
• unilateral dislocation of the articular processes,
• bilateral dislocation of the articular processes with 50% displacement,
• complete dislocation (100% displacement),

Vertebroneurological manifestations of whiplash injury

A. N. Belova

The diagnosis “cervical osteochondrosis” is widely used by general practitioners to designate a wide variety of pain syndromes in the neck and shoulder girdle, which etiologically have nothing to do with degenerative processes in the spine. Situations where the diagnosis of “osteochondrosis” is misleading also include cases of traumatic damage to neck structures [9].

The objective of this work was to present information about a very common type of injury, but not well known to clinicians—whiplash injury (whiplash) of the neck. Its vertebroneurological manifestations, in particular post-whiplash syndrome, are often interpreted by doctors as “exacerbation of cervical osteochondrosis,” while they are based on a qualitatively different process.

The term “whiplash injury” (from the English whip - whip, whip) is widespread in foreign literature, while it is rarely used by domestic specialists. The term was introduced by the American physician H. Crowe in 1928, and since then interest in such injury has steadily increased. Information about chemotherapy appeared in the Russian-language medical literature relatively recently [2].

CT indicates a neck injury due to its forced hyperextension followed by sharp flexion or, conversely, sharp flexion followed by extension [23]. Most often, such an injury occurs during car accidents, when another vehicle “crashes” into a standing car from behind, or when the car is heavily braked. In people sitting in a car, a sharp two-stage (whiplash) movement of the neck occurs, which is the cause of the corresponding injuries [22, 34]. When hitting a car from behind, the head of the person sitting in it first, by inertia, makes a sharp backward extension movement, and then a forced flexion. When a car suddenly brakes, movements in the neck occur in the reverse order (first - sharp flexion, then - extension). But in both cases, the damage to the neck structures is similar. In frontal or side collisions of vehicles, HT occurs less frequently. Such injury is also possible in divers and in some other accidents [7].

The prevalence of chemotherapy is directly proportional to the number of road traffic accidents [5, 34]. Thus, in the USA, more than 1 million cases of chemotherapy are registered annually; it occurs in almost half of car accidents [15, 19]. In Western European countries, this injury has also acquired the character of a “non-infectious epidemic”: insurance companies pay huge amounts of money annually for chemotherapy [16]. In our country, the diagnosis of chemotherapy is not yet made so often; there are no data on its prevalence.

An interesting fact is that there is no direct connection between the severity of HT and the degree of damage to the car in an accident: HT occurs more often in passengers of lightly damaged cars. The place of the victim in the car is also not significant. When using seat belts, the risk of HT increases, but the ability of belts to prevent other injuries significantly outweighs this negative effect [5, 33].

Among patients with chemotherapy, there are 2.5 times more women than men, mostly women 30-50 years old [31]. An explanation may be the lower strength of the neck muscles in females, as well as their more frequent seeking of medical help.

The pathophysiology of CT is determined primarily by trauma (overextension or compression) of the structures of the anterior (anterior longitudinal ligament, muscles, intervertebral disc) and posterior (posterior longitudinal and intervertebral ligaments, facet joints, muscles) supporting complexes of the cervical spine [7, 12, 13] . Much less common are damage to the cervical roots (the most vulnerable is the posterior branch of the C2 root, which can be pinched between the axis and the arch of the atlas), stretching of the cervical plexus, subluxations and fractures of the vertebrae, traumatic dissection of the internal carotid or vertebral arteries, and spinal cord injury [34]. It is important to note that direct neck injury and direct soft tissue bruises are usually absent during chemotherapy. Apparently, this is why the clinical manifestations of chemotherapy are often interpreted as “exacerbation of osteochondrosis, provoked by trauma.”

Clinical symptoms of chemotherapy are caused by the arrival of nociceptive impulses from damaged tissues of the neck with the subsequent development of muscle spasm and local edema. A number of manifestations (vertebral artery syndrome) may be associated with irritation of sympathetic fibers located around the vertebral artery.

