Neck Pain

Merle S. Rust, M.D.Neurosurgeon

Mercy Institute of Neuroscience & Mercy Regional Neurosurgery Center

Neck Pain

• Undergraduate study: Eastern Illinois University, B.S. Chemistry, Business minor

• Medical school: University of Illinois College of Medicine

• Residency: University of Illinois Neurological Institute• Area of interest: spinal trauma and complex

reconstruction/stabilization surgery• Serve as the neurosurgery liaison to the new Level II

Regional Trauma Center at Mercy Hospital, Janesville, Wisconsin

Neck Pain

• Common condition, like back pain, may be associated with tension headache

• In most cases, self-limiting, resolving with conservative efforts within days to a few weeks

• Can be severe, developing over a few hours during the day or may “just wake up with pain” after sleeping “wrong”

• Non-traumatic or “minor” injury versus traumatic or major injury after MVA, significant fall or sports incident

• Neck pain only versus neck and shoulder/arm pain +/- numbness/tingling in arm/hand/fingers

Neck Pain

• Can greatly diminish quality of life• May require time off work, loss of productivity• Varies in intensity and duration• Treatments range from home remedies to

formal doctor recommendations, depending on the cause, severity, duration of the pain syndrome

Neck Pain: Traumatic (Major Injury) versus non-traumatic or

Spontaneous • Trauma: significant fall, motor or recreational vehicle

accident, sports injury (e.g., football) should be evaluated by exam and x-rays by primary care or emergency room personnel before any treatment is attempted

• Non-traumatic (minor sprain injury included) or spontaneous

• In either case: important to differentiate between neck pain alone or neck pain with shoulder/arm pain, numbness or motor weakness in arms or legs (spinal cord involvement-myelopathy)

Neck Pain

• What to do? • How long is this going to last?• Should I call my doctor or go to the

emergency room?• Do I need testing, x-rays?• Should I stay home from school or

work?• Am I going to need surgery?

Non-traumatic or spontaneous (including minor injury or sprain)

• Causes– Myofascial: muscle spasm, inflammation, sprain

and strain syndrome– Degeneration or inflammation of the cervical disc– Degeneration or inflammation of the cervical joint

or facet w/ or w/o instability– Loss of the normal “slightly lordotic” alignment of

the cervical spine– Infection of disc space or spine (osteomyelitis)– Tumor or cancer involving the cervical spine

Traumatic (major trauma)

• Motor vehicle accident, falls, sports injuries- significant forces or impact

• Causes of resulting pain:– Disc herniation– Fracture– Dislocation of spineEarly formal evaluation by primary care or

emergency room personnel recommended to avoid potential spinal cord or nerve root injury (paralysis or weakness), progressive deformity, possible chronic pain condition

Evaluation of Neck Pain

• History– Onset circumstances, duration– Location of pain- neck only (Para cervical,

trapezoidal, rhomboid muscles) versus neck and shoulder or arm/forearm/hand pain +/- numbness/tingling (numbness often involves certain fingers)

– What makes it better or worse– Past medical history

Evaluation of Neck Pain

• Physical exam– Muscle tenderness/spasm, loss of range of

motion (rotation or flexion/extension)– Objective weakness in arms or legs– Loss or increase of DTRs (reflexes) or of

sensation – Abnormal signs indicating spinal cord

involvement or myelopathy

Evaluation of Neck Pain +/- arm involvement: Testing

• Plain x-rays: static, flexion/extension

• CAT scan

• MRI (recommended to evaluate discs, spinal cord, nerve roots)

• EMG/nerve conduction studies

• Blood work (if above imaging studies suggest possible infection or tumor)

Neck Pain: What Should One Do?

• Cause? i.e., injury involved versus no significant injury or “spontaneous”

• Experienced first time or had it before

• Pain in neck only or shoulder/arm as well

• Loss of function/weakness/numbness

• Other medical issues

Neck Pain: Treatment Options

• Bed rest• Immobilization• Anti-inflammatory medications: OTC (Advil or

Aleve); prescription (Tramadol or Medrol)• Anti-spasmodic or narcotic type pain relievers• Physical therapy• Injections: trigger point, facet or joint, epidural

steroids directed toward nerve root• Surgery

When is Surgery Appropriate?

• Conservative measures fail to relieve neck and shoulder/arm pain condition (intractable cervical radiculopathy) caused by disc herniation and/or arthritis (spondylosis) affecting a nerve root exit area

• Neck pain associated with spinal cord compression (cervical myelopathy)

When is Surgery Appropriate.2

• Neck fracture that has involved the spinal cord or that causes significant instability

• Tumor involving the spine

• Infection of the disc space or of the bone

Advancements in Spine Surgery

• Further understanding of the pathophysiology of natural degenerative disorders as well as unnatural events (trauma)

• Further understanding of spinal biomechanics • Improved imaging techniques (MRI)• Advancements in surgical implant devices

and surgical techniques

Surgical Procedures

• Biopsy for infection or tumor diagnosis• Anterior cervical discectomy with bone and plate

fusion treating a significant disc herniation that involves the nerve roots and/or the spinal cord (ACDF)

• Posterior laminectomy or foraminotomy to open the spinal canal or nerve root exit site (foramen); w/ or w/o fusion

• Anterior cervical discectomy with artificial disc insertion

• Anterior cervical corpectomy with strut graft and plating; used for fracture and tumor cases mostly

Thank you for your participation

Merle S. Rust, M.D.

Webinar on Neck Pain

Mercy Regional Neurosurgery Center