Osteoporosis could be cause of neck deformation


DEAR DR. ROACH: One day, I woke up and my neck was bent forward. Now my chin almost touches my chest. How much worse can this get? One doctor said he may have to break my neck and reset it. I can’t look people in the face anymore; I’m looking at their belt buckle. — R.W.

ANSWER: I can think of several reasons why your neck may be bent forward. One is a muscle problem. A severe muscle spasm in the neck can force the neck into an unnatural position, often very painful to move. This can go on for weeks. However, most people can force their neck into a normal position.

The second is a nerve problem. Cervical dystonia is the most important of these. Dystonia can present itself with the neck pointing to the side, forward or backward. It typically gets better and then worse, and is associated with sustained muscle contractions.

What the doctor said about “breaking your neck” doesn’t make sense to me in any possibility. However, since your doctor has suggested a possible spine surgery, the third, and most likely cause, is a skeletal problem. Kyphosis is the term for an abnormal forward deformity of the spine (as opposed to scoliosis, which is to the side). There are numerous causes, but in older men, the most likely is osteoporosis, which can cause very severe kyphosis, especially when in conjunction with vertebral fractures. I wonder if you had a vertebral compression fracture that made things suddenly worse.

Unfortunately, surgery for kyphosis has a very high complication rate and shouldn’t be considered unless you are facing serious impediments, such as difficulty breathing or intractable pain. The best treatment is an exercise program. An orthopedic surgeon or physiatrist could make precise recommendations for your physical therapist.

DEAR DR. ROACH: What can be done to slow down glaucoma? Mine went from bad to worse. Isn’t there any medication or surgery to stop it? — A.H.

ANSWER: Glaucoma is an eye disease caused by damage to the optic nerve, usually due to elevated pressure inside the eye. There are several types of glaucoma, but the most common in older adults is open-angle glaucoma, where the pressure inside the eye is high, probably due to increased fluid production combined with decreased outflow. Acute closed-angle glaucoma is a surgical emergency.

Open-angle glaucoma, on the other hand, can and should be treated in order to prevent progressive loss of vision. Reducing the pressure inside the eye reduces the risk of vision loss. This can be accomplished through medication — usually drops such as prostaglandins, which increase fluid outflow, or other drops like beta blockers, which reduce fluid production. Some drops, like alpha blockers, do both, but those tend to have more side effects than other treatments. Glaucoma also may be treated with laser therapy or surgery. Surgery is not usually the initial treatment due to a higher risk of complications, but laser treatment is sometimes first-line. No matter what treatment is used, people with glaucoma need careful follow-up with the ophthalmologist. Primary-care doctors, like myself, should make sure that our patients are using their drops (if appropriate) regularly and seeing their ophthalmologist, since there can be problems with compliance, especially in a usually asymptomatic condition like glaucoma.

READERS: The booklet on heart attacks, America’s No. 1 killer, explains what happens, how they are treated and how they are avoided. Readers can order a copy by writing: Dr. Roach — No. 102, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

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