FAQ Category: Cervical Spine

Home cervical traction may be of some limited benefit. Newer, better units have been developed to help with some types of neck pain. Patients with cervical radiculopathy (CR) are likely to benefit the most. CR refers to neck and arm pain caused by pulling or pressure on the spinal nerve(s) in the neck region.

Traction assists by stretching the soft tissues and pulling the soft tissues apart. This has the same effect as opening or enlarging the space where the spinal nerve exits from the spinal canal.

Intermittent traction is used most often. The pull is applied for a period of time. Then the traction is released for about half that length of time.

Traction is not advised for patients who have damage to the spinal cord itself. This condition is called cervical myelopathy when it occurs in the cervical (neck) spine. Traction can put a stretch on the already compromised spinal cord. So before using this as a home remedy for neck pain, seek out the services of a physician or physical therapist who can advise you appropriately about using this particular treatment modality.

The cosmetic results of this new operation may depend on the approach your surgeon takes. Anterior cervical decompression and fusion (ACDF) is done from the front of the neck. The anterior approach avoids contact with the spinal cord or spinal nerve roots. There is less risk of neurologic damage this way.

For most people, the anterior approach is more appealing cosmetically. The incision can be done along a natural crease in the neck. After it heals, there is minimal (if any) scar showing.

You should discuss this concern with your surgeon. There may be other important reasons to choose one method of surgery over another. Decompression and fusion can be done from the back of the neck using a posterior approach.

The level of the spine being operated on can make a difference. Any previous surgeries in the area (including any cosmetic procedures) may make a difference. If you want to avoid possible complications, a trial of at least six months of conservative care is advised. This can include medications, physical therapy, and possibly steroid injections.

Post-operative recovery after an operation like this is variable. Some patients have temporary trouble with hoarseness and difficulty swallowing. It can last a short time, but it can take months to recover. There are reported cases of permanent paralysis.

Complications of this type are more common when the surgery is done from the front of the neck (anterior). The laryngeal nerve and soft tissues of the neck are moved to the side to get to the vertebra and disc. Damage can occur to the nerve and swelling in the area is common.

Surgery can be done from the back (posterior) part of the neck. The risk of spinal cord damage is much higher with this approach. This is why surgeons prefer the anterior approach.

Be sure and let your surgeon know of your concerns. But be prepared to have a backup singer ready for your event. Most everyone experiences some mild but temporary symptoms. It’s not possible to predict who will have such problems long-term.

Damage to the laryngeal nerve during an anterior cervical decompression (ACD) operation is usually reversible. Difficulty swallowing, hoarseness, pain, and numbness are common with damage to this particular cranial nerve.

The two branches of this nerve are pulled out of the way during the operation. The stretching and compression are likely the cause of this usually temporary problem. But it can take months for the nerve to recover. Returning to normal may take even longer.

There are some tests that can be done to assess the extent of the damage. Two tests to measure changes in the vocal cords are phoniatric evaluation and laryngeal electromyography (EMG). For problems with swallowing, you can also have an endoscopic evaluation and videofluorography.

Each of these tests helps identify the severity of nerve damage and function. Your neurosurgeon will be able to advise you about further testing. You may just need a little more time for final healing to occur. Nerves regenerate at a very slow pace and require patience. Permanent nerve damage is possible though. The testing will help determine if that is the problem.

Pressure on the spinal cord in the cervical (neck) spine is called cervical myelopathy (CM). A common cause of CM in older adults is spinal stenosis.

Stenosis is a narrowing of the spinal canal. The spinal cord is inside the spinal canal, where the surrounding bone protects it. Anything that narrows the spinal canal can put pressure on the cord causing neck and/or arm pain, numbness, and weakness.

With improved technology, MRIs have become very useful. MRIs can show how much stenosis is there. Change in the MRI signal is a sign of spinal cord lesions. The change could be an increased or decreased signal intensity. An increased signal intensity is more likely in patients with cervical compression myelopathy.

