The neck is made up of a set of structures that play a fundamental role in supporting, moving and protecting the spinal cord. These structures include muscles, ligaments, fascia, intervertebral discs and vertebrae.

To understand the anatomy of the cervical spine it is necessary to take into account two pillars and two segments:

• Previous pillar: includes the vertebral bodies, intervertebral discs, the anterior longitudinal ligament, and the posterior longitudinal ligament.
• Posterior pillar: It encompasses the posterior bony structures of the neural arch, the facet joints and ligamentum fravus, the interspinous ligament and supraspinous ligament, and the musculature.
• Upper segment (C1-C2): It is responsible for providing flexion, extension and rotations.
• Lower segment(C3-C7): It is responsible for flexion, extension and rotations, as well as providing support and transmitting axial load.

When the cervical spine is observed from the front (anteroposterior view), a straight configuration is seen, but in lateral projection it presents a curvature with anterior convexity (lordosis), providing the spine with more harmonious and elastic mobility.

It is important to note that the area of the C4 and C5 vertebrae experiences greater stress, making it one of the most injury-prone areas.

cervical sprain occurs when the neck experiences a sudden movement, usually due to hyperextension (neck back) or hyperflexion (neck forward). These movements can cause excessive elongation or stretching of ligaments, muscles, joint capsules, and in some cases, compression or rupture of the annular fibers of the intervertebral disc. These stresses on the structures of the neck sometimes result in injuries that generate cervical sprain symptoms. It is important to highlight that cervical sprain is the most frequent consequence of rear-end traffic accidents.

Degrees of cervical sprain

Cervical sprains are classified into different degrees, ranging from less severe to more severe:

• Zero degree: The patient does not experience neck pain.
• First grade- There may be mild pain in the neck and head, but it does not significantly affect daily life.
• Second grade: Moderate neck pain (cervicalgia) occurs with difficulties in moving the neck and discomfort in certain points.
• Third degree: at this level, the patient suffers a neurological injury.
• Fourth grade: This grade is diagnosed when there is a fracture or dislocation, usually caused by severe trauma.

The main symptoms of cervical sprain include neck pain and a painful limitation in neck mobility. Over time, this limitation can evolve into cervical rigidity and is accompanied by vertigo or dizziness.

In cases where a rupture of the annulus fibrosus occurs, the nucleus pulposus can herniate and compress a nerve root, resulting in pain that radiates to the arm and hand (cervicobrachialgia) or in neurological disorders with abnormal sensations of tickling or changes in temperature (paresthesias).

Age, sex and physical constitution can influence the severity of symptoms. For example, women with less muscle mass or people over 50-55 years of age with degenerative spinal disorders (cervical osteoarthritis) may experience worsening and prolonged pain.

Symptoms can appear early, but more often they develop over a period of days.. The duration of the symptoms varies depending on each case, and it is common for some of the disorders to gradually improve over weeks or months. In more prolonged cases, psychological discouragement may arise that can lead to depression.

Finally, in high-energy trauma situations, more extensive tears may occur in the ligaments and joint capsules, which can lead to subluxations of the vertebrae or fractures of the vertebral body. These are more serious injuries and require urgent attention from a specialist.

To diagnose a cervical sprain, it is essential to carry out a detailed medical history and an exhaustive examination carried out by our traumatologists specialized in cervical sprains in Madrid. Additional diagnostic tests that are usually necessary include:

• simple radiology: This test involves posteroanterior and lateral projections. Additionally, in some cases an oblique and transoral projection is also required. Carrying out these studies helps to identify alterations in the physiological curvature of the spine, as rectification of cervical lordosis or cervical kyphosis, osteoarthritis degenerative signs that can exacerbate the clinical picture, and allow rule out subluxations or vertebral fractures that involve an urgent assessment by a specialist.
• Magnetic resonance: This study provides information on possible affections in the soft tissues of the neck (muscles, ligaments, joint capsules or intervertebral discs). In addition, it allows us to discriminate whether there is structural compression of a nerve due to disc herniation, inflammation in the soft tissues or edema in the vertebral bodies.
• Electromyography: Electromyography uses electrodes to analyze the functioning of peripheral nerves and the muscles to which they transmit stimuli. It suggests compression of the exit of a peripheral nerve, mainly due to a cervical hernia. When there is compressive nerve injury, it is used to monitor recovery from compressive nerve involvement.
• Computed axial tomography (CAT): This test is used to evaluate alterations in the bone, such as fractures or dislocations. Provides multiple millimeter cuts in different axes (sagittal, coronal and axial) and 3-dimensional reconstruction of the vertebrae of the spine
• Dizzying studies: When the patient suffers vertiginous alterations or dizziness, evaluation with vestibular tests by the otorhinolaryngologist is necessary.

