N is for Neck Pain & for Neurosurgeons, but not Necessarily for Surgery!

Neck pain? Let's figure it out and help you!

I hope you benefit from my blog on neck pain:

Neck pain may occur in a variety of circumstances and can be associated with headaches, jaw and ear symptoms, upper back pain, stiffness (with reduced neck motion), and shoulder/arm radiating symptoms including pain, numbness/tingling, and/or weakness. Such neck area symptoms can be caused by injuries, prolonged positioning, degeneration (wear and tear), infections, congenital deformities, inflammatory diseases, and tumors. Although many clinicians can address neck pain and associated symptoms, only one type of physician can treat all of these neck symptoms in all forms from start to finish: a neurological surgeon (neurosurgeon).

Neurosurgeons to Evaluate Neck Pain

Neurosurgeons are best apt to evaluate your neck pain and symptoms due to the important anatomy contained within it, including the spinal cord. This structure is the main conduit of neurological information from the body to the brain, and from the brain to the body. It is part of the central nervous system and is a serious and sensitive piece of anatomy. 

Any damage to the cord is likely permanent and neurosurgeons are the most trained professionals to help a patient learn to avoid such permanent neurological damage.

Diagnosing Neck Pain

Proper neck (cervical) area-imaging including x-rays, MRI, and possibly CT scans are the most common evaluative approaches to the internal anatomy. For symptoms of neurologic impairment, after a number of weeks, “nerve tests” or electrodiagnostic may be performed, and should always include the neck muscles (“paraspinal muscles”) for proper and sensitive evaluation. 

However, it is cautioned that such testing is of low yield in the absence of frank muscle weakness, and a normal “nerve” test does not rule out a significant neck problem and/or neurological impairment related to such a neck problem.

Neck Pain Treatment Options

Treatment options should always be predicated on a thorough history of the symptoms and physical evaluation including an evaluation of the neck structures, and all four extremities, since neurological pathways in the neck may affect all of the limbs. 

Initial therapies for neck pain consist of symptomatic reduction approaches, including anti-inflammatories, and gentle rehabilitation therapies. This approach is similar for acute injuries, and/or other causes of neck symptoms. After an acute course of therapy, bursts of such treatments for flare-ups are appropriate. Therapy is to be curtailed for any increase in symptoms related to such treatments.

Neck Pain Treatment by Injections

If there is an imaging find that allows the clinician to match or correlate the neck pain and related symptoms to the anatomy, then targeted and specific neck injections may be properly utilized to both test where the pain is coming from, such as “targeted epidural injections” for disc and/or related nerve issues, and/or “facet joint injections”  for joint area problems of the neck. Sometimes, neck symptoms can come from a mixed source of pain generators: most often disc and/or joint issues. 

Such injections are best strategized and guided by a neurosurgeon, although most often delivered by a pain interventional pain specialist. The key follow-up is to determine how much of the symptoms were improved by a particular injection, but also what specific areas were improved. 

Any residual symptoms may need to be addressed by different injections. Unfortunately, these injections do not last forever, and repeat injections and similar procedures are appropriate in an effort to delay surgical options.

More recently, regenerative medicine and stem cell biological techniques are available to try and support neck tissue healing and structural rebuilding. Ask me about these offerings!

Surgery for Neck Pain Relief

When injections are not adequately effective (either by how much they help or for how long they may help), and often as the last step (unless a neurological emergency exists), surgery may be the appropriate treatment. Surgery comes in various forms, and most often in this modern era, is performed through the front of the neck.  There is no one better than a neurosurgeon to help a patient stay away from surgery. However, if the symptoms are too great and unlivable, then a neurosurgeon is the best one to perform the surgery, with detailed attention to the spinal cord, nerves, and supporting structures.

Surgeries may include the removal of discs including any herniated, slipped, or fragmented portions, as well as bone growths called “spurs,” if present. These structures may compress and/or irritate (sometimes without direct compression) the local neurological structures (spinal cord and/or the nerve roots emanating from the spinal cord). Surgeries also include the insertion of devices for stabilization of the neck, including both rigid (fusion) and movable (artificial disc) implants. Minimally invasive options are also available. 

Dr. Jeffrey Gross Neurosurgeon Provides Second Opinions to Surgery

Dr. Jeffrey D. Gross, the chief neurosurgeon and chief medical officer at SPINE enjoys finding ways for his patients to avoid and/delay surgery. He works directly and strategically with other medical colleagues, including pain specialists to perform tailored injections for both diagnostic and therapeutic purposes, customized to address an individual patient’s specific neck pain and related symptoms.

Thank you for reading!