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By Jeffrey S. Yablon, M.D., Neurosurgeon
The Chester County Hospital
Published: September 17, 2007
Neck pain is one of the most common complaints that adults will encounter in their lifetime. Most neck pain is short lived related to muscular and/or ligamentous problems. These are commonly known as cervical sprains and strains. They are usually not treated at all or resolved with heat, ice, or over-the-counter pain relievers such as acetaminophen [Tylenol] or ibuprofen [Advil, Aleve, Motrin]. They may or may not become recurrent problems but they are never an issue requiring neurosurgical intervention.
There are many causes of neck pain, however, that are in the bailiwick of the neurosurgeon. These include problems related to tumors of the spinal cord and the surrounding bony structures, trauma, infections, inflammatory diseases, vascular diseases, congenital malformations and degenerative conditions. In this article I will be discussing only disc herniations and degenerative cervical arthritis (spondylosis).
A disc is a cushion between the bones permitting movement of the spine. It is composed of an outer band called the annulus and a soft inner core of multiple pieces similar to crab meat called the nucleus. If the annulus tears and nuclear material exudes outward this is a herniation. Often, herniations will cause either neck pain (axial pain) or radiating arm pain (radiculopathy). Cervical degenerative arthritis is caused by erosion of the smooth lining between two adjacent bones (joint). It may also cause axial neck pain and/or radiculopathy. Rarely these conditions can cause compression of the spinal cord (myelopathy) resulting in spasticity (increased tone in the muscles) and/or a disorder of balance and walking (gait).
These cervical conditions, other than myelopathy, are often treatable without surgery. Measures such as physical therapy, exercise, electrical stimulation, epidural steroids (cortisone injections), and most importantly tincture of time will relieve the symptoms of axial neck pain and radicular arm pain.
Patients who fail to respond to the aforementioned conservative therapies and whose activities of daily living are significantly affected are candidates for surgery. Multiple approaches both from the front of the neck (anterior) and back of the neck (posterior) are available. New minimally invasive techniques are also available and in the near future artificial cervical disc surgery should be FDA approved.
If you are suffering from unrelieved neck and/or arm pain do not hesitate to seek medical advice.
This article was published as part of the Daily Local News Medical Column series which appears every Monday. It has been reprinted by permission of the Daily Local News.
Last Updated: 7/27/2009