Symptoms usually appear immediately or soon after injury (in a third of patients in the first hours, in the rest in the first 2-3 days), their severity may vary [25]. The leading symptom that almost always accompanies chemotherapy is pain in the neck and shoulder girdle, which intensifies with movements of the head and arms, accompanied by limitation of movements in the neck (primarily flexion of the head). A headache often occurs, which is often localized in the back of the head, but sometimes radiates to the temple and eye socket. Another typical symptom is dizziness, which accompanies approximately 20-25% of cases of chemotherapy. It can be systemic and combined with imbalance. Cochlear (noise, ringing in the ears) and visual (blurred image, blurred vision) disturbances are also characteristic, and paresthesia in the facial area may be observed. In almost a third of cases, nonspecific moderately severe cognitive impairment develops: decreased ability to concentrate, mild memory impairment [20]. Mood changes (anxiety, depression) are often observed. It should be noted that after an injury, the neck very often becomes a zone of psychological fixation. Constant neck pain after chemotherapy provokes depression, while anxiety and conversion disorders contribute to chronic pain [26].

Objective symptoms in chronic chemotherapy, uncomplicated by radiculo-, plexo-, or myelopathy, are limited to a decrease in the range of active movements in the cervical spine, tension and the presence of painful points in the area of ​​the cervical and scapular muscles, and local pain in the articular processes upon palpation. Assessing mobility and palpating the structures of the cervical spine during chemotherapy requires certain skills [6]. No neurological symptoms are detected; sensory disturbances, if detected, are often sclerotomal in nature [19]. Neurological symptoms are typical for those rather rare cases when there is damage to the roots, plexuses or spinal cord [21].

During chemotherapy, an X-ray examination of the cervical spine is mandatory. A pathognomonic sign for this type of injury is straightening of the cervical lordosis as a sign of a sharp spasm of the muscles that support the neck [3, 19]. If the patient’s age exceeds 40-50 years, it is very likely that there will be radiological signs of spondylosis and osteochondrosis, which, however, should not confuse the clinician regarding the causes of vertebroneurological symptoms. At the same time, it is important to note that the absence of changes on radiographs does not exclude damage to the capsules of the intervertebral joints and articular cartilage, the presence of hemarthrosis, separation of discs from the end plates of the vertebrae, rupture of muscles or ligaments [5].

The fact that such changes are possible is evidenced by the results of pathomorphological studies of persons who died due to traumatic brain injury, but did not have any changes on radiographs of the cervical spine. In all cases, morphological changes were found: hematomas of paravertebral muscles, ruptures of the ligamentum flavum and joint capsules, pterygoid and cruciate ligaments, damage to facet joints, meniscoids and uncovertebral joints, protrusion of intervertebral discs [28, 33]. More accurate neuroimaging methods - CT and MRI - make it possible in some cases to detect such changes, but often even when using them, disorders are not detected [14]. Electroneuromyography is performed only to exclude the radicular nature of the lesion in case of persistent pain syndrome and radicular type of sensitivity disorders.

Subjective and objective symptoms of chemotherapy can be expressed to varying degrees. In accordance with the Quebec classification developed by the Association for the Study of HT (Quebec Task Force on Whiplash-Associated Disorders), there are four degrees of its severity (cited [5]).

I degree of severity

Pain and stiffness in the cervical region. There are no objective signs of injury. Morphologically - microscopic damage to soft tissues that does not cause muscle spasm. Patients often see a doctor a day or more after the injury. Regression of symptoms is usually observed in the first 3-4 weeks.

II degree of severity

Neck pain in combination with objective signs of damage to soft tissues (ligaments, tendons, muscles) or facet joints in the form of limited range of motion and local pain. The pain may radiate to the head or arm. Stiffness in the cervical region. There are no objective signs of injury. Morphologically, soft tissue sprains, hemorrhages in joint capsules, ligaments, tendons, muscles, and secondary muscle spasms are revealed. Patients usually see a doctor on the first day after injury.

III degree of severity

There are focal neurological symptoms in the form of weakening or loss of tendon reflexes, paresis, and sensory disturbances.

