Neck Pain-Surgical Considerations

Over 66% of population will have neck pain at some point in their lifetime. Varying degrees of cervical spondylosis occur with aging. Cervical spondylosis symptoms are categorized as axial neck pain, radiculopathy, and myelopathy. Axial neck pain involves pain along the spine; radiculopathy involves a combination of neck pain and radiating arm pain, numbness, tingling and weakness; myelopathy typically involves hand numbness along with dexterity and gait problems. 

Identifying the true source of pain helps to determine the best treatment approach.  Axial pain can result from injury, stress, ergonomic factors and chronic muscle fatigue.  Degenerative changes in cervical discs or facet joints often cause pain, which tends to increase gradually over time.

Neck pain, similar to back pain, is often self-limited and usually resolves with time and conservative treatment.  Diagnostic imaging for patients with persistant symptoms docements areas of significant spondylosis.  MRI has become the imaging modality of choice because of its ability to visualize nerve root morphology and signal changes in intervatebral bodies and discs.  Cervical discography has been occasionally and selectively used to identify "pain generators."

Criteria for operative intervention include axial pain due to spondylosis or instability, radiculopathy, and myelopathy.  The most common treatment is anterior cervical discetomy and fusion.  High cervical problems are typically addressed with posterior surgical approaches.  Posterior cervical spine surgery is often used for radiculopathy caused by disc heriation or degeneration in the abscense of neck pain.  Motor weakness, progressive neurological deficits and progressive symptoms not repsonsive to conservative measures are indications for cervical spine surgery.

There are advantages and disadvantages to both anterior and posterior surgical approaches.  There is no single technique that best addresses all pathology and situations and surgeons familiar with both strategies are better suited to provide optimal care.  Posterior procedures have been used for a long time and provide direct visualization of the nerve root and ability for decompression without fusion; disadvantages include dural injury, cerebrospinal fluid fistula, and air embolus, all rare.

Risks of the anterior approach include inadequate decompression, laryngeal nerve injury, and thoracic duct injury, again all quite rare. Minimally invasive techniques provide excellent results and minimize postoperative pain but, like all surgical procedures, have risks of their own. The best candidates for surgery are younger nonsmokers with lateral disc herniations.

Controversy continues regarding best options for treatment of neck pain, arm pain, and myelopathy.  Research has demonstrated that improvement in function and decreased pain are outcomes from surgical interventions for those who have failed conservative treatment. Surgical approaches, including minimally invasive procedures, require further study and refinement.

If you have any questions, please contact one of the neurosurgeons listed below.

summon.bhattacharjee@neurosciencegroup.com
randall.johnson@neurosciencegroup.com
philip.yazbak@neurosciencegroup.com