Cervicalgie commune et névralgies cervicobrachiales

Abstract

The following is a description of neck pain. Such pain, which may radiate to the upper extremities, should be considered in the framework of cervical degenerative disorders. Neck pain often corresponds to referred pain from facet joints or may involve the greater occipital nerve. Neck pain is symptomatic or secondary to cervical degenerative osteoarthritis. In most cases treatment is conservative, associating physiotherapy, massages, traction and, in certain cases, chiropratic manipulation. The therapeutic arsenal includes facet joint injections, acupuncture and mesotherapy. Long-term treatment associating posture training, rehabilitation with cervical and periscapular muscle strengthening is intended to avoid recurrences. Cervicobrachial pain frequently involves compromised spinal nerve or nerve root, in most cases by a soft or calcified herniated disc. This neuralgia generally involves one root and is rarely accompanied by signs of motor deficit. Nerve root and spinal cord compression may lead to cervicobrachial pain, which is typically bilateral. Additional investigations to establish the cause of compression primarily include computed tomography and, above all, magnetic resonance imaging. Electrophysiological studies (electromyogram and somatosensory evoked potentials), can confirm nerve-root injury, establish the topographic distribution of this damage and clarify its severity. Conservative treatment should be proposed initially except in cases of neurological deficit. Such treatment includes immobilization with a cervical collar, axial traction, physiotherapy, medical treatment with analgesics, anti-inflammatory drugs and myorelaxants. Chiropractic cervical manipulation is controversial in case of subligamentous herniated disc but foraminal infiltrations with scan control or epidural infiltrations may be effective when other techniques fail. When all of these methods fail or in case of motor deficit, surgery is typically performed through an anterior approach. Isolated discectomy fosters kyphosis. Filling of the disc space can be performed using autologous bone graft, interbody cages, or even a disc prosthesis in young subjects.