Although neck pain is not nearly as common as low back pain, approximately 50 percent of people will experience a significant episode of neck pain in their lifetime. Neck pain is more common in sedentary individuals, especially those who work at a desk
and/or computer station. Fortunately, the prognosis for patients with neck pain is excellent, since well over 90 percent of patients with neck pain improve with conservative (non-surgical) treatment.

How is it diagnosed?

A list of possible diagnoses is developed before and especially after all of the symptoms, physical findings, imaging studies, and laboratory tests are analyzed. Often, there is one diagnosis that can be firmly established if all of the appropriate examinations and studies were performed. Some diagnoses include:

Mechanical Conditions

  • Strain
  • Sprain
  • Annular Tear (disc tear)
  • Herniated Disc

Degenerative Conditions

  • Degenerative Disc Disease
  • Facet Arthropathy (joint pain)
  • Spinal Stenosis

Inflammatory Conditions

  • Rheumatoid Arthritis
  • Ankylosing Spondylitis (chronic inflammatory arthritis)

Infectious Conditions

  • Discitis
  • Osteomyelitis
  • Epidural Abscess (Pyogenic, Tuberculous, Fungal)

Traumatic Conditions

  • Fracture
  • Subluxation
  • Dislocation

Oncologic Conditions

  • Benign or Malignant Spine Tumor
  • Metastatic Spine Tumor

Congenital Conditions

  • Klippel-Feil syndrome

Idiopathic Conditions

  • Unknown causes

Psychogenic Conditions

  • Psychiatric disorders with manifestation of neck pain

What are the treatment options?

Treatments for neck pain, like those for many medical conditions, can be conservative (non-operative) or surgical. Conservative, noninvasive treatments are generally the first treatments recommended to patients since most conditions affecting the spine are self-limited and improve or completely resolve with these treatments. Spinal injections and surgical treatments are only considered if the diagnosis is amenable to surgery and non-operative treatments have failed. Rarely, some spinal conditions are more serious (fractures, cancer, etc.) and require immediate surgical management.

  • Rest or Activity Reduction
  • Oral Medications
  • Topical (Ice packs, heat, ointments, etc.)
  • Orthotics (Back brace, corset, etc.)
  • Yoga or Pilates exercises
  • Massage
  • Physical Therapy
  • Chiropractic Manipulation
  • Sauna or Whirlpool
  • Modalities, including ultrasound, phonophoresis (ultrasound to apply drugs) and iontophoresis (a kind of electrical stimulation used to administer medication)
  • Transcutaneous electrical nerve stimulation (TENS)
  • Interferential Unit (electrical nerve stimulation)
  • Traction
  • Acupuncture
  • Facet Joint Injections
  • Epidural Steroid Injections

What is it?

Anterior cervical discectomy and fusion is the most common neck surgery performed by spine surgeons. It is performed to remove a portion of the intervertebral disc, the herniated or protruding portion that is compressing the spinal cord and nerve root. However, in order to do so generally involves removing nearly the entire disc, which must be replaced with a piece of bone graft and fused together to maintain stability.

Who should have it?

Anterior cervical discectomy and fusion (ACDF) is performed for patients with a symptomatic, painful herniated disc in the neck.

Post-Operative Care

  • In-patient physical and occupational therapy during the first one to two days after surgery
  • No excessive bending and twisting of the neck in the first two to four weeks after surgery
  • Gradual bending and twisting of the neck after two to four weeks as the pain subsides and the neck and back muscles get stronger
  • No heavy lifting in the first two to four weeks after surgery
  • Use of a soft cervical collar or a padded, plastic neck brace in the first few weeks and months after surgery to reduce stress on the neck area, improve bone healing and decrease pain

What is it?

Anterior Cervical Corpectomy and Fusion removes large, arthritic osteophytes (bone spurs) that compress the spinal cord and spinal nerves. However, in order to do so generally involves removing nearly the entire vertebral body and disc, which must be replaced with a piece of bone graft and fused together to maintain stability.

Who should have it?

Anterior cervical corpectomy and fusion (ACCF) is performed for patients with symptomatic, progressive cervical narrowing of the spinal canal (stenosis) or damage to the spinal cord through compression (myelopathy).

Post-Operative Care

  • In-patient physical and occupational therapy during the first four to five days after surgery
  • Avoid bending and twisting of the neck as well as heavy lifting in the first four to six weeks after surgery
  • Gradual bending and twisting of the neck after 6–8 weeks as the pain subsides and the neck and back muscles get stronger
  • No heavy lifting in the first three to four weeks after surgery
  • Use of a padded, plastic neck brace or cervicothoracic (neck and chest) brase in the first few weeks and months after surgery to reduce stress on the neck area, improve bone healing and decrease pain

What is it?

