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faq - neck / Cervical pain

What causes neck pain?
Neck pain has a variety of causes. Poor body mechanics, herniated discs, spinal fracture, muscle spasms, spinal deformity, and osteoarthritis are a few reasons. Your physician will determine if the pain is mechanical (coming from the joint or the disc); radicular (coming from a nerve or nerve root); or myelopathic (coming from the spinal cord) and determine a treatment plan.

What is a herniated disc?
A disc is the fibrous cartilage pads that lie between the spinal vertebrae; each is made up of two parts: a jelly-like center (the nucleus pulposus) that loses moisture with age, and a tough outer ring (the annulus fibrosus) that can split with age or injury. A herniated disc occurs when the disc's jelly-like center (the nucleus pulposus) ruptures the tough, fibrous outer ring (the annulus fibrosus) oozing through small openings and pressing on the nerves.

What is the difference between a herniated disc and a bulging disc?
A bulging disc is a slight protrusion of the center of the disc (nucleus pulposus) into the spinal canal. In a bulging disc, the annulus fibrosus (outer ring) has not been ruptured.
A disc herniation is a large protrusion of the nucleus pulposus (center of the disc), which has burst through the annulus fiborsus (outer ring of the disc) into the spinal canal, invading the surrounding nerves and causing pain in the neck, shoulders or arms.

Does whiplash cause herniated discs?
Whiplash refers to a sprain or strain of the muscles in the neck. This occurs when there is a sudden flexion and extension of the neck. A disc that is bulging or predisposed to herniation may become herniated at the time of trauma.

What is Cervical Radiculopathy?
Usually, when something hurts, you don't have to look far to find the source of the pain. But an injury near the root of a nerve could result in pain at the end of the nerve, where sensation is felt. For example, an injury to the disks in your neck could result in pain, numbness or weakness in your shoulder, arm, wrist or hand. That's because the nerves that extend out from the cervical vertebrae provide sensation and movement in these areas, this condition is called cervical radiculopathy

What can I do to avoid surgery?
The best way to avoid surgery is to keep physically fit, maintain a healthy weight, avoid smoking, avoid repetitive motion, and use proper body mechanics. Alternative therapies may relieve the symptoms and allow patients to avoid or delay surgical intervention.

Are there alternative therapies available to help me deal with my pain?
Alternative therapies such as traction, acupuncture, anti-inflammatory medication, a short course of steroids, or trigger point injections are often treatment options for neck pain. While these may relieve some symptoms, there is not a "cure" for herniated discs.

When do I need surgery?
Surgery is only indicated if conservative therapy fails, the patient becomes dysfunctional, or the patient should experience progressive neurological problems.

Will I have irreversible damage if I delay surgery?
Your physician will advise you based on your condition. In general, if there is severe spinal cord compression or a nerve is compressed over a period of time there may be irreversible damage. If a patient experiences an increase in weakness, weakness in the legs, loss of balance, or loss of bladder or bowel control, they should be reevaluated by their spine specialist immediately.

When do I need a fusion?
The treatment plan is individualized for each patient. A fusion becomes necessary when there is instability in the spine. This may occur because of degeneration of the disc, a spinal deformity , or during as a result of removing a disc during surgery. A fusion is performed to reconstruct the spine's natural balance and lordosis (curvature). Instrumentation such as screws and plates may be used to stabilize the spine while the boney fusion grows.

What effect does a fusion have on the rest of the cervical spine?
That is an excellent question. In a one level fusion, there is little impact on the spine. In a multilevel fusion, the major concern about performing a fusion is adjacent segment degeneration. When the spine is fused, the levels above or below the fusion may absorb the sheer force from every day motion, and thus wear out the discs. When the fusion is performed with the appropriate size bone graft, the balance of the spine is maintained and the adjacent segments are at less risk of degeneration.

Should I have allograft or autograft bone?
This is decided on an individualized basis. In general, I use an allograft (donor bone) in single level fusions, and autograft (bone graft taken from the patient's hip) for multilevel fusions. Under some circumstances in a single level fusion, and in multilevel fusions, using bone harvested from the patient's hip may have a higher fusion success rate.

Will the surgery lessen my mobility?
A one level fusion does not greatly limit a patient's mobility. In a multilevel fusion, a patient may have some decreased motion.

Will I have pain after my surgery?
Most patients have minimal pain following an anterior fusion surgery. The first few days following surgery are the most uncomfortable, and patients often experience a sore throat. The pain is well tolerated, and easily managed with pain medication.

What are my chances for success?
The success of the surgery is determined by the reconstruction of the balance of the spine and the reduction/elimination of the patient's symptoms. The outcome is dependent on the condition of the spine and surgeon performing the surgery.

What are my risks?
There are risks associated with any surgical procedure. The risks for a cervical surgery include but are not limited to: inter operative complications, infection, bleeding, hardware failure, hoarseness, paralysis, and death.

Will I have to wear a collar after surgery?
In the majority of cases, a soft collar may be given over of 2-3 weeks.

When will I be back to my normal activities? Driving?
Patients resume normal activities when they have recovered full coordination and experiencing minimal pain.

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