The neck consists of seven pieces of bone (vertebrae) with soft cushions (discs) in between. Every time you move your neck, these vertebrae and discs work in sync to allow movement. There are several causes of the aches and pains that can develop in the neck, with its many structures.

First, there is degeneration (spondylosis), a wearing out of the intervertebral discs that cushion individual neck bones. As a disc wears out, it cannot support the neck as well as it used to. The body tries to repair this by forming extra bone structures, known as bone spurs (osteophytes), for support. Bone spurs can compress nerves and the spinal cord, resulting in severe symptoms, such as difficulties in walking or loss of bladder or bowel control.

Second, there is disc prolapse. As a disc wears out, it can protrude (herniate), resulting in sharp arm pain sometimes experienced by sufferers of acute disc prolapse. It may also cause tingling (or weakness, in severe cases) in the arms and hands.

Third is inflammation, such as rheumatoid arthritis '€” a condition affecting the fingers and other big joints like the knee. In the neck, it usually affects the upper cervical spine, resulting in pain and loss of stability.

Fourth is posture, which is the most common cause of neck pain, typically resulting from prolonged bending of the neck in unnatural positions, such as sleeping on the sofa or from extended computer work with the neck bent forward.

The fifth and sixth causes are traumatic injuries, ranging from minor sprains to severe injuries, such as whiplash; and other rare reasons, such as infections, tumors and congenital abnormalities.

Most of the time, pain is self-limiting, meaning it will reduce over time with simple medication like paracetamol or NSAIDs (non-steroidal anti-inflammatory drugs), and stretching exercises.

However, the situation can become serious if you have weakness, numbness or tingling, or loss of bladder and bowel control.

Weakness may result from nerve compression with damage to nerve fibres. If untreated, paralysis may occur and can be permanent.

Occasional, short-lasting numbness or tingling may be a sign of early nerve pressure. If persistent, it means nerve damage has taken place and muscle weakness will soon follow.

Loss of bladder and bowel control is very serious and warrants immediate hospital admission and surgery. Sudden incontinence means severe spinal cord or root compression, which, if left untreated, will result in total and permanent paralysis.

Persistent pain on neck movement is also worrisome. Pain from neck sprains usually lasts from several days to one week. If pain persists in severity or worsens, especially after a fall or accident, you may have an undiagnosed neck fracture.

As a next step, a doctor must exclude serious conditions that can cause permanent damage, reviewing your medical history and conducting a neurological examination.

Images of the spine are needed and can be obtained through X-rays (simple and cheap, with limited information. Typically used to look for fractures and spinal misalignments); CT scans (good for bony details but insufficient for the disc and spinal cord. Typically reserved for those with metallic implants like pacemakers, who cannot have Magnetic Resonance Imaging [MRI]); or MRIs (preferred, as they provide a good view of nerve roots, the spinal cord and any prolapsed discs or tumors).

Conservative treatment options include rest, using a collar to reduce motion; analgesiacs like paracetamol; stretching and strengthening exercises; hot packs; lifestyle modification; or physiotherapy, including traction or immobilisation.

Surgery is sometimes needed when the above methods fail to provide relief or when there is danger of permanent nerve or spinal cord damage. Options for the cervical spine include fusion, where the damaged disc is removed and bone or a cage is inserted between vertebrae to relieve pressure on the nerve and spinal cord. However, it also increases stress on the discs above and below the operated level.

There is also arthroplasty, an artificial spinal disc. This is a new approach where after a disc is removed, an artificial metallic disc is inserted. This performs the same function as the disc by allowing motion at the operated level and reduces damage to the adjacent discs.

Laminectomy or laminoplasty is also an option. This is a time-tested way to reduce pressure over a large area of the spinal cord by removing part of the bone. This surgery is performed from the back of the neck.

Then there are facet blocks and fadio-frequency (RF) neurotomy, a minimally-invasive technique to reduce neck pain. A fine needle is inserted into the side of the neck. Using RF, pain signals coming from the facet joints are reduced. These joints, located at the back of the neck, undergo increased stress when the disc starts to wear out, leading to muscle spasms and persistent aches in the neck.

There is also disc nucleoplasty, a new minimally-invasive method to treat mild prolapsed discs and neck pain caused by disc degeneration. It uses '€œcoblation'€ technology, i.e., controlled ablation using RF, to remove part of the disc and reduce pressure inside. It also encourages the formation of new collagen to repair the disc.

It is important to take good care of the neck by having proper posture when we sit, work and play. Once degeneration starts, it is not reversible. The good news is if we start taking proper care of our necks, degeneration can be slowed and it may be years before intervention is needed.

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The writer is a consulting neurosurgeon at NeuroSurgery International at Gleneagles Hospital in Singapore. For more information, visit ortho-intl.com.

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