Neck Pain

Chronic neck pain is common, affecting roughly 15-20% of adults. Causes include arthritis, spinal instability (including spondylolisthesis), degenerative disc disease, cervical stenosis, vertebral fractures, occipital neuralgia, failed neck syndrome, and others.

For most patients, initial treatment should include non-invasive measures such as physical therapy and non-steroidal anti-inflammatories (i.e. NSAIDS such as ibuprofen or naproxen) . Some patients find relief with other therapies, including massage, yoga, and acupuncture. For those with bothersome pain despite these measures, I may recommend referral to a pain specialist for epidural steroid injections or facet radiofrequency ablations. In general, surgery is only considered after patients have not found lasting relief with the above interventions.

If surgery is needed, my philosophy is to select the least invasive option needed to address your pain. The appropriate type of surgery will depend on factors including your X-ray and MRI findings, medical history, and, importantly, the source of your pain.

Neck pain due to spondylolisthesis or arthritis, for example, may be treated with a spinal fusion such as an ACDF or posterior cervical fusion. Some forms of degenerative disc disease - particularly in younger patients - may be better suited to a cervical arthroplasty (disc replacement). Pain that is mostly in the arms or off to the side of the spine could be due to cervical stenosis or cervical radiculopathy, which might be treated with an ACDF or cervical laminectomy. Pain that travels up into the back of your head could be occipital neuralgia, which I would treat with occipital nerve stimulation. Neuropathic pain due to failed neck syndrome may be best treated with spinal cord stimulation. If your pain is due to the muscles and soft tissues around your spine (so-called myofascial neck pain), I may not recommend any surgery.

When preparing for your appointment, please consider the following questions. These help me distinguish the source of your pain (and thus, the recommended treatment):

  • Where is the pain the worst?

  • What activities or body positions make the pain better or worse?

  • Does the pain travel anywhere - particularly down to your arms? If so, where in your arms does it travel?

  • Do you have any sensory loss in your arms or trouble with hand strength or dexterity?

  • Which of non-surgical interventions (e.g. injections, ablations) have you tried? Which ones helped the most?

  • Have you previously had surgery on your cervical spine?