Many doctors advise their patients with early signs of spinal stenosis to try conservative therapy first before surgery. This may include pain relievers, antiinflammatories, and physical therapy. If the symptoms persist or get worse after nonoperative care, then surgery may be the next step.

A recent study looking at MRIs taken before surgery and compared to results after surgery offered some useful information. The study showed that older patients who wait too long have the worst results after surgery.

Age and duration of symptoms are important to consider. It looks like patients with MRI changes but mild or no neurologic symptoms may be the best ones to have the surgery sooner than later. Overall results are better and the risk of neurologic disability is less.

You may be referring to a treatment called neuroreflexotherapy (NRT). Tiny staples are implanted in trigger points along the spine and in tender points in the ear. Trigger points are painful areas in the muscle that cause local and referred pain when pressed or stimulated.

Studies have shown that NRT actually works. Patients with neck pain seem to respond better than patients with low back pain. But despite its success, it is still only used in Spain where it was first developed. And even in Spain, it’s been slow to catch on.

Researchers are studying this treatment tool to figure out which patients can benefit the most. There is a 10 to 15 per cent failure rate. It would be good to avoid using this treatment on patients who won’t benefit. Finding predictive factors is the goal of current research.

So far it looks like the more chronic your pain is, the less likely you’ll get results with this treatment. But that’s not always true as some patients expected to fail (based on this criteria) actually got better.

NRT is not availble yet in the United States. Combining acupuncture with biofeedback such as you are doing is an acceptable alternative until further research can be completed.

Torticollis, like a herniated disc in the neck, can be very painful, but torticollis affects the soft tissue in the body, like the muscles or ligaments, or the nerves, not the discs.

Adults who get torticollis usually get it from a trauma to the neck, such as turning too hard, being in an accident, falling, or something similar. The ligaments, which stabilize the muscles, can stretch or tear, causing the pain. More rarely, tumors or infections can cause the pain of torticollis. Most often, it is treated with a soft neck brace or collar, to keep your neck stable, medications for the pain, heat to the site and maybe physiotherapy. Your doctor will recommend what is best for you.

People with osteoporosis, or thinning of the bones, can break the vertebrae, or bones, in the spine. Sometimes they break because of a fall or injury, but they can break on their own if they are thin enough. Although any vertebrae are at risk, the fractures do happen more often in the upper back area, where you can see the “humped back” shape.

As with anything, hardware like screws, plates, and wires can break when they are inside the human body. There are also times when pieces of the hardware move to an area where they aren’t supposed to be. Luckily, this doesn’t happen very often. If it does, another surgery is needed to repair, remove, or replace the hardware.

Cancer that spreads to the bones from another site is called metastases. The spine is a common place for metastases from certain kinds of cancer. Lung, breast, and thyroid cancer can spread to the cervical spine (neck). Colon and stomach cancer are more likely to metastasize to the lumbar spine.

Treatment decisions for cancer patients often do require a team of experts. Your oncologic status must be taken into consideration. What kind of primary cancer is present? Is the cancer in your spine really from the original cancer? Or do you have a second kind of tumor? This is important in looking at whether or not radiation or chemotherapy is the best approach.

The orthopedic surgeon will discuss the stability of your spine and what’s needed there. Are the bones too brittle for screws? Would a fusion help? Usually, even a single level needs stabilization above and below to hold it in place. Further testing may be needed to see if the tumor is wrapped around important blood vessels.

The goals of treatment are to improve or maintain neurologic function. At the same time, they try to control tumor growth and give you pain relief. Stabilizing the spine with a neck fusion or other spine surgery may help. They may recommend further chemotherapy or radiation therapy either before or after surgery to stabilize your spine.

Your overall general health is part of the equation. Are you stable enough to have surgery or further cancer treatment if needed? There’s actually a model proposed for use in such decision-making. It’s called the NOMS framework. By taking each area (neurologic, oncologic, mechanical, systemic) into consideration, a plan of care can be determined.

Treatment decisions for many cancer patients can be very complex. It’s difficult to predict the exact prognosis. We don’t always know how long someone’s life will last. And quality of life (not just quantity) is an important factor.

