Neck & Spine

The neck, also called the cervical spine, consists of the upper seven vertebrae which connect the skull to the chest. The upper and mid back, also called the thoracic spine, consists of the next 12 vertebrae and are unique for their connection to the rib cage. The rib cage provides a level of stability not found in the cervical and lumbar spine, and so thoracic pain is generally less frequent than cervical pain. Neck pain can be due to a number of causes including sprain and strain injuries, degenerative disc disease, arthritis, and disc herniations. 

Common symptoms associated with neck pain include stiffness, muscle spasms, and headaches. When disc herniations or arthritis cause a pinched nerve, it can cause cervical radiculopathy, which is characterized by shooting pain down the upper extremities that may be accompanied by numbness, tingling, and weakness. Neck pain can be also caused by serious non-spine related issues such as carotid artery dissection, head and neck cancer, and referred pain from myocardial infarction.

Mid-back pain is most commonly mechanical in nature, with contributing factors including poor posture, overuse, poor conditioning, and trauma. It frequently affects the myofascial tissue (muscular and connective tissue) and can cause painful trigger points. Disc herniations can also occur in the thoracic spine, but less frequently than in the cervical spine, and may cause radicular symptoms in the form of numbness, burning, electrical, and shooting pain that wraps around the ribs. Rib fractures and spinal tumors can also mimic radicular pain. In some situations, pain in the mid-back may represent pain originating from the lower cervical spine. Trauma, and individuals with osteoporosis, can develop pain related to vertebral compression fractures. 

Treatment for neck and mid-back pain can generally be divided into pharmacologic and nonpharmacologic treatments, nonsurgical interventional treatments, and surgical treatments.  Nonpharmacologic treatments include brief rest, ice/heat, electrical stimulation, physical therapy, spinal manipulation, and massage. Pharmacologic treatments include acetaminophen, NSAIDs, muscle relaxants, antidepressants, anticonvulsants, and topical medications. Nonsurgical interventions include various spine and musculoskeletal injections. Many of these involve the injection of glucocorticoids, powerful anti-inflammatory agents.