IV degree of severity

Fractures and dislocations of the vertebrae, possible compression of neural structures with the development of corresponding neurological symptoms. Patients usually see a doctor immediately after an injury.

CT of I severity occurs in 43% of cases, grades II, III and IV - in 29, 12 and 6%, respectively [5, 20].

There are several periods of chemotherapy: acute (up to 4 days), acute (from 4 to 21 days), subacute (from 22 to 45 days), intermediate (symptoms persist for 46-180 days), chronic (symptoms persist for more than 6 months) [30]. In most victims, symptoms regress within 1-6 months after injury (6 months is a sufficient period for complete healing of soft tissue injuries); in cases of complete regression of symptoms, the reverse development of clinical manifestations occurs in the first 3 months [11]. The longer symptoms persist, the more likely they are to remain for a long time. In general, according to the literature, in 60% of patients who underwent chemotherapy, spontaneous improvement occurs during the first year, in 32% - during the next year, and in 8% of patients the symptoms become permanent, i.e. “post-whiplash syndrome” develops [11, 25, 32]. The latter is manifested by pain in the neck and limited mobility in it, pain and paresthesia in the arms, and visual disturbances. Severe neurotic disorders are characteristic.

The question of the relationship between the symptoms of chemotherapy and psychological changes has been discussed for a long time - since the appearance of the term “whiplash injury”. A vicious circle is likely to form: mental characteristics of the individual (emotional instability, hostility, dependence) contribute to the chronicity of the symptoms of chemotherapy, and chemotherapy itself contributes to the accentuation of natural personal properties [10, 17, 23, 24, 27]. Rental installations are not excluded. Thus, according to a number of studies, in countries where there is no insurance compensation system, the frequency of chronic neck pain and headaches in survivors of chemotherapy corresponds to the average in the population - 15% (cited [5]). At the same time, it has been proven that “post-whiplash syndrome” develops significantly more often after severe chemotherapy (III-IV degrees), which indicates the important role of organic damage to the musculoskeletal system and nervous system in its development [25]. Discussions regarding the nature of the clinical manifestations of the chronic period of chemotherapy continue.

Treatment of chemotherapy in most cases is conservative (surgery in the acute period may be indicated in cases of compression of the spinal cord or its threat, in open spinal cord injury) [2]. The goals of treatment are to relieve pain, achieve complete restoration of range of motion in the cervical spine, restore ability to work, and prevent chronicity of clinical manifestations. Treatment options include orthopedic aids, pharmacotherapy, physiotherapy, therapeutic exercises, manual therapy, and psychotherapy.

Orthopedic measures consist of immobilizing the cervical spine using a rigid cervical collar. If no fractures or instability of the cervical vertebrae are detected, immobilization is necessary only for the acute period of the injury. It is recommended to wear a cervical collar for no more than 72 hours—longer continuous wearing of it slows down the healing process [3, 19].

Drug therapy is aimed primarily at relieving pain, as well as stimulating regenerative processes in damaged tissues. The basis of pharmacotherapy is non-steroidal anti-inflammatory drugs, the use of which can reduce the production of prostaglandin, substance P and other algogens formed as a result of injury, prevent the increase in local tissue edema, and reduce the sensitivity of nerve endings to the action of inflammatory mediators. Nonsteroidal anti-inflammatory drugs are prescribed for up to 2 weeks in standard doses. In some cases, it is advisable to use these drugs in the form of suppositories (suppositories). With this form of drug administration, the gastric mucosa is less damaged; in addition, the risk of developing infiltrates, suppuration and muscle necrosis, which often accompany intramuscular injections of these drugs during their long-term (more than 2-3 days) use, is eliminated. Very often, suppositories are used in combination therapy: during the day the patient receives either injections or tablets, and at night - suppositories, which ensures a more uniform and long-term maintenance of the concentration of drugs in the blood.

