What a pain in the neck!

Approximately 10% of adults have neck pain at any one time. There are many possible causes, but it’s often difficult to determine with certainty what’s causing the pain.

The most common causes include:

• Cervical strain is caused by injury, which is realized as spasms of the muscles of the cervical spine and upper back.

• Cervical spondylosis is caused by degenerative changes of the cervical spine. Wear and tear causes narrowing in the disc space, a loss of the normal shape of the bone and growth of bone spurs.

• Cervical discogenic pain is very common and caused by changes in the structure of the cervical intervertebral disc(s). Symptoms commonly occur when turning or tilting the head.

• Cervical facet syndrome affects the facet joint, located on the left and right side of the vertebra. Injuries in this area present as whiplashrelated neck pain, headaches, and in cases where a person has a job that includes repetitive extension of the neck.

• Whiplash injury

• Cervical myofacial pain is a result of tightness or tenderness of muscle.

• Cervical radiculopathy occurs when a nerve root is irritated by a protruding disc, arthritis of the spine or a mass that compresses the nerve. Herniation of a disc is the most common cause.

A majority of patients respond to nonsurgical treatment of neck pain. For more information we talked to Todd Albert, M.D., of Hospital for Special Surgery (HSS).

What type of cases do you recommend surgery, rather than non-surgical alternatives, as a first line treatment?

Todd Albert, MD

If there is a suspicion of a tumor or infection (red flags include fever or weight loss), an early MRI should be done to confirm the diagnosis, and then surgery should be performed.

If there is evidence of spinal cord compression, “cervical myelopathy” surgery should be considered as a first line approach. Symptoms of the myelopathy can include numbness, tingling, significant weakness, balance issues or bowel or bladder dysfunction.

If a patient has been undergoing treatment with a physiatrist without improvement, at what point do you recommend surgical treatment?

Most causes of cervical pain will resolve within six weeks to three months without surgical intervention. There are several situations when surgery may be considered earlier. If the pinched nerves have caused a C5 palsy, which affects the muscles of the shoulder, this can be a very disabling condition. Similarly, a C8 palsy affecting hand muscles can also be disabling if it occurs in the dominant hand. Small muscles of the hand do not recover as well as larger muscles.

What are the risks of these procedures?

Anterior cervical decompression and fusion is a very safe procedure with a greater than 90% success rate. The most common risk is that of short-term swallowing dysfunction, which resolves in the majority of patients. There is about a 1-2% non-healing rate with a one-level fusion.

SUSAN LOCKE, MD, is Healthnetwork Foundation’s medical director.

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