When To Get Surgery for Neck Pain

First, a bit of neck anatomy: your neck connects your skull to your spine and is made up of seven spine bones called the cervical spine. These bones are separated by discs, which act like shock absorbers and allow the neck to move. The back of each bone is shaped like an arch, and the spinal cord is "housed" in each arch. Nerves to the neck and arms exit from the spinal cord between openings on the sides of each bone.

Common causes of neck pain include degeneration of the discs, narrowing of the canal where the spinal cord is housed and herniated discs.

Neurosurgeon Dr. Dawn Tartaglione weighs in. "For all the jokes in the world about different things being a 'pain in the neck,’ neck pain IS a big pain," she says. "Whether it is a mild nuisance, a nagging ache or an intense pain, neck pain limits our ability to do so many things. I always tell patients that we shouldn’t be surprised that we have neck pain from time to time -- as the neck is really a stick on top of our body holding a bowling ball! For the most part, we tend to overuse certain muscles of the neck and many of our activities in daily living make that worse. We should probably all be doing daily neck range-of-motion and isometric exercises, and take frequent breaks from holding our heads in one spot (like we all do at the computer). Probably a bit more sleep wouldn't hurt, either."

Dr. Tartaglione says that treatment for neck pain usually begins with non-surgical care, which can include:

• medications to reduce inflammation and pain
• muscle relaxants, and sometimes the wearing of a cervical collar, to allow time for the neck to heal itself
• injections to treat pain
• physical therapy with home exercise programs
• treatment with a rehabilitation therapist

If non-surgical options like these don’t succeed, your primary care physician might send you for a consultation with a neurosurgeon.

Dr. Tartaglione says the most common reason people with neck problems are sent to a neurosurgeon is for herniated discs or bone spurs, which put pressure on a nerve and cause pain in the arm and neck along with numbness or weakness in the arm and tingling in the fingers or hand. Patients with arthritis are also sometimes sent to a neurosurgeon because of a condition known as cervical stenosis. A neurosurgeon can operate on people with cervical stenosis to give their spinal cords more room to send messages to the arms, body and legs.

Other common reasons someone might consult with a neurosurgeon include:

• people who are suffering neck pain from a blow to the head
• if a patient’s neck is so stiff he can’t touch his chest with his chin
• if pain shoots down one arm
• if a person is suffering from tingling, numbness or weakness in arms or hands
• if the neck symptoms are associated with leg weakness or loss of coordination
• if neck pain doesn’t improve on its own after a few weeks

To determine if someone is a good candidate for surgery, a neurosurgeon will take an oral history from the patient and will review their diagnostic studies, which can include xrays, CT scans, myelograms and MRIs.

Once a neurosurgeon examines you, talks with you about the findings of your imaging studies and diagnoses the cause of your neck pain, surgery may be the best option. As Dr. Tartaglione says, “Surgery is a last resort but to preserve function and treat pain, it is sometimes necessary.”

She points out that in most cases, cervical spinal surgery is extremely successful, and for most the recovery and rehabilitation period is short. For patients with ongoing pain, numbness and weakness, and a limitation of activities, surgery can offer relatively rapid and successful relief.

If you think you might be a candidate for neck surgery, you can contact the INTEGRIS Health neurosurgeons at the INTEGRIS Spine and Neurological Surgery Clinic at 405-552-0401.