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1# The Ligaments

The vertebrae are held together by ligaments to form one spine. Ligaments also form a capsule around the joints. The ligaments help to maintain a harmonious movement of the spine. During an accident if the ligaments is tom the movement will become abnormal and will cause pain in the neck. Unfortunately, ligaments are not seen on X-ray. One has to keep an open mind if one has to appreciate the problems of this kind. Ligaments make an important contribution to the dynamics of the spine and this in the causation of pain in the neck. Once a ligament is torn there is abnormal movement which in turn precipitates the degeneration in the disc resulting in added pain in the neck. The abnormal movement in the cervical spine is accentuated once correctly conceived it can be treated in good time to give relief from pain to the patient. With abnormal movement, the blood vessels supplying blood to the spinal cord and get kinked. For want of blood supply the cells of the spinal cord die and their function cannot be retrieved by doing successful operation to prevent abnormal movement. This is why once paralysis sets in, one of the contributing factors is lack of blood supply and recovery becomes unpredictable. The neurological deficit or paralysis in cervical spondylosis has more than one factor contributing to it and the results cannot always be gratifying.

2# Spur or Osteophyte

Under normal circumstances, the bodies of the vertebrae are smooth at their edges. When the disc degenerates, the edges of vertebral bodies start rubbing against each other. This movement is rough and gritty as against the normal movement with presence of normal disc when the movement is smooth. This movement is abnormal and edges if the bodies develop bony spikes. They are pointed and sharp. They are a source of pain in the neck and they can be seen on X-ray. If one of these pointed spurs sokes into the nerve root, it causes severe pain in the arm. Others can cause compression of the cord and produce paralysis in the legs. Therefore if the X-rays of the spine show spur, then one has to be more careful than others.

3# Abnormal Movement

If an X-ray of the spine is done at the age of 40 years, 30 persons of them show degenerative changes and at the age of 50, almost 50 percent of the people would show evidence of cervical spondylosis Not all have complained of the pain in the neck and one has to be judicious in correlating the X-ray findings with symptoms of the patient. Abnormal movements of a degenerated spine are not smooth. There is no flexibility as elasticity in the ligaments and the intervertebral disc is lost. Even a relatively minor blow can produce severe pain the neck. Take the example of the driver whose head is thrown back when his car is hit from behind. If the cervical spine is degenerated, then he will get severe pain in the back and perhaps paralysis.

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