A lot of my employees complain of neck pain. I’ve done everything I can to make the office more “ergonomic.” Is there something else I should do?

Researchers have suggested that, when it comes to neck pain, the psychological or social qualities of a workplace may be just as important as the physical ones.

A group of researchers in the Netherlands tried to identify “psychosocial” factors that may put workers at risk for neck pain. They followed nearly one thousand workers for three years. The researchers found that having to work under time pressure was linked to neck pain. So was a lack of support among coworkers. To a lesser extent, not having opportunities to make decisions at work was a risk factor for neck pain.

With these results in mind, you might think about ways to reduce the deadlines employees face at work. You may also want to encourage more social support among coworkers. Whatever you can do to reduce the stress of the workplace may keep your employees healthier–and your office more productive.

I know that certain physical activities can cause neck pain in the workplace. But what about other, less visible factors? Does the “personality” of the office make a difference?

Absolutely. When it comes to neck pain, the social and psychological characteristics of a workplace may be just as important as the physical demands placed on workers.

Researchers in the Netherlands tried to identify work-related risk factors for neck pain. They followed a group of nearly one thousand workers for three years. The researchers found that people who worked under time pressure were more likely to have neck pain. So were those who didn’t feel support from their coworkers. To a lesser extent, people who didn’t get to make many decisions at work were also more likely to have neck pain. Other “psychosocial” factors, such as supervisor support and job security, were not linked to neck pain.

Clearly, many factors play a part in neck pain. Both physical and social factors need to be addressed in order to make healthier environments for workers.

I seem to hold a lot of tension in my neck at work. My job isn’t physical, but it’s stressful. Could my neck pain have anything to do with my work?

Experts believe there’s a fairly strong connection between mental stress and the kind of muscular tension that causes neck pain. This relationship seems to apply to the workplace.

Researchers in the Netherlands recently looked at the relationship between job factors and neck pain. Examining data from 977 workers over a three-year period, they found that people who worked under a lot of time pressure were more likely to have neck pain. So were people who didn’t feel like they got much support from their coworkers. To a lesser extent, people who didn’t get to make decisions at work were also more susceptible to neck pain.

You may want to talk with your doctor about ways to manage your neck pain–and your stress at work. The more you can minimize your stress level, the better you’ll feel all around.

Is conservative treatment enough for patients who have pressure on their spinal cords from a ruptured disc in their necks?

Researchers in Japan recently tried to answer this question. They studied 27 patients with mild symptoms of spinal cord pressure due to a ruptured disc in their necks.

Patients wore neck braces and restricted their activities for up to six months. Seventeen of the patients (63 percent) improved or stayed the same. The injured discs actually healed themselves in 10 of these patients (59 percent).

The other 10 patients either did not improve or got worse in six months’ time. These patients eventually had surgery to get the pressure off the spinal cord.

Both groups had the same amount of function at follow-up. And both groups were satisfied with their results. This research suggests that conservative treatment may help some patients with disc herniations that cause mild pressure on the spinal cord.

I have some problems from a ruptured disc in my neck that’s putting mild pressure on my spinal cord. My doctor said I may need surgery but that I could just wear a neck brace instead. Am I better off deciding to have surgery right away?

Chances are, you have some time to make your decision. A recent study observed patients who had disc herniations that caused mild symptoms of spinal cord pressure. Ten patients had surgery right away. Twenty-seven patients tried conservative treatment instead. They wore neck braces and limited their activities for three to six months. Seventeen of these patients (63 percent) did well without surgery. The others didn’t do as well and wound up having surgery.

Later on, all three groups of patients–those who had surgery right away, those who had surgery later, and those who didn’t have surgery at all–had the same amount of function.

Patients who didn’t have surgery and those who waited to have surgery were both satisfied with their results. In fact, patients who had surgery after trying conservative treatment were a little more satisfied (90 versus 77 percent).

These results suggest that you may get good results from conservative treatment alone. Be sure to talk more with your doctor about what you can expect from conservative treatment.

My MRI showed I have a ruptured disc in my neck that is putting mild pressure on the spinal cord. My doctor feels my symptoms aren’t too bad and that we can fix them without surgery. Is there any way to tell whether treatment without surgery will work for me?

Magnetic resonance imaging (MRI) may give clues as to whether you’ll improve without surgery. An MRI can show the type and location of the disc that’s causing the pressure in your neck. This information can help determine whether you’ll get good results without surgery.

“Diffuse” herniations that spread out are more likely to heal without surgery than those confined to smaller spaces. Diffuse herniations tend to shrink with time, and the pressure on the spinal cord eventually goes away.

Herniations near the front and middle of the spinal cord seem to improve without surgery more often than those off to the side. This is because the spinal canal is widest in front, so the spinal cord isn’t squeezed as easily by a disc pressing in from the front.

