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Signs and Symptoms
Like lower back pain, neck pain (also referred to as cervical pain) affects a large portion of the population. Neck pain is commonly associated with dull aching, but can sometimes be described as other symptoms, such as numbness, tingling, tenderness, sharp shooting pain, fullness, difficulty swallowing, pulsations, dizziness, and gland swelling. For most people with acute neck pain, symptoms will resolve within four to six weeks with some simple treatments. Neck pain that lasts for longer than 6 weeks-3 months is no longer termed acute neck pain, but rather chronic neck pain.
Causes of Neck and Shoulder Pain
Neck pain can be due to a variety of causes. Cervical degenerative disc disease (spondylosis, arthritis) may manifest itself as neck pain and/or arm pain (as a result of a “pinched nerve”). The cervical discs act as shock absorbers between the bones in the neck (vertebrae). With aging or a specific injury (acute or chronic) the discs may become dehydrated, degenerated and lose their biomechanical properties that allow them to do their job. As the discs degenerate they may lose their height and/or cause a disc bulge or a disc herniation. This in turn may lead to the joints in the neck (facet joints) to become arthritic and form bone spurs. The ligaments in the cervical spine may also in turn change in composition and become calcified and thickened.
All these processes may manifest in different conditions depending on the anatomy of the individual patient.
Herniated disc (disk), pinched nerve, bulging disc (disk) and bone spurs all may cause a cervical radiculopathy. Cervical radiculopathy is pain, numbness and/or weakness along a specific nerve root that is being irritated by the disease process. Cervical myelopathy is a more serious condition that is caused by compression of the spinal cord itself (rather than the nerve root) and an internal damage to the spinal cord “wiring.” Cervical myelopathy may or may not be accompanied with neck pain, but the main symptoms involve overall motor dysfunction.
Diagnosis of Neck Pain
To diagnose your neck pain, your physician will review your medical history of symptoms and/or past injury, and perform a complete physical examination to determine the location, intensity, duration, and radiation of the pain you are experiencing. Additional diagnostic tests may include a CAT scan, bone scan, MRI scan, myelogram, and electrical tests like an electromyography (EMG) and nerve conduction velocity test (NCV).
Mild to Severe Neck Pain Treatment
The objective of back surgery is to reduce pain by changing the spine’s anatomy. Before a spinal surgery is performed, the doctor must identify the anatomical lesion (injury) that is the probable cause of the back or neck pain. The primary reason back surgeries are not effective and some patients experience continued pain after surgery is because the lesion that was operated on may not, in fact, be the cause of the patient’s pain. In order to find the exact cause of pain, we use advanced testing methods, the highest quality X-rays, MRIs, and CT scans, as well as very specialized diagnostic injections. Despite all diagnostic tests and narrowing the diagnosis as much as possible, patients looking into surgery for pure back pain need to know that there is a percentage of patients that will not improve from surgery despite all appropriate workup, treatment and post operative course.
Treatment for Failed Back Surgery Syndrome
For the most part, patients should exhaust non-operative modalities prior to considering spinal surgery as treatment to find neck pain relief. Physical therapy, anti-inflammatory medications, exercises, and certain activity modifications are shown to alleviate symptoms for most patients with acute neck pain. Certain conditions that cause neck pain such as spinal tumors, fractures and myelopathy may require more urgent intervention. It is important to seek advice from a physician that has all the diagnostic and treatment capabilities in order to make the best choice. A fellowship trained spine surgeon (orthopedic surgeon or a neurosurgeon) who devotes all of his/her time to the treatment of spinal conditions has the latest tools and techniques to allow for the best treatment of spinal conditions. |
