Chapter 15: Spinal dysfunction

INTRODUCTION

Spinal or vertebral dysfunction can be regarded as a masquerade mainly because the importance of the spine as a source of various pain syndromes has not been emphasised in medical training. Practitioners whose training and treatment are focused almost totally on the spine may swing to the other extreme and some may attribute almost every clinical syndrome to dysfunction of spinal segments. The true picture lies somewhere in between.

The diagnosis is straightforward when the patient is able to give a history of a precipitating event such as lifting, twisting the neck or having a motor vehicle accident, and can then localise the pain to the midline of the neck or back. The diagnostic problem arises when the pain is located distally to its source, whether it is radicular (due to pressure on a nerve root) or referred pain. The problem applies particularly to pain in anterior structures of the body.

If a patient has pain anywhere, it is possible that it could be spondylogenic and practitioners should always keep this in mind.

The various syndromes caused by spinal dysfunction will be presented in more detail under neck pain, thoracic back pain and lumbar back pain.

Cervical spinal dysfunction¹

The cervical spine is the origin of many confusing clinical problems and syndromes.

Clinical problems of cervical spinal origin

Pain originating from disorders of the cervical spine is usually, although not always, experienced in the neck. The patient may experience headache or pain around the ear, face, arm, shoulder, upper anterior or posterior chest.²

Possible symptoms:

• neck pain

• neck stiffness

• headache

• ‘migraine’-like headache

• facial pain

• arm pain (referred or radicular)

• myelopathy (sensory and motor changes in arms and legs)

• ipsilateral sensory changes of scalp

• ear pain (peri-auricular)

• scapular pain

• anterior chest pain

• torticollis

• dizziness/vertigo

• visual dysfunction

FIGURE 15.1 indicates typical directions of referred pain from the cervical spine. Pain in the arm (brachialgia) is common and tends to cover the shoulder and upper arm as indicated.

If the cervical spine is overlooked as a source of pain (such as in the head, shoulder, arm, upper chest—anterior and posterior—and around the ear or face) the cause of the symptoms will remain masked and mismanagement will follow.

Dysfunction of the cervical spine can cause many unusual symptoms such as headache and ...