In the context of cervical sprain, it is crucial to establish clear differences between the terms associated with this pathology:

Cervicalgia

It is a symptomatic concept and means cervical pain. It does not indicate a specific injury, as it is based on the patient's description of the pain. Neck pain can be chronic, meaning that pain persists continuously in the region of the neck, head, or other surrounding areas.

whiplash

It indicates that a flexion-extension mechanism has occurred on the cervical spine but does not allow a diagnosis of the injuries produced. Generally, the origin is post-traumatic due to a car accident.

When whiplash occurs and as a consequence you suffer neck pain, neck stiffness or dizziness, it is very complex to distinguish which anatomical alteration has occurred and is causing the discomfort.

The most common symptoms of whiplash are mainly neck stiffness or dizziness. It is very complex to distinguish which anatomical alteration has occurred and is causing the discomfort.

Whiplash does not present sequelae in most cases, the patient will have to follow treatment for a successful recovery.

Cervical discopathy

This condition occurs when one of the discs in the spine is damaged, causing pain in the patient. Although it may share symptoms with cervical sprain, it is a different condition that directly affects the intervertebral discs of the cervical spine.

The patient's attitude plays a crucial role in recovery from a cervical sprain. Maintaining a positive state of mind and being committed to the recovery process are essential to achieving rapid clinical improvement.

When there are no serious injuries, such as dislocations or additional cervical fractures, Prolonged rest should be avoided, which should not exceed two days. Generally, the use of neck braces is usually counterproductive, since excessive immobilization of the neck muscles can cause failure due to atrophy.

The focus should be on maintaining a normal life, continuing with usual activities and gradually regaining neck mobility.

In the case of cervical or muscle contractures, medical treatment usually includes anti-inflammatories – analgesics and muscle relaxants.. Likewise, the application of local heat can help relax muscles and improve blood flow through vasodilation, helping to eliminate substances accumulated by soft tissue injuries such as histamine and prostaglandins.

Starting from the first week, it is possible to combine active progressive mobility exercises with physical rehabilitation.

If the process progresses with vertigo or dizziness, the use of antivertigin drugs may be necessary.. If this situation continues, evaluation by the otorhinolaryngologist and/or neurologist is important to diagnose or rule out alterations that may have occurred in the vestibular system or the nervous system.

Antineuritic drugs are only used in situations where there is compression of a peripheral nerve, such as in the case of a cervical hernia. These cases are characterized by cervicobrachialgia, which translates into cervical pain that radiates to the arm or hand, accompanied by neuropathic symptoms such as paresthesias, muscle atrophy or weakness.

When symptoms persist and gradual improvement is not observed, the patient may experience discouragement and depression, which may require psychological and/or psychiatric treatment.

Do not hesitate to visit our spine clinic in Madrid, where we offer the most advanced techniques for the treatment of cervical sprain.

Recovery after cervical treatment or surgery is a crucial process that requires patience and specific care.

After the intervention, it is essential that patients strictly follow medical instructions. This includes, in some cases, keeping the area immobilized, performing rehabilitation exercises if recommended, and taking prescribed medications for pain and inflammation.

The length of recovery may vary depending on the severity of the treatment or surgery, as well as each patient's individual response. Regular medical follow-up is essential to ensure a successful recovery in the shortest time possible.

The consequences of a cervical sprain can manifest themselves in various ways and, sometimes, can last for a prolonged period..

Importantly, while many patients make a full recovery, others may experience ongoing symptoms, including neck pain, stiffness, headaches, and dizziness.

Treatment to address these sequelae generally involves physical therapy, strengthening exercises, and pain management techniques. It is crucial that patients follow medical recommendations and seek care if symptoms persist or worsen., as an early approach to treatment can prevent long-term complications.