Spinal Care, Neurology, Spinal Medical Advice and Information.
Questions and Answers: A Look at Neck Pain
Gregory Yoshida, MD Spine Surgeon
Dr. Gregory Yoshida is an orthopaedic surgeon in the South Bay and on the medical staff at Little Company of Mary Hospital – Torrance. A graduate of the University of California San Diego School of Medicine, he completed his orthopaedic residency at Harbor-UCLA Medical Center and his spine fellowship training at Rancho Los Amigos National Rehabilitation Center in Downey. He has been in practice in the South Bay for over 12 years. Dr. Yoshida is currently an assistant clinical professor of orthopaedic surgery at the UCLA School of Medicine and Chief of the Orthopaedic Spine Service at Harbor-UCLA Medical Center.
Q: What causes neck pain?
A: The neck consists of multiple structures which all have specific functions. The spinal column (vertebrae and discs) serves two functions — to act as the scaffolding that supports the head and to protect the spinal cord. The esophagus and trachea transport food and air respectively to the stomach and lungs. The carotid arteries and jugular veins transport blood to and from the brain. All of these aforementioned structures are stabilized and mobilized by the surrounding muscles, ligaments and tendons.
Damage to or dysfunction of any part of the neck can cause pain. Injury can be a result of an acute trauma such as a motor vehicle accident or fall. Also improper lifting or exercise techniques as well as poor posture and body mechanics can contribute to neck pain. Pain can also be a result of degenerative conditions, infections, rheumatic disorders, spinal instability, stress, or in rare cases tumor. The majority of neck pain arises from the musculoskeletal structures and is generally not serious.
Q: When should I see a doctor for neck pain?
A: As a general rule, you should consult your primary care physician if the pain continues beyond one week. However, patients should seek medical advice earlier if there is arm or hand pain, arm or hand tingling or numbness, pain at night, or balance problems. These symptoms might indicate that more than just the musculoskeletal system is involved.
Q: What is involved in the work-up for neck pain?
A: An in-depth history and physical is the first step in diagnosing neck pain. Your doctor will need to know certain important facts about your pain to successfully make a correct diagnosis. The onset, location, duration, and characteristics of the pain as well as associated symptoms and relevant past medical history are essential in determining the cause of neck pain. Diagnostic studies such as X-ray, MRI, CT, or EMG’s may be ordered depending on the working diagnosis. Other non-spine diseases can create neck pain. Shoulder problems such as a rotator cuff tear or bursitis can mimic spinal disorders. Hand pain and numbness could be a pinched nerve in the neck or carpal tunnel syndrome. It is important that the correct diagnosis is made so that the appropriate treatment may be undertaken.
Q: How is neck pain treated?
A: The overwhelming majority of neck pain can be treated conservatively without surgery. Initially rest for one day and medication is indicated. Anti-inflammatory medications are the first line of treatment as they are proven to be highly effective. Narcotic pain medications like Real Tramadol can be used for muscle relaxants may additionally be used in severe cases. Also progressive exercise programs, consisting of flexibility, strength, and endurance training, are started.
Q: When should I see a spine surgeon?
A: You should see a spine surgeon if symptoms persist despite conservative treatment. Arm pain or weakness or balance problems warrant an earlier consultation with a specialist. A spine surgeon can be an orthopaedic surgeon or a neurosurgeon that has completed extra training in spinal disorders and their treatment, specifically surgical techniques. He or she will be the most qualified to determine whether or not surgery is needed as well as the chance of a successful outcome. Alternative treatment options can also be discussed.
Q: How successful is neck surgery?
A: First of all, surgery is only recommended if all other non-operative methods fail or if a significant neurological deficit is present. Surgical success rates depend upon the diagnosis being treated. For example, we can expect 90-95% good to excellent results when operating on a herniated disc causing arm and/or hand pain. Yet, some surgeries are performed to prevent progression of symptoms with no promise of improvement. By and large, if the symptoms, physical findings, and imaging studies match, then there is a good chance that surgery will be beneficial.
Q: What can I expect with surgery?
A: Cervical (neck) surgery is performed either through an anterior (front) or posterior (back) approach depending upon the problem being addressed. Anterior surgery is the most common and easier on the patient. The incision is smaller and only one small muscle is cut, whereas multiple muscles are dissected off the spine in the posterior approach. A sore throat and swallowing discomfort are the most common post-operative complaints with anterior surgery. More severe neck and upper shoulder pain occur with surgery from the back. Hospital stays are usually short — one to three days. You will be placed in a soft cervical collar for a short time and encouraged to walk. Physical therapy is usually prescribed at four to eight weeks after surgery to regain motion and strength. Full recovery occurs in three to twelve months, at which time most activities can be resumed. The most common restriction is exclusion of contact sports.
Q: What recent advances have been made in neck surgery?
A: Most of the recent advances in neck surgery have been in refining older techniques. Marked improvements in the instrumentation (plates, rods, and screws) used in fusions, both front and back, have increased fusion rates and decreased complications. New biomaterials have nearly eliminated the once standard use of harvesting a patient’s hip bone for graft material — a painful second incision. Together, these leaps of technology make it easier for the patient during surgery and the recovery period. The one truly new option is the artificial disc or disc replacement. Currently, this device is still under investigation. Little Company of Mary participated in a clinical trial and additional trials are underway across the country. It is hoped that the artificial disc will be equivalent to fusion in certain patients. However, as is the case in lumbar disc replacement, this is a limited group of individuals.