Among the most effective rectal suppositories is diclovit, which contains as an active ingredient one of the most popular non-steroidal anti-inflammatory drugs - diclofenac (one suppository contains 50 mg of diclofenac). Diclovit is administered into the rectum after an enema or spontaneous bowel movement and it is recommended to stay in bed for 20-30 minutes. Use one suppository 2 times a day. The drug is usually well tolerated, side effects in the form of dyspeptic disorders are rare and go away on their own. Contraindications to the prescription of diclovit are gastric or duodenal ulcers, exacerbation of hemorrhoids, hemorrhagic colitis, as well as age under 15 years, hypersensitivity to diclofenac or other non-steroidal anti-inflammatory drugs. The clinical effectiveness of diklovit has been confirmed by special studies conducted in many research and clinical institutions in Russia [1].

For very acute pain, narcotic analgesics and corticosteroids can be prescribed for a short period of time in the acute phase [29]. For prolonged pain, antidepressants are added to treatment [3].

It is advisable to combine oral or parenteral administration of analgesics with local use of ointments. The main advantage of ointments is that the severity of side effects on the gastrointestinal tract is significantly less than that of tablet and injection forms of non-narcotic analgesics, as well as the possibility of local action directly on the lesion. In the treatment of chemotherapy, ointments are traditionally used that are based on non-steroidal anti-inflammatory drugs or have irritating and distracting properties. In addition, a very promising direction in the treatment of neck chemotherapy is the local use of chondroprotective agents.

Of particular interest is chondroxide ointment 5%, containing chondroitin sulfate and dimethyl sulfoxide. The presence of chondroitin sulfate, isolated from the tissues of cattle, in the ointment provides compensation for the deficiency of this important component of cartilage and accelerates the recovery process of affected intervertebral discs. The second component of the ointment, dimexide, has a pronounced anti-inflammatory and analgesic effect, and also, thanks to its special physicochemical properties, promotes rapid deep penetration into the tissues of the substances used in combination with it, in this case chondroitin sulfate. The ointment is applied to the skin in the area of ​​the affected spinal motion segment 2-4 times a day and lightly rubbed in for 2-3 minutes until completely absorbed. Side effects in the form of a local allergic reaction are extremely rare. The effectiveness of chondroxide ointment in the treatment of patients with vertebrogenic pain syndromes was assessed at the Department of Vertebroneurology and Manual Therapy of the Kazan State Medical Academy [8]. The ointment was applied daily (3-4 times a day) to the affected areas of the spine for 2 weeks. After the course of treatment, the severity of pain and vertebral syndromes significantly decreased. Repeated courses, according to the authors’ recommendations, should be carried out every 3 months. A follow-up study of long-term results, conducted by the authors over the course of a year, confirmed the effectiveness and validity of such maintenance courses of therapy with chondroxide ointment.

During chemotherapy, manual therapy, namely mobilization techniques, can be very effective, but it is first necessary to exclude phenomena of instability in the cervical spine, fractures, and disc herniations [4]. Manual therapy is aimed at eliminating intra- and periarticular adhesions, releasing synovial folds, eliminating areas of local muscle hypertonicity [5], it is most effective in the subacute period [18]. 5-7 sessions are carried out.

As early as possible, therapeutic exercises are prescribed, the purpose of which is to strengthen the muscles and tendon-ligamentous apparatus of the neck, eliminate pathological protective postures (kyphosis of the thoracic region, skewing of the shoulders, tilt of the head forward), leading to overload of the facet joints, intervertebral discs and ligaments. Physiotherapeutic procedures can have a good effect: ultrasound, electrical muscle stimulation; massage of the neck and shoulder girdle is also indicated [19].

Psychotherapy plays a vital role in the treatment of chemotherapy, primarily in the prevention and treatment of “post-whiplash syndrome” [33]. It is important to explain to the patient the mechanism of injury, to instill confidence in the possibility of a full recovery, to teach the correct postures when working, and relaxation methods. A patient who has undergone chemotherapy is recommended to sit upright while reading, writing, working at the computer, and to monitor his posture; sleep on a small elastic or special orthopedic pillow; rub your neck three times a day with ointments containing analgesics and chondroprotectors. It is not recommended to throw your head back for a long time, often turn it in the direction of pain, tilt it when lifting an object, read or write bending over for a long time, wear a collar splint for a long time, or sleep on a high pillow [4]. Special methods of psychotherapy are also used, for example behavioral, aimed at changing the patient’s attitude towards his painful condition [30].

