Wear in the neck increases with age, and many people have no symptoms. If pain runs into the arm, or the hands and walking change, we need to know whether the pressure is on a nerve root or on the spinal cord.

What happens in the neck?

With age, the discs and joints of the neck wear, and bony spurs sometimes form. This wear is called cervical spondylosis. Many people over 40 have these changes, and many of them have no symptoms.

These changes sometimes press on one of two places, and the signs differ.

Pressure on a nerve root

Nerve roots leave beside the spinal cord and run to the shoulder and arm. When one is under pressure:

Pain runs from the neck to the shoulder, arm or fingers
One arm tingles or goes numb
Some muscles of the arm or shoulder weaken
Pain gets worse with coughing, sneezing or turning the neck

Pressure on the spinal cord

This is less common but more serious, because the cord carries signals to both arms and both legs.

Heaviness or weakness in the arms or legs
Clumsy hands, for example with buttons
Poor balance when walking
In advanced cases, trouble controlling urine or stools

Report these signs early. If they appear suddenly, they are an emergency.

Tests

The examination comes first: neck movement, strength, feeling, reflexes and walking. An MRI or CT is done when severe pain does not improve with treatment, or when there is weakness or numbness in the arms. A nerve conduction study shows how far a nerve root is involved. A numb hand is not always from the neck.

Treatment

Most patients improve without surgery:

Neck exercises and physiotherapy
Medicines for pain as your doctor advises
Cold or heat packs on bad days
Better posture at work

Treatment usually takes a few weeks to work, and pain and stiffness can come back.

When does surgery come up?

When a disc or bone presses on a nerve or the cord and pain does not improve with treatment, or strength or feeling is lost. The aim is to remove the pressure, sometimes with fusing bones together. Surgery does not always remove symptoms completely, but it may stop them getting worse.

Risks include infection, bleeding, nerve injury and a spinal fluid leak. The bones above and below a fusion are also more likely to wear later.

These signs cannot wait for an appointment

Call 115 or go to an emergency department if:

You have new problems walking
You lose control of urine or stools
Your hands suddenly lose co-ordination
One side of the face droops, an arm cannot stay raised, or speech becomes difficult

Neck disc and arthritis