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Neck Pain: When to Worry

As a surgeon who treats only spinal disease, I see patients all day in the office with neck and low back pain. Many of them suffer quietly for years before seeking any explanation or help. Oftentimes, I find myself wishing that they hadn't waited so long to come find me.

Studying data on human neck (cervical spine) pain, the simple truth is this; there is a very good chance you are going to have neck pain at some point in your life. It is rarely is bad enough to cause you to stop enjoying your day, and it normally goes away on its own within days, weeks, or sometimes a few months. Neck pain is usually not dangerous, and is normally treated quite well with anti-inflammatory medications (like ibuprofen), physical therapy, chiropractic care and lifestyle modifications. Sometimes simply adjusting the placement of your computer monitor is enough to cause it to be relieved. Sometimes a series of chiropractic adjustments is enough to correct subluxations and relieve your neck pain.

But is neck pain ever part of a dangerous problem? What are the signs that it is more than a pulled muscle or a neck out of alignment? When is that neck pain the sign of a serious problem that needs a surgeon's attention promptly?

If there are symptoms in addition to the neck pain, there may be a real problem. The most common additional symptoms that I consider possible "red flags" include the following:

1) pain shooting uncomfortably into the arms, hands, shoulder blades or further down the back

2) numbness or weakness in the hands, arms or shoulders

3) balance issues or coordination problems in the hands

4) bladder or bowel function changes

5) pain from significant trauma such as a motor vehicle collision or a fall

6) pain so severe or long-lasting you find it hard to complete simple daily tasks.

These additional symptoms are associated with "neurologic compression"; most commonly a herniated disc or bone spurs pushing on the sensitive nerves or more sensitive spinal cord. While many of the medical and chiropractic treatment options can still benefit you when you have these additional symptoms, getting an accurate and specific diagnosis of what is causing your pain becomes very important.

Neurologic compression gone wrong has consequences that are serious, permanent and potentially debilitating. Paralysis of muscles can be crippling, making you reliant on wearing braces and taking away your physical fitness. Numbness and clumsiness in fingers may take away away your ability to write, grip or perform your job properly. Longstanding (and sometimes irreversible) pain can lead to depression and addiction to drugs.

In scenarios like these, surgery of the cervical spine may be recommended. While prudence is important, there is benefit to be had from stopping a problem well before it becomes a disaster. Surgery most commonly result in an immediate reduction in the symptoms that arise from compression of the nerves and spinal cord.

There are many varieties of surgical procedures for the neck, but nearly all share the intention of performing "decompression", or the lessening of the pressure upon the nerves or spinal cord.

Foraminotomy is the smallest procedure, and involves the creation of a small window, relieving the underlying nerve compression.

Cervical fusion is the most common neck procedure performed, as it has the ability to relieve much more compression by removing a whole joint (most commonly the disc) of the neck.

Some people may be candidates for a newer procedure that relieves as much compression as a fusion, but doesn't involve bone grafting or screws. This is the so called "disc replacement" operation, where I place a small articulating spacer in the disc space, quite similar to a knee or shoulder replacement.

If you think that you or a loved one's pain is more than just "bothersome", and especially if you have any of the additional symptoms listed above, please call my office and schedule a consultation. You will find that I am purposefully intent on educating you about your spinal condition, and ensuring you know all the options available to treat your pain.

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