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GENERAL CONSIDERATIONS

Neck pain is a common clinical problem experienced by nearly two-thirds of people. Neck pain can be quite disabling, in some countries accounting for nearly as much disability as low back pain. Neck pain is also similar to low back pain in that the etiology is poorly understood and the clinical diagnoses can be vague. Compared to low back pain, however, neck pain has received limited study. The few available randomized controlled studies lack consistency in study design. This chapter reviews the epidemiology and anatomy of neck pain and provides an evidence-based guide for the evaluation, diagnosis, and management of this challenging disorder.

Neck pain is most prevalent in middle-aged adults; however, prevalence tends to vary with differing definitions and differing survey methodologies of neck pain. One study, found that the 1-year prevalence in adults ranged from 16.7% (youngest) to 75.1% (oldest). Almost 85% of neck pain may be attributed to chronic stress and strains or acute or repetitive injuries associated with poor posture, anxiety, depression, and occupational or sporting risks. The acceleration-deceleration of a whiplash injury may result in cervical sprains or strains, which, in turn, are common causes of neck pain. Radicular neck pain occurs later in life, with an estimated incidence of 10% among 25–29-year-olds, rising to 25–40% in those aged >45 years.

Occupational neck pain is ubiquitous and not limited to any particular work setting. Predictors for occupational neck pain include perception of little influence on the work situation, other work-related psychosocial factors, and perceived general tension. Predictors of occupational neck pain include prolonged sitting at work (>95% of the workday), especially with the neck forward-flexed ≥20° for >70% of the work time.

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Fejer  R  et al.. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J. 2006;15:834.
[PubMed: 15999284]

PATHOGENESIS & FUNCTIONAL ANATOMY

The cervical spine is a highly mobile column that supports the 6–8-lb head, provides protection for the cervical spinal cord, and consists of 7 vertebrae intercalated by 5 intervertebral disks; 14 facet joints (zygapophyseal joints or Z-joints); 12 joints of Luschka (uncovertebral joints); and 14 paired anterior, lateral, and posterior muscles. The vertebrae can viewed as three major groups: the atlas (C1), the axis (C2), and the others (C3-C7). C1 is a ring-shaped vertebra with two lateral masses articulating with the occiput and C2. The C2 consists of a large vertebral body (the largest in the cervical spine) with the anterior odontoid process (dens) articulating with C1. This odontoid process has a precarious blood supply, placing it at risk for nonunion when fractured. The atlantooccipital articulation accounts for 50% of the flexion and extension neck range of motion (RoM), and the C1-C2 joints account for 50% of the rotational ...

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