I am a two-pack per day smoker. I’m planning to quit smoking so that I can have three bones in my neck fused together. The doctor has advised me that smoker’s have more failed neck fusions than nonsmokers. How long before the operation should I quit to get this effect?

There isn’t an exact answer to this question. The American Cancer Society reports that within 20 minutes of smoking cessation, blood pressure and pulse improve. By eight hours, the oxygen levels in your body will increase and carbon monoxide will decrease.

Within 24 hours, your risk of a heart attack is reduced. From two weeks to three months, there is improved blood flow and lung function. By the end of nine months, damaged cells in the body and lungs have regrown new ones. At the end of a year, your risk of heart disease is reduced to half of a smoker.

Most doctors suggest waiting three to six months. This depends on your ability to handle the pain and the condition of your spine. If a fusion is needed right away to protect your spinal cord, stop smoking now. Even the short-term change will improve your bone healing.

I’m planning to have my neck fused in three places. I understand there are some risks with this operation. What can you tell me about these?

There are always some risks with any operation. Fusion of the neck has its own set of risks because of the potential for spinal cord or nerve damage. The worst thing that could happen is death or paralysis.

Other serious problems include blood clots, heart attack, stroke, or major blood loss. There can also be damage to the trachea, esophagus, or vocal cords. If bone is used from your hip to complete the fusion, there can be a painful or tender area where the bone is removed.

Overall, the chances of having a serious problem after this operation are fairly low.
The risk of fusion failure increases with multi-level fusions. This is a separate problem than those caused by the actual surgery. Various studies report 80 to 90 percent good or excellent results with neck fusion.

I’ve been having neck and arm pain on the left side for three months now. I’m supposed to see a physical therapist for this problem. What can I expect from this treatment?

The physical therapist will do a variety of tests to measure your strength, range of motion, reflexes, and sensation. Some additional tests may help pinpoint the location of the problem. These findings guide the therapist in choosing the right treatment for each patient.

Treatment may include neck traction, ultrasound, and nerve, joint, and soft tissue mobilization. Exercises to stretch and strengthen the neck and arms may be added later. The therapist will also look at your posture at home, work, during sleep, and other activities. A program to improve your posture is likely.

My niece has been diagnosed with bone cancer. The doctors have talked to the family about “limb salvage.” What is this?

In the past, bone tumors couldn’t be removed without destroying the bone. This often required an amputation. Today, tumors can be removed and surgery done to reconstruct the arm or leg. This is referred to as limb salvage.


Sometimes it is possible to save the arm or leg, but the person can’t use the limb. A limb salvage rating system has been devised. This is a way to measure how useful the body part is after salvage and reconstruction. Some people still decide to have amputation if the limb can be saved but not used. Surgery methods continue to improve, making this choice less and less common.

I am 70 years old and had a stroke two years ago. Last week I slept too long in one position, and now I have a stiff neck. I would like to see a specialist for a neck adjustment. Is there a chance that neck manipulation will cause another stroke?

It’s extremely unlikely. In rare cases (approximately one in every one million cases), neck manipulation is followed by stroke. Causes and risk factors remain unknown. There is no evidence that people at risk for stroke are more likely to have problems after neck manipulation. As a precaution, please make sure the medical provider performing the treatment is aware of your medical history.

I’ve been having adjustments for neck and shoulder pain. I’ve been told it’s possible to have a stroke after neck manipulation. How soon would this happen, and how would I know it was happening?

The chances of having a stroke after neck manipulation are very slim (about one in every one million manipulations). In more than 90 percent of cases, symptoms occur within 48 hours of manipulation. At least half of the time, the start of symptoms is immediate. A delay of more than a week is extremely rare and has only been reported once.


The most common symptom of stroke is loss of coordination. Other symptoms include difficulty swallowing, dizziness, change in vision, and numbness in the face, head, neck, arm, or hand. Any new or unusual symptoms after neck manipulation should be reported to your doctor.

