Neck Pain

Chronic neck pain is common, affecting roughly 15-20% of adults. Causes include poor posture, degenerative arthritis, spinal instability (including spondylolisthesis), disc or facet joint disease, cervical stenosis, vertebral fractures, pseudoarthrosis after prior surgery, 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). 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 injections or radiofrequency ablations.

In general, surgery is only considered after patients have not found lasting relief with non-surgical treatment.

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, age, medical history, and, importantly, the source of your pain.

The right operation depends on the source of your pain. These are examples:

• Neck pain due to spondylolisthesis or spondylosis, for example, may be treated with a spinal fusion such as an ACDF or a 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, cervical disc replacement, or cervical laminectomy/foraminotomy.
• Pain on one side of the neck might be facet-mediated and best approached with facet blocks, ablations, and, possibly, a fusion.
• Pain after a prior cervical fusion could be from a pseudoarthrosis, which might be treated with a minimally invasive CORUS posterior fusion or another form of cervical spine revision surgery.
• Pain that travels up to the back of your head could be a Chiari malformation.
• 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 at all.

My patient guides for ACDF, cervical disc replacement, and CORUS cervical fusion describe those procedures in detail.

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 non-surgical interventions (e.g. physical therapy, injections, ablations, etc.) have you tried? Which ones helped the most?
• Have you previously had surgery on your cervical spine? Was it helpful, and, if so, for how long? Are your symptoms different than before?

If you have struggled with neck pain and live near Denver, please consider meeting me in consultation to learn more about your treatment options.