In conclusion, it should be said that many issues related to the pathogenesis of chemotherapy symptoms and treatment approaches are still not clear enough and require further study. The identification of vertebroneurological manifestations of chemotherapy with “exacerbation of cervical osteochondrosis” inevitably leads to unfounded therapeutic tactics.

Literature

1. Gatina D.R. Diclovit - freedom of movement without pain. Vertebroneurology 2002; 1:2:74-77. 2. Irger I.M., Yumashev G.S., Rumyantsev Yu.V. Hyperextension injury of the cervical spine and spinal cord. In the book: Guide to neurotraumatology. Ed. A.I. Arutyunova. M: Medicine 1979; 99-114. 3. Karakhan V.B., Krylov V.V., Lebedev V.V. Whiplash injury. In the book: Diseases of the nervous system. Ed. N.N. Yakhno, D.R. Shtulman. M: Medicine 2001; 1: 742-744. 4. Kozlov M.Yu. Diagnosis and treatment of cervical whiplash injury. Atmosphere (nervous diseases) 2002; 1:21-23. 5. Levin O.S., Makarov G.V. Neurological complications of whiplash injury. Neurol journal 2002; 3: 46-53. 6. Murtha J. Neck pain. Consilium 1999; 2: 76-84. 7. Ogleznev K.Ya., Stankevich P.V. Closed mild traumatic brain injury in combination with whiplash injury of the cervical spine in victims of road traffic accidents. Vertebroneurology 2001; 8:1:2:38-40. 8. Khabirov F.A., Devlikamova F.I. Some aspects of the treatment of spondyloarthrosis. Journal of neurol and psychiat 2001; 101: 11: 57-58. 9. Khabirov F.A., Popelyansky Ya.Yu. Clinic and pathogenesis of initial manifestations of vertebrogenic diseases of the nervous system. Vertebroneurology 2002; 9:1:2:8-12. 10. Awerbuch MS Whiplash in Australia: illness or injury? Med J Aust 1992; 157: 193-196. 11. Bannister G., Gargan M. Prognosis of whiplash injuries State. Art Rev Spine 1993; 7: 557-570. 12. Barnsley L., Lord S., Bogduk N. Pathophysiology of whiplash state. Art Rev Spine 1993; 7: 330. 13. Bogduk N. The anatomy and pathophysiology of whiplash. Clin Biochem 1986; 1: 92-101. 14. Davis SJ, Teresi LM, Bradley WG et al. Cervical spine hyperextension injuries: MR findings. Radiology 1991; 180: 245-251. 15. Evans RW Some observations on whiplash injuries. Neurol Clin 1992; 10: 975-997. 16. Galasko S.S., Murray P.M., Ritcher M. et al. Neck sprains after road traffic events: a modern epidemic. Injury 1993; 24: 155-157. 17. Gotten N. Survey of one hundred cases of whiplash injury after settlement of litigation. JAMA 1956; 162:865-867. 18. Hoehler F., Tobis J., Buerger A. Spinal manipulation for low back pain. JAMA 1981; 245: 1835. 19. Lagattuta F., Falco F. Assessment and treatment of cervical spine disorders. In: R. Braddom (eds). Physical Medicine and Rehabilitation. USA:WBSaunders Company 1996; 728-752. 20. Lee J., Giles K., Drummond P. Psychological disturbances and an exagerated response to pain in patients with whiplash injuries. J Psychosom Res 1993; 37: 105-110. 21. Lillius G., Laasonen E.M., Myllynen P. et al. Lumbar facet syndrome. A randomized clinical trial. J Bone Jt Surg 1989; 1: 681-684. 22. Macnab I. Acceleration of injuries of the cervical spine. J Bone Jt Surg Am 1964; 46: 1797-1799. 23. Maimaris C., Barnes MR, Allen MJ “Whiplash injuries” of the neck: a retrospective study. Injury 1988; 19: 393-396. 24. Mayou R., Bryant B., Duthie R. Psychiatric consequences of road traffic. BMJ 1993; 307:1047-1050. 25. Norris SH, Watt I. The prognosis of neck injuries resulting from rear-end vehicle collisions. J Bone Jt Surg Br 1983; 65: 608-611. 26. Olsnes BT Neurobehavioral findings in whiplash patients with long-lasting symptoms. Acta Neurol Scand 1989; 80: 548-568. 27. Radanov BP, Stefano G., Schidrig A. et al Role of psychosocial stress in recovery from common whiplash. Lancet 1991; 338: 712-715. 28. Rauschning W., McAfee P., Jonsson HR Pathoanatomical and surgical findings in cervical spine injuries. J Spinal Dis 1989; 2: 213-222. 29. Selecki B. Whiplash. Aust Fam Phys 1984; 13: 243-247. 30. Spitzer WO, Scovron ML, Salmi LR et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders (WAD). Spine 1995; 20: Suppl: 1-73. 31. Su HC, Su RK Treatment of whiplash injuries with acupuncture. Clin J Pain 1988; 4: 233. 32. Watkinson A., Gargan MF, Bannister GC Prognostic factors in soft tissue injuries of the cervical spine. Injury 1991; 22: 307-309. 33. Whiplash injuries: current concepts in prevention, diagnosis and treatment of the cervical whiplash syndrome. R. Gunzburg, M. Szpalski (eds). Philadelphia: Lippincott-Raven 1998. 34. Yogandon N., Pintar FA, Kleinberger M. Whiplash injuriy. Spine 1999; 24: 84-85.