Depending on the type and location of the ruptured disc, your doctor may suggest trying a neck brace for a few months. If you still don’t feel better, surgery may be the next step.

I had a cervical fusion many years ago. I’m eighty-two years old now, and I don’t want surgery again. How can I take care of the pain in my neck without having another operation?

Surgery is rarely the first choice of treatment for neck pain. It may be suggested if you develop muscle weakness, pressure on the spinal cord, or severe pain that doesn’t go away. And knowing your desire to avoid another surgery, your doctor will likely suggest ways other than surgery to help you take care of your neck pain.

Along with medication to help ease pain and inflammation, doctors may prescribe “first aid” measures such as heat or ice. Try to avoid activities that tend to increase your pain. If you continue to have problems, your doctor may suggest that you visit a physical therapist. Working with a therapist can help ease pain and improve neck mobility, strength, and posture.

Does the success rate for neck fusion surgery change depending on whether two or three levels in the neck are operated on?

A recent study compared patients who had neck fusion of two or three levels. The surgical team took a section of bone from the outside edge of the patients’ lower leg, the fibula bone. The graft was used to join the neck vertebrae.

Of 145 patients, only 14 patients did not have solid bone fusions two years after surgery. The success rate for surgery at two levels was 92 percent. For three levels, the success rate was slightly lower–84 percent. The difference between success rates was felt to be slight.

Conventional wisdom holds that the more sites operated on, the greater the risk. But this research suggests that patients can safely have surgery at multiple levels using a graft of bone from the fibula with good results.

I’ve heard that some of the devices implanted during neck surgery can break or malfunction. Are there any new types of implants out there with better results?

It’s true that, in some cases, metal hardware has broken or been associated with other complications. Some of the devices available aren’t as effective or stable as surgeons would like.

Doctors are constantly working on new hardware systems. An article recently presented results of a new device made in France. This device, called the PCB, is placed between the vertebrae to create a solid bone fusion. The PCB has a “cage” that holds chips of bone graft material, making it impossible for the chips to fall out of place. The PCB also has a plate that fits between vertebral discs to prevent them from collapsing together.

The PCB was used on 29 patients with excellent results. Twenty-seven of the patients showed improvement five months to two years after surgery.

There were no complications from the PCB. It immediately created enough stability in the neck that it decreased pain without the need for a neck brace. The PCB maintained the space between vertebral discs. It also corrected the normal curve of the neck.

Every new device goes through extensive testing before it goes into wide use. Doctors are just beginning to investigate the PCB as a safe surgical option. However, the results for this and other new devices look promising so far.

My doctor has mentioned attaching a metal plate and screws in my neck when I have my upcoming neck fusion surgery. He used the term “instrumentation” to describe the surgery. What is instrumentation?

Instrumentation refers to the special devices surgeons sometimes use when fusing bones together. Another term for these devices is hardware. Instrumentation is used to get the best possible results from the surgery.

In the case of neck surgery, for example, a surgeon may implant a special man-made device to hold the neck bones in place. In most cases, this device will be sturdier than natural bone alone. Instrumentation can help the area heal correctly, which can speed recovery time and make the results of the  surgery last.

I had a discectomy and fusion at C5 and C6 two years ago. I did well for about two years. Now I’m having more pain and problems with my neck. My doctor just did some tests, and apparently there is a bulge in the disc at C6 and C7. What should I do?

When two bones in the spine are fused, the action of the joints above and below changes. This can lead to problems in the joints above or below the fused area. It could explain why you are having problems at the level just below the fused segments of C5 and C6. Your doctor may want you to work with a physical therapist to help ease pain, improve the quality of neck motion, and optimize your posture. A program like this usually includes strengthening exercises for the neck and upper back muscles. The goal is to help improve your condition and give you ways to take care of future pain or problems with your neck.

However, if you keep having significant pain or develop progressive arm or hand numbness, your doctor will examine you again and make further recommendations. A second surgery may have a lower chance of success because of the scar tissue from the first surgery. You and your doctor will need to discuss the risks and benefits when deciding whether another surgery should be done.

After losing strength in her left arm and having pain that keeps her up at night, my wife had an MRI of her neck. The doctor says she has a herniation of the discs between C5 and C6 and wants to operate. Are there options other than surgery?

Doctors generally prefer to begin with nonsurgical treatment. As long as the injured disc is not squeezing the spinal cord, the pain is tolerable, and any numbness or weakness is not getting worse, surgery may be avoided. If any or all of these symptoms worsen, surgery may be suggested.

When it comes to neck fusion surgery, do men and women have different results?

In general, gender doesn’t seem to make a difference in how well patients do after neck fusion surgery.