Tumors to the cervical spine (neck) can be very dangerous. They can cause spinal cord compression. Pain, numbness, weakness, and muscle atrophy may develop. And in the worse case scenario, paralysis is possible.

Many surgeons suggest surgery to stabilize the spine is advised. Even with a limited life expectancy, the chances of serious problems developing from an unstable neck is not worth the risk.

Some doctors are using a new model to help them make these decisions. It’s called the NOMS framework. It combines the neurologic status (N) of the patient with the oncologic (O), mechanical (M), and systemic conditions (S). So, as you described yourself, it sounds like you are having neurologic symptoms (N) and your neck is unstable (M).

The next step is to look at your oncologic status. What cancer treatment have you had so far (O)? How well has it worked? If you have surgery to stabilize your spine, would you be able to handle more radiation therapy or chemotherapy (S)?

Discuss all the options with your doctors. Find out what treatment is possible. And make a decision weighing in all the factors from the NOMS model. Keep in mind quality of life as a deciding factor, too.

Whiplash can be very painful and can greatly affect your life. You move your neck a lot more often than you probably realize – until you can’t move it so well.

Your doctor will likely give you medications for pain, swelling and muscle spasms. To keep you neck from moving, you’ll probably be fitted with a cervical collar, a soft thick collar that rests on your shoulders, supporting your head. You may be advised to use moist heat and ice packs as well.

Many people who have whiplash see a physical therapist who can help manage the pain and help you do exercises to strengthen the muscles and ease the spasms.

Whiplash is an injury that occurs to your neck when your body has been stopped suddenly and your head is forced forward and back, snapping. Most people associate whiplash with car accidents but it can also be the result of a sports injury, at an amusement park (from some of the rides), and from falls. Even shaken-baby syndrome can result in whiplash.

Your neck is made up of seven cervical bones, which is why you may hear neck injuries referred to as cervical injuries. The bones are held together by muscles and ligaments. There are also many nerves that run through your neck. If your head snaps back and forth violently, these muscles and ligaments become stretched, producing swelling or inflammation, causing pain.

Researchers are starting to combine study results in the United States and Europe to get a look at the big picture. Artificial disc replacements (ADRs) have been used much longer in Europe so they have more long-term results.

Everything points to improvement in final outcomes with ADRs. There is less soft tissue damage for disc replacement now. The time it takes to do the surgery is less with less blood loss. Hospital stays are longer if there is more than one level operated on.

Studies are just beginning to compare single-level replacement with multiple level implants. The short-term (up to two years) and mid-term results (two to five years) are very positive. The first FDA pilot study published results on the use of multi-level cervical spine ADRs. They compared outcomes against single-level implants.

The patients with the multi-level ADRs had better motion and function. They had less pain and less disability. This was when results were compared to a similar group of patients who only had a single level replaced.

It will still be awhile before multiple level operations are done routinely. For now, the safety and improvements with single level implants are consistent and encouraging.

Spinal fusion has been around a lot longer than the artificial disc replacement (ADR). So there are more results of long-term studies available from fusions. We do know that although fusion works well, there is a high rate of reoperation needed about 10 years after the fusion is done.

With fusion, there is no motion left at the level operated on. This can translate the force of the load through the spine to the next level up. There have been many concerns about disc degeneration at the adjacent level.

ADR is a fairly new operation. The implants are being studied and improved upon. Surgeons are still gaining practice and improving in the skills needed to do this procedure. But studies so far show four distinct advantages of ADR over fusion.

First, there is less soft tissue damage and a decreased risk of dysphagia (difficulty swallowing) with ADR. Fewer muscles have to be cut and moved out of the way. Second, the load and strain placed on the next-level of vertebra is less with ADR. Since motion is preserved, the natural forces are shared by all segments.

Third, large studies have shown that there’s a higher reoperation rate with cervical fusion. And there’s also more adjacent level disease that occurs after fusion.

Finally, when more than one level is fused, there is a corresponding increase in problems and poor results. The opposite may be true with multiple ADRs. At least one study (the first) showed that multiple level ADRs had better overall results compared to single-level implants.