Source Journal of Neurology and Psychiatry named after. S.S. Korsakov No. 4 | 2004

Diagnosis of neck injury and cervicocranial syndrome

To diagnose injury and bruise of the neck (cervical spine) and cervicocranial syndrome, you should consult a doctor for a neurological examination, during which the biomechanics of the cervical spine should be assessed (range of motion, muscle tone and strength, the presence of fibromyalgia in the neck muscles, etc.). d.).

A neurological examination of a patient with a neck injury may reveal:

• symptoms of monoradiculopathy,
• symptoms of spinal cord compression.

Monoradiculopathy occurs in patients with unilateral dislocation. Unilateral dislocation of the articular processes at the level of the C5 - C6 vertebrae usually manifests itself in the form of radiculopathy C6 root. In this case, the patient complains of muscle weakness when extending the hand, numbness and tingling in the fingers.

The pattern of segmental innervation on the surface of the human body helps to clarify the localization of the level of radiculopathy and spinal cord compression.

Unilateral dislocation of the articular processes at the level of the C6 - C7 vertebrae usually manifests as radiculopathy C7 root. In this case, the patient complains of muscle weakness when extending the arm at the elbow (triceps), when bending the hand, as well as numbness and tingling on the index and middle fingers.

Neurological symptoms of spinal cord compression occur with bilateral dislocations of the cervical vertebrae, which may worsen as the subluxation increases.

Based on the results of the examination, a clinical diagnosis can be made and treatment can be suggested. In case of an unspecified diagnosis, additional diagnostic appointments may be given:

• REG, USDG of vessels of the neck and brain
• X-ray of the cervical spine with functional tests
• cervical spine
• MRI of the cervical spine

Magnetic resonance imaging (MRI) of the cervical spine (lateral view) helps diagnose disc damage and determine the position of the cervical vertebrae when they are displaced.

Causes of neck pain

There are many reasons that can lead to cervicalgia. They are usually divided into two groups3:

1. associated with the spine (vertebrogenic):

• osteochondrosis;
• arthrosis;
• infectious lesions of the skeleton;
• autoimmune pathologies;
• metabolic disorders;
• neoplasms;
• injuries.

1. unrelated to the spine (non-vertebrogenic):

• myofascial syndrome;
• psychogenic pain syndrome;
• referred pain in diseases of internal organs3.

