Sudden Neck Pain

July 26, 2006 The Spine The spine is the long column of bones that supports the body and head. The area in the lower back is called the lumbar spine. The thoracic spine is the middle area and the cervical spine forms the neck. Bones, called vertebrae, are arranged like rungs on a ladder along the spinal column. The spinal column encases a network of nerve fibers called the spinal cord. The spinal cord is covered with the dura mater, a fibrous membrane. A pair of spinal nerves runs from the spinal cord into the space between each of the vertebrae. Those nerves transmit sensory and motor information between the spinal cord and the rest of the body. Spinal Epidural Hematoma and Sudden Neck Pain A spinal epidural hematoma is a collection of blood that forms in the space between the dura mater and the inside of the spinal column. It occurs when a blood vessel ruptures or is broken, causing blood to leak out. The blood is trapped inside the spinal column and can press against the spinal cord or nerve roots. Spinal epidural hematomas are most commonly associated with trauma to the spine, spinal surgery, administration of epidural anesthesia and spinal manipulation. Non-traumatic (spontaneous) epidural hematomas can occur, but are relatively rare. Researchers estimate spontaneous spinal epidural hematomas occur in about 1 out of every one million people. Patients who are taking blood thinners, have clotting disorders or blood diseases, like leukemia, appear to be at higher risk for the condition. But in many cases, the cause of the problem is unknown. Greg Schucany, M.D., a Diagnostic Radiologist at Baylor University Medical Center, says the problem can sometimes occur in some people when there is a sudden increase in blood pressure (like when lifting a heavy object) because the higher blood pressure can cause an unusually fragile vein in the spinal canal to rupture. Signs of a spinal epidural hematoma vary according to the location of the pocket of blood and the area it compresses. Blood pooling in the lower back can cause numbness and weakness in the legs. In the neck, patients may experience a sudden onset of neck pain that radiates down the arm and numbness and/or weakness in the affected arm. In severe cases, the condition can lead to paralysis within minutes to hours. If the blood pools near the top of the spinal column, it can press against the nerves that help control the diaphragm, leading to breathing problems. Diagnosing and Treating Sudden Neck Pain Neck pain caused by a spinal epidural hematoma can often be confused with a herniated disc. However, MRI scans show the abnormal collection of blood pooling in the spinal column. Sometimes the blood will naturally be absorbed by the body. But when the symptoms are severe or progressive, or are causing significant weakness, surgery is recommended to remove the clot to prevent permanent damage. Schucany says spinal hematomas are rare. Patients who experience sudden onset of pain or severe pain and muscle weakness should see a doctor for a medical evaluation. AUDIENCE INQUIRY For general information on neck pain: American Academy of Orthopaedic Surgeons, public website, http://orthoinfo.aaos.org BIBLIOGRAPHY Case, Ashley, M.D., and Patrick Ramsey, M.D., "Spontaneous Epidural Hematoma of the Spine in Pregnancy," American Journal of Obstetrics and Gynecology, September 2005, Vol. 193, No. 3, Pt. 1, pp. 875-877. "Epidural Hematoma," Encyclopedia of Neurological Disorders, downloaded from website (http://health.enotes.com), July 6, 2006. Herd, Anthony, M.D., "A Major Pain in the Neck," Canadian Family Physician, April 2005, Vol. 51, pp. 497, 506. Hess, Erik, M.D., and Matthew Sztajnkrycer, M.D., Ph.D., "Images In Clinical Medicine," Annals of Emergency Medicine, October 2005, Vol. 46, No. 4, pp. 382, 392. Kebaish, Khaled, M.D., and John Awad, M.D., "Spinal Epidural Hematoima Cauisng Acute Cauda Equina Syndrome," Neurosurgical Focus, June 2004, Vol. 16, No. 6, p. e1. Liebeskind, David, M.D., "Epidural Hematoma," eMedicine, updated April 17, 206, downloaded from website (http://www.emedicine.com), July 6, 2006. "Neck Pain," Rosemont: American Academy of Orthopaedic Surgeons, downloaded from public website (http://orthoinfo.aaos.org), July 6, 2006. Spuck, Sebastian, M.D., et al., "A Rare Cause of Radicular Complaints," Clinical Orthopaedics and Related Research, February 2006, No. 443, pp. 337-341. Tender, G., and D. Awasthi, "Spontaneous Cervical Spinal Epidural Hematoma in a 12-year-old Girl," Journal of the Louisiana State Medical Society, July-August 2004, Vol. 156, No. 4, pp. 196-198. Research compiled and edited by Barbara J. Fister