Singapore - Safeguard your spine

Extended hours spent in front of your computer is not only bad for your eyes and posture but it can also be detrimental to your spine.

Doctors are seeing more younger people with cervical spondylotic myelopathy (CSM), which used to only affect the elderly.

The reason? We spend longer hours at our desks in front of the computers or with notebooks on our laps. Most chairs are not ergonomically designed for our tasks and this causes anxiety which builds up pressure in our neck and back from incorrect posture.

Young people are also increasingly engaged on their mobile devices for long hours, causing undue strain and pain in these same areas.

Myelopathy happened when the central disc herniates (bulges out of position) and compresses the spinal cord.

The typical symptoms are weakness and clumsiness of the hands, feeling of "pins and needles" in the hand and gait disturbances (patients walk with their feet far apart).

One typical example of a symptom is when patients find it difficult to carry out simple tasks such as buttoning their shirts or using chopsticks.

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Universiti Kebangsaan Malaysia Medical Centre, an orthopaedic consultant and spine surgeon Mr Shaharuddin Abdul Rhani says many Malaysians are not aware of CSM which can affect the arms and hands, legs, bowels and bladder function.

He explains that the spinal cord is a bundle of individual nerve fibres beginning at the base of the brain and continues through the bony canal of the neck and chest portions of the spine ending near the lower back.

"The spinal cord carries the neural impulses to the regions of the body. In the upper cervical spine, the spinal cord contains fibres that transmit impulses to the arms, chest, and legs," he says. The clinical syndrome that results from a disorder in the spinal cord which disrupts or interrupts the normal transmission of the neural signals is known as "myelopathy".

He says although there are many causes of CSM, the common ones are trauma, congenital, inflammatory or autoimmune disorders, viral processes, tumour or degenerative processes, including spondylosis and intervertebral disc herniation.

"The cervical spinal canal may become narrowed over time due to degenerative changes within the spine. Bone spurs (osteophytes), disc bulges, and thickened ligaments may develop and encroach on the spinal canal," he says.

Compromised spine

In some cases, he adds, the space normally surrounding the spinal cord may be severely compromised and pressure on the spinal cord occurs.

Dr Shaharuddin says: "Over time, the normal wear-and-tear effects of ageing can lead to a narrowing of the spinal canal. This compresses or squeezes the spinal cord. CSM commonly affects persons more than 50 years of age and can be seen in both genders."

He adds that the progression of the symptoms varies from person to person, although there is no certain way to predict the natural history of CSM in an individual.

Asked on diagnosis of CSM, he says it is usually based on the patient's history and examination and radiographic studies that confirm critical cervical stenosis (narrowing of the spinal canal) with compression of the spinal cord. Reflexes will also be tested to see if there is a weakness of the arms and loss of sensation in the fingers.

He says post-myelography computed tomography (myelo-CT) or magnetic resonance imaging (MRI) may also be used to obtained high-resolution images of the cervical spinal canal and the spinal cord. CSM is treated by removing pressure from the spinal cord. If the degeneration is caught at the early stages, then exercises to strengthen the neck, physiotherapy and wearing soft collars can provide relief from the condition.

Normally, surgery is performed to prevent the progression of symptoms. Clinical improvement may or may not occur.

Occupational hazard

In recent years, Dr Shaharuddin has been seeing more younger patients, mainly office workers, coming in with CSM and this he attributes to poor posture, staring at the computer screen for three hours or more.

He advises keeping our head and neck as straight as possible, positioning the screen level with the eye. The screen should also be about one arm's length away to reduce the strain on the eye and the neck.

Other than this, Dr Shaharuddin also attributes CSM to wearing helmets that are too heavy as this causes undue stress on the neck.

Ultimately compression of the spinal cord can occur. As such, he advises motorcyclists to invest in lightweight helmets to reduce the risk of CSM.

"As a surgeon, I too sometimes feel the strain on the neck when I am required to look downwards during prolonged surgery. I usually go for physiotherapy for relief," confesses Dr Shaharuddin.

Reduce the risks

According to Mayo Clinic in USA, you may not be able to prevent CSM. However, you may be able to reduce your risk by following these suggestions:

-       Get regular physical exercise, following just about any fitness programme that suits you after consulting with the physiotherapy.

-       No high-impact activities, such as running, jumping or jogging if you have any neck pain. Do brisk walking.

-       Practice neck exercises to maintain neck muscle strength, flexibility and range of motion.

-       Take breaks when driving, reading, typing or watching TV or working on a computer to keep from holding your head in the same position for long periods (20-30 minutes interval).

-       Practice good posture, with your neck aligned over your shoulders and maintain a straight back posture.

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Protect your neck from injury by using a seat belt when in a car.

CSM is degeneration of the spine (in the neck region) which disrupts signals sent through the spinal cord. As the spinal cord is compressed, the supply of blood to the nerves which control other parts of the body is ultimately affected.

Sharon Cheah

New Straits Times