Let's take a closer look at the most common pathologies that can cause neck and head pain.

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Osteochondrosis

Osteochondrosis is one of the most common problems of our time. It is manifested by deformation and thinning of the intervertebral discs.

Unfortunately, there is a tendency for osteochondrosis to appear at a young age; increasingly, this diagnosis is made even at the age of 204. Factors that can trigger the development of this disease4:

• hereditary predisposition;
• sedentary lifestyle;
• stress and overexertion4.

Most often, complications of osteochondrosis arise due to late consultation with a doctor. At the first stage, this disease practically does not bother you. There may be slight stiffness in the morning, a crunching sound when moving the head, a feeling of heaviness4. In this case, the inner part of the intervertebral disc loses moisture, and the outer part becomes covered with cracks and delaminates. The vertebrae begin to come closer together and injure each other4.

At the second stage, the vertebrae are subjected to excessive stress, and overstrain of muscles and ligaments appears. It is at this stage that intervertebral hernias and vertebral displacements can occur4.

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Myofascial syndrome

The main cause of myofascial pain syndrome is constant or periodic overstrain of the neck muscles, which causes muscle fiber spasms5.

Risk factors5:

• curvature of posture;
• flat feet;
• heavy physical activity;
• constant overvoltage;
• vibration;
• prolonged immobile position of the body (for example, when treating fractures);
• wearing tight and uncomfortable clothes;
• eating disorders;
• diseases of internal organs5.

Taking these factors into account, it is difficult to imagine the variety of clinical cases in which myofascial syndrome occurs. In order to recognize this problem, it is important to pay attention to its main signs: muscle tightness, soreness and involuntary contractions7.

There are three degrees of myofascial pain syndrome6:

1. First degree - painful sensations appear only when moving the head, as well as when pressing and stretching the affected muscle6.
2. The second degree is a nagging pain in the entire neck that occurs spontaneously. You can detect a place where muscle tissue is hypertonic. When you press it, spasm and pain in neighboring areas are noted6.
3. In the third degree, the entire back or side of the neck hurts severely, even at rest. The sensations become more pronounced with movement and pressure6.

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Facet joint dysfunction

Facet joints connect the vertebrae to each other8. Their main function is to ensure stability of the spine by limiting its mobility9.

Acute joint pain occurs when the facet joint is injured during a sudden movement of the head or neck. The joint is pinched by the vertebrae, which leads to inflammation, swelling and pain in the neck area. Symptoms usually go away within a few days9.

Chronic dysfunction of the facet joints (facet syndrome) is more common in medical practice. This problem is associated with gradually developing changes in the structure of the joints9. Let's look at this process in more detail.

In healthy people, the facet joint is constantly exposed to stress. Gradually, the elastic core of the intervertebral disc, which is responsible for shock absorption and mobility, loses the water it contains, loses its elasticity and ceases to perform its functions properly. There is also a decrease in the height of the intervertebral discs. Under such conditions, increased load is transferred to the vertebrae and joints, causing degenerative changes in them9.

Facet syndrome is characterized by dull, monotonous pain in the neck, which worsens with prolonged sitting or standing in one position. Short-term pain in the morning is typical, decreasing after physical activity and increasing again in the evening9.

Unpleasant sensations sharply intensify when bending, turning and straightening the spine9. For example, if a person has pain in the back right of his neck, then it will be painful for him to turn his head in this direction. Unloading the spine - slight slow bending, as well as support under the back while sitting - brings relief9.

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Hernias and protrusions of intervertebral discs

Herniated intervertebral discs are the most severe complication of osteochondrosis10. The following stages of their formation are distinguished:10

1. Bulging (protrusion) of the disc.
2. Prolapse of the nucleus and other fragments of the disc into the spinal canal (hernia itself).
3. Hidden spondylolisthesis (displacement only during flexion and extension of the spine).
4. Stabilization or self-healing10.

The first sign of intervertebral disc protrusion is increased pain with movement and its decrease at rest. Most often, patients with this problem feel worse when lying down, so they have to sleep half-sitting. The pain is pressing, bursting, often radiating to other areas3.