Once you complete your course of rehab, your surgeon will be better able to advise you as to your options. He or she will review the pros and cons of each treatment choice to better help you make a final decision.

Maybe not. A recent study showed results very similar to what you describe. And their patients continued to do well despite the MRI findings.

It has been proposed that fusing the spine and stopping motion at that level is enough to prevent further trauma to the spinal cord. For many patients fusion stabilizes or even improves the neurologic condition.

Stopping further trauma seems to be an important part of recovery. With less compression, there is better blood supply to the area. And autopsy studies show that even when MRI signals show there’s a problem, in actual fact, once the mechanical factors (pressure and movement) are eliminated, repair can take place.

The mismatch between findings on MRI and patient function remains a mystery. Some people with no findings have extreme symptoms. Others with no symptoms at all have significant changes in their MRIs or other imaging studies.

Right now, it’s not clear how to predict who will have good long-term results. Age and duration of symptoms have been shown to be important variables in some, but not all, studies. Further study of this problem is needed before doctors can assure patients one way or the other about the final results.

No one can predict 100 per cent who will get better or how much they will improve after surgery. In the case of your condition (called cervical compression myelopathy (CCM)) the chances are very good that you will get significant improvement with cervical fusion.

Many studies done show up to 80 per cent of patients with CCM get pain relief and improved function with this treatment. The neck and arm pain, numbness and tingling, and arm weakness get better and so does function.

Scientists have tried to figure out what makes the difference between someone who gets better with surgery and someone who does not. Is it age? Severity of symptoms? Length of time the symptoms were present before surgery? Curvature of the spine?

A recent study to look at predictive factors found that it wasn’t any of those things. Just having the fusion was enough to bring about the good results. One way to test how much benefit you might get from a fusion is to try wearing a neck brace or cervical collar for two or three days.

Get a firm neck collar (not the soft foam kind). Try one that really restricts your motion. Keep in mind that a cervical fusion will only stop motion at the level that’s been fused, not the entire neck. Since muscles atrophy quickly and motion is important for overall function, don’t try this for more than the two or three days suggested.

If you experience improvement, you may want to consider having the operation sooner than later. This is not a foolproof method of prediction. No studies have been done comparing patients before and after fusion who used this test to predict results.

Whiplash was more common years ago, most often after a car accident because seats in cars didn’t always have a head supports and people didn’t wear seatbelts regularly. This type of injury can also happen in some contact sports or after a physical fight with heavy punching. Whiplash can also be caused by shaking a baby, part of shaken baby syndrome.

If you’re in a vehicle and you’re hit from behind, your body is pushed forward quickly. As your body pitches forward, your neck extends as far as possible forward, stretching the soft tissue, and then when it reaches as far as it can go, your neck snaps back. The force of snapping forward and then backwards is what causes the damage in your neck, whiplash.

Treatment of whiplash is quite simple and involves keeping your neck still. This means wearing a soft brace or cervical collar to keep your head in position. This can take a few weeks. Your doctor might prescribe some medication for the pain and to relax the muscles, heat therapy and/or physical therapy.

Whiplash doesn’t always cause pain right away. Often following an accident, there isn’t any neck pain, but after a while, some stiffness sets in. The length of time can vary from a few hours to a few weeks. Symptoms of whiplash include pain and stiffness in the neck, but it may also radiate to the neck, shoulders, arms and back. You may also experience headaches, dizziness, difficulty chewing, a hoarse voice or pins and needles in your hands, arms, or shoulders.

Whiplash is an injury of the muscle and soft tissue in your neck that can’t be seen by x-ray. Whiplash is usually a diagnosis of exclusion, meaning once other injuries have been ruled out, your doctor may feel that the only explanation for your pain and symptoms is whiplash.

In order to rule out other injuries, your doctor could order more specialized tests than x-rays, such as magnetic resonance imaging (MRI) or computed tomography scan (CT). These are more specific than x-rays and allow your doctor to look at the body tissue more closely.