A microscopic posterior cervical foraminotomy is an innovative technology that uses a small poke-hole incision to accomplish cervical decompression. Since it involves minimal tissue dissection, it can be performed in less time, with less tissue damage and less pain than traditional open cervical spinal surgery. It can also result in a faster recovery.

Who should have it?

A microscopic posterior cervical foraminotomy is performed for patients with a symptomatic slipped disc with nerve compression occurring at one or two levels of the spine. It is performed to remove the large, arthritic bone spur(s) and a portion of the herniated disc(s) that are compressing the spinal nerves. A microscopic posterior cervical foraminotomy is favored for patients with a small or moderate herniated disc and nerve compression at one or two levels, yet it is not recommended for patients with cervical kyphosis (abnormal curvature of the neck), severe neck pain or large herniated discs.

Post-Operative Care

  • In-patient physical and occupational therapy during the first one to two days after surgery
  • No excessive bending and twisting of the neck in the first one to two weeks after surgery
  • Gradual bending and twisting of the neck after two to three weeks as the pain subsides and the back muscles get stronger
  • No heavy lifting in the first three to four weeks after surgery
  • Possible use of a soft cervical collar in the first few weeks and months after surgery to reduce stress on the neck area and decrease pain

What is it?

Laminaplasty is a unique posterior (back of the neck incision) cervical surgery performed to open and increase the space for the spinal cord and nerves.

Who should have it?

It is commonly performed for patients with symptomatic, progressive cervical spinal narrowing (stenosis) and compression (myelopathy) when the majority of spinal compression is in the posterior aspect of the spinal cord. However, laminaplasty is typically not recommended for patients with cervical disc herniation(s), curvature deformity or instability.

Why should I consider it?

The primary advantage of a laminaplasty is that it does not involve placing a large strut graft and fusing multiple spinal levels together, as compared with an anterior cervical corpectomy and fusion. Although cervical laminaplasty may provide slightly better surgical results with a lower complication rate than anterior cervical corpectomy and fusion, not all patients with cervical spondylotic myelopathy, or spinal cord compression in the neck, are appropriate candidates for this procedure.

Post-Operative Care

  • In-patient physical and occupational therapy during the first three to five days after surgery
  • No excessive bending and twisting of the neck in the first four to six months after surgery
  • Gradual bending and twisting of the neck after six to eight weeks as the pain subsides and the neck muscles get stronger
  • No heavy lifting in the first four to six weeks after surgery
  • Use of a padded, plastic neck brace or cervicothoracic (neck and chest) brace in the first few weeks and months after surgery to reduce stress on the neck area, improve bone healing and decrease pain

What is it?

Posterior Cervical Fusion (PCF) is the general term used to describe the technique of surgically mending two or more cervical spine bones together along the sides of the bone using a posterior (back of the neck) incision. Bone graft is placed along the sides the spine bones, which over time, fuse together. PCF may be performed in conjunction with or without a posterior decompression (laminectomy) and/or use of metal screws and rods. Metal screws and rods are almost always used to add immediate stability and increase the successful bone fusion.

Who should have it?

PCF is most commonly performed for patients with cervical fractures or instability, but is also performed for a variety of other spinal conditions, such as tumors, infections and deformity. PCF may also be performed in conjunction with anterior cervical surgery, especially when multiple vertebrae levels are involved.

Post-Operative Care

  • Physical and occupational therapy during the first three to five days after surgery
  • No excessive bending and twisting of the neck in the first one to two months after surgery
  • Gradual bending and moving of the neck after two to three weeks when the fusion solidifies and the pain subsides
  • No heavy lifting in the first two to three months after surgery
  • Use of a neck brace after surgery to reduce stress on the neck area, improve bone healing and decrease pain

What is it?

Artificial disc replacement (ADR) is a type of spinal disc procedure that utilizes an anterior approach, or one through the abdominal region, to replace a painful, arthritic and worn-out intervertebral disc of the lumbar spine with a metal and plastic prosthesis.

Who should have it?

Artificial disc replacement is primarily considered for patients with isolated 1-level (one disc only) degenerative disc disease. Prior to the development of ADR, spinal fusion was the principal treatment for painful degenerative disc disease that failed to improve with nonoperative management. ADR is generally NOT recommended for patients with spinal fractures, instability, neurologic compression or multiple level degenerative disc disease. Spinal fusion remains the treatment of choice for these conditions.

Why should I consider it?

The advantages of ADR include a faster recovery time than spinal fusion and preserved motion at the disc level.

Post-Operative Care

  • In-patient physical and occupational therapy during the first two to four days after surgery.
  • No bending at the waist, lifting (more than five pounds) and twisting in the first two to four weeks after surgery to avoid a strain injury
  • Gradual bending, twisting and lifting after four to six weeks as the pain subsides and back muscles get stronger
  • If necessary, use of a small, soft lumbar corset to provide additional neck or back support after surgery
  • Anterior or Posterior Cervical Osteotomy
  • Cervical Laminectomy

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