At the stage of a formed hernia, the spinal nerve or its roots are pinched. Manifestations are varied: pain in the neck, radiating to the shoulder and arm, changes in blood pressure, dizziness, weakness and drowsiness, numbness of the fingers, and in rare cases, hearing, vision and walking disorders11.

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Cervical myelopathy

The cause of the development of cervical myelopathy is compression of the spinal cord and its vessels. This disease can be caused either by a herniated disc2 or by a narrowing of the diameter of the spinal canal due to degenerative changes in the vertebrae12. Myelopathy is more common in men over 50 years of age and develops gradually over 1-2 years2. As a rule, patients consult a doctor with the following complaints12:

• movement disorders (increased muscle tone, decreased strength, problems with coordination of movements);
• sensory disorders (changes in pain and joint-muscular sensitivity);
• reflex disorders (increased or decreased tendon reflexes of the arms and legs)12.

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Injuries

Injuries to the cervical spine account for 55-80% of all spinal injuries13.

Whiplash injury (WHT) occupies one of the first places in the structure of cervical injuries14.

The term “whiplash” was first used in 1928 to refer to a specific injury to the neck during a vehicle collision13. After being hit by a car, the victim’s body moves sharply forward, and the head leans back; excessive extension occurs in the lower cervical segments of the spine15.

Most often, the cause of CTS is a traffic accident, but damage can also occur as a result of domestic, sports, industrial and combat injuries. In this case, the integrity of muscles, ligaments and soft tissues is violated, and in severe cases, vertebral fracture occurs14.

Depending on the victim’s complaints, there are 4 degrees of HTS15:

1. the first is pain and limitation of head movement, pain when pressing the neck muscles;
2. second - muscle spasms are detected, and when pressure is applied, pain points are detected;
3. third - neurological manifestations are added: decreased reflexes to the point of their absence, partial paralysis, impaired sensitivity;
4. fourth - fracture and displacement of the cervical vertebrae, prolapse of intervertebral discs15.

Common symptoms of neck injuries include dizziness and headache, noise and ringing in the ears, changes in skin color (pale, blue or red), increased sweating and nervous system disorders: obsessive thoughts, apathy, depression, acute outbursts of fear15 .

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The main reasons why your back hurts after an accident

Spinal fracture

Healthy vertebrae have a significant margin of strength and can withstand significant loads. However, even the strong vertebrae of young and middle-aged people are often unable to withstand such a powerful impact as a car accident.

There are two types of vertebral fractures. Fractures that result in a decrease in the height of the vertebra and destruction of its anterior part are called compression fractures. They are usually promoted by simultaneous forward flexion and compression of the spinal column.

Another type of spinal fracture is comminuted, in which the vertebral body splits into several fragments. This type of fracture is considered the most dangerous and is a direct indication for surgery, since even a slight displacement of bone fragments can lead to damage to the spinal cord.

Vertebral displacement (spondylolisthesis)

Displacement of the vertebrae occurs when there is sudden flexion or extension of the spinal column. When the vertebrae become misaligned, they begin to affect nearby tissues, particularly nerve structures, causing pain, weakness and numbness in the parts of the body innervated by the irritated or pinched nerve. In addition, chronic back pain occurs, the intensity of which increases as the back straightens.

Soft tissue injuries

The sudden and extreme flexion and extension of the neck during a car accident, in particular during a rear impact, instantaneous braking or acceleration, often causes the so-called whiplash injury of the cervical spine. The strong tension that occurs during this movement, and then a sharp relaxation of the neck, leads to damage to the ligaments, muscles and capsules of the intervertebral joints of the cervical spine.

The danger of this injury is that most people do not perceive it as such. Moreover, the consequences - pain in the cervical region and shoulders, accompanied by vegetative-vascular disorders and weakness - without proper treatment can bother the patient for several months. Abnormalities in the neck can also cause changes in the biomechanics of the entire spinal column, making it vulnerable to various degenerative processes.