My 72-year-old mother was just diagnosed with spinal stenosis of her neck. Is this a common condition in women?

Spinal stenosis is a narrowing of the spinal canal. When it occurs in the neck, it can begin to put pressure on the spinal cord. In the United States, there is no difference in the number of men and women affected by this condition. Older adults are more likely to develop stenosis because of changes in the spine from the aging process.


In Japan, more men have stenosis in their necks than women. The combination of narrow spinal canals and large spine bones in the necks of Japanese men makes them more likely than women to have this problem.

What is “Lhermitte’s sign”?

This medical term is named after a French neurologist who lived in the late 1800s and early 1900s. It refers to an electric, shock-like sensation down the arms. It happens when the neck is bent forward, bringing the chin to chest. The underlying cause may signify multiple sclerosis or pressure on the spinal cord in the neck.


Pressure on the spinal cord can develop when the opening for the spinal cord, called the spinal canal, is too small. This may be due to the shape of the bone or spinal canal at birth. Pressure can also come from changes in the bone from arthritis or trauma, or from disc protrusion. Whatever the cause, the presence of Lhermitte’s sign requires a doctor’s attention.

I had a whiplash injury two months ago. Since I didn’t get better with activity and exercise, the doctor sent me to a physical therapist. I still have a lot of pain and stiffness with movement. It seems like the therapist is asking me to do things beyond my abilities. How far should I push through the symptoms of this injury?

The healing time for most soft tissue injuries is about six weeks. Unless you have reinjured yourself during this time, you should be nearly past the time of healing and tissue remodeling. At this point, treatment can help prevent your injury from becoming a chronic problem.


There are guidelines for the treatment of whiplash injury. According to these guidelines, there are five different phases of recovery, starting with the first four days and going past three months. You are in Phase 4 (six weeks to three months). During this phase, treatment is focused on increasing activities. In the case of delayed recovery, learning to cope with the symptoms is important.


At this point in recovery, it’s helpful for patients to take a more active role in treatment. Patients should increase their activities in small bits as pain allows.

Sometimes I see people wearing soft neck collars after car accidents. When should these be used?

Many studies show that these collars are not effective and should not be used. Early movement, exercise, and advice on posture have proven useful in treating whiplash injury. Returning to usual activities is preferable to rest and wearing a collar.


Occasionally, a doctor or physical therapist may advise a patient to use a soft collar for 24 to 48 hours. This is an individual decision based on the particulars of the case.

I had a car accident six months ago and suffered whiplash injury. After about six weeks, the painful symptoms went away, and I could move my head and neck normally. My neighbor had a similar accident. Two years later, she is still having trouble with her neck. Why is that?

Whiplash injuries are different depending on the force of impact, the position of the head and neck at the time of injury, and the age of the patient. In normal recovery, symptoms slowly get better. Head and neck function and ability to do daily activities improve gradually during the first six weeks.


In delayed recovery, only minimal or small improvements are reported. Six months later, painful symptoms prevent patients from doing activities. Other factors may contribute to these symptoms, including previous neck injury, older age, belief that there is a serious disease or problem, depression and anxiety, and poor coping skills.

I was involved in a rear-end car crash. My doctor told me I have a “whiplash injury.” What is this?

During a rear-end impact, the force of the crash causes several things to happen very quickly. First, the car seat is pushed toward the person, and the upper body hits the seat. This pushes the body forward. The head snaps backward against the head restraint. The vehicle impact is over, but the upper body continues to move forward. Finally, the head bounces off the head restraint and comes forward again. As the head moves forward, the upper body returns to rest against the seat back.


Recent studies have shown that during this type of accident, the lower part of the neck is thrust forward while the head remains level. This action causes a shearing motion of one neck bone moving forward under another. The result is abnormal movement of the neck joints. This stretches the tissue around the joint and puts pressure on the nerves.


Neck pain, stiffness, and muscle soreness a day or two later are referred to as whiplash. Doctors and therapists may also refer to this type of injury as a flexion-extension injury.