A recent study looked at about 150 patients who had fusion surgery at multiple levels (or locations) in the neck. The surgical team used bone from the fibula, the small outer calf bone, to join the vertebrae in patients’ necks. Only 14 patients did not have solid bone fusions two years after surgery. Ten of these patients were women. However, the difference in the success rates of men and women was felt to be slight. According to most research, gender doesn’t affect results from neck fusion surgery in any reliable way.

I have a herniated disc in my neck. Why does my surgeon want to operate on more than one location in my neck? Isn’t the sore disc just in one place?

A recent study presented the results of a surgical procedure that uses a bone graft from the outer edge of the lower leg (fibula) to fuse the bones in the neck. Nearly 150 patients had this procedure. Success was judged by whether the neck bones had grown together two years after surgery. 

Success rates were 92 percent for patients who had surgery at two levels and 84 percent for patients who had surgery at three levels. These numbers were hardly different. And there were few complications from surgery. These results suggest that most patients get good results from surgery at multiple levels when the graft is taken from the fibula bone.

I am having surgery to take pressure off of the spinal cord in my neck. My doctor says the results of my MRI can be used to predict how I will do after surgery. Is this really possible?

As you may know, MRI stands for magnetic resonance imaging, a test that allows doctors to see pictures of tissues in the body. Certain patterns seen on MRI are thought to give an indication of how well a person will do after surgery to take pressure off the spinal cord. When the pattern shows lots of tissue damage in the spinal cord, the results of surgery may not be as good.

Though some patterns have been linked to surgery results, MRI is not a foolproof tool when it comes to predicting how all patients will do. In fact, a test like this is only one piece of the puzzle. Other factors, such as patients’ age and how long they’ve had symptoms, come into play. Younger patients who haven’t had symptoms as long seem to fare better than older patients who’ve had problems for longer. You may want to talk with your doctor to find out how your MRI fits with other information and test results.

I am a professional singer who has to have neck surgery. The doctor wants to go in through the front of my neck to join the bones in my spine. Will I lose my voice?

Probably not. In a recent study of 382 operations like yours, only nine patients (2.7 percent) had any hoarseness after surgery. And only two of these patients had problems that lasted more than three months.

Doctors used to think there was a greater risk of hurting the nerve that goes to the vocal cords if surgery was done on the right side of the neck. Right-sided surgery was believed to endanger the recurrent laryngeal nerve, which hooks up with the voice box (larynx). Research now suggests that the risk for injuring this nerve is minimal and is the same for both right- and left-sided surgeries. If you have any voice changes after surgery, they’ll likely be subtle and short-lived.

I’ve heard that surgery to fuse the spine done through the front of the neck can make patients lose their voices. Does it matter which side of the neck the surgeon operates on?

In the past, surgeons typically made incisions on the left side of the neck for this type of procedure. This was to avoid hurting the recurrent laryngeal nerve, or RLN. The nerve takes a more winding path on the right side of the neck, which was thought to put it at increased risk of injury during surgery on the right side of the neck. The RLN connects to the voice box (larynx). Injury to this nerve can cause hoarseness and even vocal cord paralysis.

However, research tells us that the risk of RLN injury is the same no matter which side of the neck is operated on. In a study of 328 patients, only nine (2.7 percent) had voice problems after surgery. The percentage of patients with injuries was 2.3 for those operated on from the right and 3.2 for those operated on from the left. In other words, the risk was basically the same for both sides. If this is your first surgery of this kind, the surgeon can operate on either side of your neck.

What’s the best way to predict whether patients will get good results from neck surgery to relieve pressure on the spinal cord?

Their age and the length of time they’ve have had symptoms of spinal cord pressure seem to be good clues as to how well patients will do after this kind of surgery. In a recent study, patients who were in their forties or fifties and had symptoms for about a year did better than older patients whose symptoms had lasted two or three years.

Certain patterns seen on MRI may also give clues about surgery results. MRI–magnetic resonance imaging–is a test that shows tissues in the body. An MRI scan showing lots of tissue damage in the spinal cord is an indication the patient won’t have optimal results with surgery.

My 70-year-old mother is having surgery to take pressure off the spinal cord in her neck. Does her age put her at a disadvantage?

Possibly. A recent study showed that, compared to people in their forties and fifties, older patients were less likely to have good results from this kind of surgery. However, other factors also come into play.

The duration of your mother’s symptoms may make a difference in how well she does after surgery. If she’s had symptoms for a year or so, she may get better results from surgery than if she’s had symptoms for longer. Her doctor may be able to give you more specific information based on MRI, or magnetic resonance imaging. MRI results can show the doctor how much tissue damage there is and may provide an indication of how well your mother will do with surgery.