Neck Pain

Neck pain is a common symptom in adults that has many potential causes. Most cases of neck pain not related to trauma reflect aging processes of the spine and its associated support structures, including the muscles and ligaments. For most patients whose symptoms are limited to the neck and shoulder girdle treatments are directed toward improvement in mechanics such as stretching and postural exercise. Use of non-addictive medications such as acetaminophen and anti-inflammatories (such as Advil or Alleve) can be helpful in reducing symptoms when beginning an exercise based treatment program. The majority of patients do not require imaging to begin treatment of neck pain. 4 to 6 weeks of symptomatic treatment are generally recommended prior to obtaining diagnostic imaging.

When neck pain is resistant to initial treatment X-rays can provide useful information to gain a greater understanding of the cause of neck pain symptoms. X-rays should always be performed before advanced diagnostic imaging, and should always be reviewed by the treating physician. As primary care physicians have little training in the interpretation of spinal radiographs it is wise to consider deferring this task to an appropriately trained subspecialist. Although radiologist interpretations can provide useful information to the generalist, the radiologist does not have the benefit of correlating the history and physical examination of the patient that is necessary to correlate x-ray findings with clinical symptoms and provide useful guidance as to appropriate treatment. This task is most appropriately left to a specialist such as an orthopedic spine surgeon.

An orthopedic spine surgeon evaluating a patient with refractory neck pain symptoms will generally be able to make a specific diagnosis that will define the appropriate treatment options. Most often treatment of neck pain of less than six months duration will be non-surgical. Diagnoses that are common in this group of patients include myofascial (muscle/soft tissue) pain, spondylosis (arthritis), and discogenic pain. On rare occasion what appears to be simple neck pain represents a more serious condition such as a tumor. This is frequently identified on simple x-rays and will always require additional evaluation. For patients with the more common benign conditions cited previously, understanding is the key to avoiding unnecessary invasive intervention. Although it may be frustrating, most patients with these conditions do well long-term with simple symptomatic care and independent rehab programs which will be outlined by the spinal specialist. A point to be aware of is that proper diagnosis and treatment leads to efficient and cost effective treatment programs.

In a small percentage of individuals neck pain becomes chronic and debilitating. Despite prolonged treatment with exercise based therapies and appropriate medical treatment neck pain may result in a greatly diminished quality of life. In patients with neck pain of greater than 6 months of reasonable care evaluation for surgical options is appropriate. Evaluation usually requires MRI imaging in order to establish a highly specific diagnosis. This may occasionally require additional diagnostics such as a CT myelogram. Establishment of a diagnosis of limited spondylosis or discogenic neck pain (commonly referred to as a “bulging disc”) can be treated effectively in a select group of patients. Surgical treatment recommended may include a cervical fusion (ACDF) or a cervical arthroplasty (disc replacement). The decision to pursue surgical treatment requires a thorough understanding of the goals of treatment that can only be obtained through careful evaluation and treatment directed by an appropriately trained and experienced spinal surgeon. Surgeons who recommend surgery on the basis of review of imaging alone should be avoided as inappropriate and ineffective treatment is the common result. Surgeons who do not treat patients without surgery are not well positioned to make surgical decisions in patients with chronic neck pain.

The good news for individuals with chronic neck pain is that effective treatments are available and in most cases do not require surgical treatment. For those patients with refractory chronic neck pain surgical treatment can offer significant long term relief and improved quality of life.