I have seen some commercials on television about the importance of wearing seat belts. The research for these infomercials always seems to be done on crash dummies. How do they know the results are the same for humans?

Researchers have spent many hours recording and measuring the effects of car crashes on cadavers, crash dummies, and human volunteers. Experts have compared the results to see if they are the same.


When it comes to studying whiplash injuries, there are some concerns that crash dummies and cadavers have stiffer necks than humans. This may affect the accuracy of test results. For this reason, a computer simulation program has been planned. The results of this program match findings from human volunteers.
 
Thanks to advanced technology, researchers can look at the effect of changing car speeds on the force of impact. They can also change head positions at these different speeds. This provides accurate information without injury to anyone.

I have whiplash from a car accident that happened six months ago. It still hurts to move my head forward and back. Is this common? What can I do about it?

Sometimes symptoms of whiplash last long after an accident. In these cases, a person may be said to have a “whiplash-associated disorder” (WAD). This might require medical attention.


A recent study found that the movement you describe (moving the head toward the chest and back) is typically the most difficult for people with WADs. The ability to look left and right and tip the head to both shoulders is also reduced, though not as much.


A doctor and/or physical therapist can help you deal with the painful effects of whiplash. Talk to your doctor about treatment options. There are exercises you can do to make neck movement more comfortable over time.

If you have whiplash, is your ability to move your neck different from the average person’s?

Researchers have had some doubts about this. But a recent study found that people with persistent whiplash (three months or more) have a lot less neck movement in all directions than healthy subjects.


Amount of neck movement may separate people who have whiplash from those who don’t. Neck movement correctly distinguishes people with whiplash from those without 80 percent of the time. This number goes up when age and gender are also taken into account. So yes, neck movement really is different for people with whiplash.

Does whiplash actually change the way people move their necks, or does it only change how much they move?

This is a subtle distinction. A recent study found that people with persistent whiplash couldn’t move their necks as much in several directions as those who didn’t have whiplash. However, the patterns or kinds of movement weren’t all that different between the two groups. This means that, according to this study, whiplash doesn’t cause abnormal movement in the neck. It simply restricts the amount of movement that can be comfortably done.


Exactly how whiplash restricts movement has yet to be determined. Researchers think whiplash affects movement by way of pain or changes in the tissues. There may be other factors at work as well.

Last week I was sitting in my car at a red light when someone rear-ended me. The car that hit me was only going 20 miles per hour, but it caused considerable damage to my car. At the time of the accident, I felt fine. But the next day, I woke up with a headache and neck pain that hasn’t gone away. Why is that?

Scientists are still studying the mechanisms of damage to the neck and surrounding tissues after a rear-end collision. Researchers have been able to show that during the impact, the bones of the upper neck are forced to move abnormally, causing tissue injury. There may also be pressure on one or more nerves as they exit the spine in the neck region. This can cause the kind of pain that starts in the neck and travels down the arm.


The joints of the neck may also slide and get compressed during a rear-end collision. This can cause neck joint pinching and possible damage. It remains unknown why some people have symptoms for a few days and others continue to have problems weeks and even months later. Tell your doctor about your symptoms and see what he or she recommends.

I am driving a 1990 American-made minivan. The seats are designed with built-in head and neck rests, so there is no adjustment possible. I am much shorter than my husband, who also drives the van. The seats seem to fit him just fine, but I feel like the extended headrest pushes my head forward. Is this style safe for both of us in a car accident? What’s the best position for a headrest?

Most of the extended seats in minivans do not offer individual adjustments to the headrests. According to engineers who research these issues, there is a big variation in what’s “standard” for headrests in vehicles.


Studies show that the force of a rear-end impact on the head is less when the headrest is close to the head at the time of the accident and positioned just above the ears. Researchers are working to devise a seat with a head restraint that offers closer contact to the driver and maximally absorbs the impact energy.