How Do I Know I Need Neck Surgery?

By Dr. B. Theo Mellion
     Carbondale, IL

There are several things to consider before having surgery for neck pain, including all of the components associated with neck pain, whether its headaches, radiating shoulder and arm pain, or numbness and tingling in the arms and hands. Neck pain itself can be a manifestation of several things such as musculoskeletal disease and stress. Often times people have had no treatment by the time they come to see a surgeon. They may have seen their family doctor and because they did not have a neurologic deficit, weakness, or loss of sensation in part of their arm or hand no treatment was prescribed.

If the problem really is simply a pain problem then treating it conservatively should be the first step before surgery is even suggested. The best methods of conservative treatment are nonsteroidal anti-inflammatory agents and physical therapy. Physical therapy can entail ultra sound, massage, exercise, electrical stimulation, and/or traction. Also stretching exercises are often used for people who have limitation of mobility in their neck. People often get stuck in a cycle of pain that leads to muscle spasm, muscle tightening, limitation of mobility, increasing pain, and increasing loss of mobility. By getting into a good stretching program and adding non-surgical treatment methods such as those described above, the cycle can often be turned around. For people with neck problems and an absence of neurologic deficit, conservative treatment is often the solution.

Very often when a surgeon brings up the subject of physical therapy, the issue of chiropractic care may come up. Chiropractic care is an option, and for some people with pain it can be a reasonable alternative. The problem arises if you have an unrecognized neurologic deficit and the chiropractor does not do any radiological studies to determine if there is any compromise of the nerves or the spinal cord. If this happens then the practice of aggressive chiropractic manipulation can be detrimental. That scenario does not occur too often but it obviously is something that needs to be prevented. A good chiropractor will obtain radiographic evaluations and perform a physical exam to determine if there are any abnormal findings. If there are abnormalities then further studies should be obtained. If a patient does have a neurologic deficit or evidence of spinal cord compression with a myelopathy, then chiropractic manipulation is contraindicated. Some patients will get chiropractic care as their first line of treatment and barring the situation where they have spinal cord compromise it is generally not a problem. People with muscular problems can benefit with chiropractic care and/or physical therapy.

Bracing alone is generally not terribly effective. Bracing immobilizes the neck and for someone with neck pain or limitation of mobility bracing the neck may not be the best long-term solution for him or her because the goal is to increase their mobility. For acute neck pain or acute cervical strain from a car accident then bracing is sometimes helpful at limiting the pain associated with movement.

When a patient does not improve with chiropractic care, physical therapy, and anti-inflammatory agents, then x-rays and/or an MRI are indicated. At that point, if the patient has an obvious structural abnormality or they've failed to improve after at least six weeks of therapy and medications then surgery is an option. For patients without a neurological deficit six weeks of physical therapy is a reasonable amount of time to wait before taking the next step to have surgery. Someone with weakness in their arms, shoulders, etc. should be evaluated for evidence of neurologic compromise. If the patient has a ruptured disc with a pinched nerve, and their symptoms have gone away but they still have significant weakness but no spinal cord compression (abnormal reflexes, weakness in the legs, problems walking, problems with their bowel and/or bladder function) then surgery isn't always absolutely essential. It is, however an option to decompress the nerve and regain motor strength.

Age is not a major issue when it comes to neck surgery. It may contribute to determining the operative approach (anterior or posterior or both) along with considering other medical problems, and the underlying structural problems. Age itself, however, is not a factor in someone who is otherwise healthy enough to undergo an operation.

If a patient wants to try and avoid having surgery, probably the single most effective preventative measure is to avoid smoking cigarettes. Otherwise a healthy diet and exercise is probably the best prevention. Unfortunately degenerative disc disease is a genetically programmed event, which can be accelerated by some other medical problems that can not be prevented like rheumatoid arthritis, diabetes, and ankylosing spondylitis which are also genetically determined. But if there is a single factor that can be controlled by behavior it is cigarette smoking. We know for a fact that cigarette smoking interferes with bone healing, bone remodeling, cartilage healing, and cartilage remodeling. So if a patient is interfering with the normal healing processes that are taking place during the aging cycle and cigarettes interfere with that, then limiting smoking can certainly improve the situation. Cigarette smoking also interferes with the fusion process after surgery. Fusion failure (psuedoarthrosis) is clearly higher in cigarette smokers.

Unrecognized neurologic problems with spinal cord compression are sometimes seen and may not necessarily involve a lot of pain. People may begin to notice they're walking funny, have difficulty walking, notice subtle changes in their bowel, bladder or sexual functions, may complain of neck pain, some occasional arm or shoulder pain, and some clumsiness in the fingers. But these are things that people may not always necessarily refer to some problem in the neck, and so it's really not uncommon that these severe cases of spinal cord compression in the neck go unrecognized for a long period of time or misdiagnosed as some other problem. These are symptoms that both patients and primary care providers should be aware of, and prompt further investigation.

Unrelenting pain, numbness, and weakness are factors that should be explored early rather than later so that the patient can begin treatment whether it's conservative or surgical. The thing that's nice about cervical spinal surgery is that it is extremely successful, there is generally mild postoperative pain, and for most cervical spinal surgery, the recovery and rehabilitation period is relatively short. Obviously most people like to avoid an operation if they can and if it can be treated with conservative measures than that's obviously better for the patient. But often times if we can't treat it conservatively and the patient is having pain, disability, and limitation of activities, then cervical spine surgery can offer relatively rapid and successful resolution of symptoms.

The materials on this Web site are for your general educational information only. Information you read on this Web site cannot replace the relationship that you have with your health care professional. We do not practice medicine or provide medical services or advice as a part of this Web site. You should always talk to your health care professional for diagnosis and treatment.

Published: May 02, 2007
Updated: April 28, 2010