FAQ Category: Cervical Spine

Many studies report that acupuncture is safe and moderately effective. Research shows it’s better than doing nothing and often better than pretend or sham treatment. Some other treatments such as neck mobilization works as well as acupuncture.

There are some possible side effects of acupuncture but these are rare and minimal. Increased pain, bruising, and dizziness are reported most often. Side effects are not life-threatening.

Studies suggest at least six or more acupuncture sessions give the best results. It’s not clear if there are better results if the needles are inserted deeper or if one location is best.

Sometimes the needles are electrically stimulated or heated. Herbal extracts can also be injected into acupuncture points. Whether or not one of these methods has a better effect is also unknown.

It seems that treatments for neck pain are varied as are the results. Benefits are perceived by patients on a case by case basis. One treatment doesn’t seem to work best for everyone. Each patient must find what works for him or her. Acupuncture is an acceptable choice and effective for some pain patients.

Dropped head syndrome as you just described it is a problem caused by a variety of neuromuscular disorders. Parkinson’s is one of them. Others include myasthenia gravis, spinal muscular atrophy, and amyotrophic lateral sclerosis (ALS).

With Parkinson’s, there is a movement disorder. The person hasn’t lost the ability to move, but there is a problem with activating movement and loss of automatic movements. Everyday, automatic movements like turning, walking, or lifting the head diminish.

Freezing is another problem with Parkinson’s. The person suddenly stops moving in the middle of an action. The foot gets stuck to the floor or the chin gets stuck on the chest. It’s not clear exactly what causes this problem. There are many different theories. It occurs most often as the disease progresses suggesting degeneration of the neurologic system.

There is no cure for the movement disorders in people with Parkinson’s. Physical therapy may help your brother learn strategies to improve movement. The therapist can teach him ways to improve smooth, coordinated movement. Sometimes something as simple as body rocking, clapping the hands, or jerking the eyes in one direction can help them get unstuck and moving again.

Forward head, dropped head, or stooped posture can occur as we get older. Gravity, weakness, and fatigue pull us forward into a more flexed posture. Many times these postures can be prevented with exercise and conscious attempts to maintain an upright position.

Something as dramatic as you describe may be caused by an orthopedic or neurologic condition. A medical exam is needed to find out what might be causing the problem. X-rays or imaging tests will help identify any underlying cervical spine (neck) instability.

Weakness can be improved with an exercise program. Surgery may be needed if there is a spinal instability. Finding out what’s causing the postural changes is needed first before a specific plan of action can be determined. Encourage him to see his doctor. Perhaps offering to go with him might help.

There has been much debate over the years about the use of groups versus individual treatment. Insurance companies often do not cover group sessions, but only private therapy between therapist and patient. There are reasons for this decision.

On the one hand, if all you need is group supervision, then you could get that kind of service at a health club or with a fitness group. The cost would be far less. A disadvantage to this method is that the trainer is not as highly trained as a physical therapist. But supposedly, you don’t need this much guidance.

The therapist takes into account your vital signs, past medical health, and personal risk factors for diseases and illnesses. The therapist also reviews potential side effects of medications you may be taking. Exercise is prescribed specifically for you based on your age, general health, and the presence of other problems like heart disease or diabetes. Exercise can improve some conditions but can also make others worse if not applied properly.

In Canada, where there is universal health coverage, fitness and rehab groups are available for patients after a whiplash injury. In a recent Canadian study, groups of acute whiplash patients were compared. Some were in a group fitness program at a health club. Others were in a multidisciplinary outpatient group at a private clinic. A third group were treated one-on-one in an individualized in-patient hospital program.

The results showed that individualized treatment influenced recovery in a positive way. The rate of recovery was much faster for the in-patient group treated during the first two months after the accident. Recovery was twice as slow for the outpatient group compared to the other groups.

The authors of that study suggested that there isn’t enough evidence to support group fitness or group rehab for whiplash injuries. More research is needed in this area to find the best way to treat whiplash.

Pain that persists beyond the expected time for healing is called chronic pain. In the case of a whiplash injury, most of the physiologic healing of the soft tissues takes place in the first eight to 10 weeks after the accident.

This is not to say that chronic pain can’t be treated or won’t respond to treatment. Many whiplash patients can and do improve with a rehab program. A physical therapist works with the patients to restore full and normal, pain free motion.

Weakness of the muscles around the neck may be part of the problem. A strengthening program may be needed. And because tiny receptors in the joints can be damaged during the injury, treatment to increase or restore proprioception can be very important. Proprioception is the joint’s sense of position in the spine during rest and during motion.

Some patients seek out the services of a massage therapist, chiropractor, or acupuncturist for painful symptoms of chronic whiplash syndrome. If your physician has ruled out more serious problems such as tumor, infection, or fracture, then you may want to pursue various other approaches to treatment mentioned.

There are two kinds of diagnoses: symptom-based and pathology-based. The medical diagnosis your mother was given is an example of a symptom-based diagnosis. When it comes to joint pain, back pain, or neck pain, the underlying cause is often unknown.

For the older adult. aging and degeneration cause the symptoms listed. Treatment is often the same no matter what the cause is anyway. Patients are more likely to get a specific diagnosis based on more advanced testing (lab work, X-rays, MRIs) if they don’t get better with conservative care.

Patients who are hospitalized are also more likely to be given a pathology-based diagnosis. If no pathology can be determined, then the physician once again relies on a symptom-based diagnosis.

Medical researchers are very busy trying to find ways to better classify or group patients with neck or back pain. These type of groupings is called a taxonomy. Improving taxonomy for painful musculoskeletal conditions could help direct research and ultimately find better treatment for each condition.

Your situation is the exception rather than the rule. Of the 28 million people who reported neck pain last year, 10 million saw their doctors. Eight per cent (80%) of those individuals got better with treatment to treat the symptoms. Most often this included antiinflammatories, muscle relaxants, and physical therapy.

This is a fairly typical big picture view of neck pain. Doctors know that further testing is really only needed in a small number of cases. Patients who don’t get better on their own or who don’t get better with conservative care are the best candidates for advanced imaging studies.

X-rays are usually ordered first. If further tests are needed, MRI or CT scans are done. The physician makes the decision as to when additional testing is needed and what to do based on patient history and the results of the examination. Failure to improve after three months of conservative care is also an indicator that more testing is needed.

The high cost of MRIs keep this from being a standard test given to anyone and everyone with neck or back pain. This is especially true given how many people with neck pain have normal MRIs and the number of abnormalities seen on imaging studies in people with no symptoms at all.

No one knows exactly why calcium deposits form in the anterior (front of the) neck. One muscle in particular, the longus colli is affected most often. Age may be a factor as this condition (called calcific retropharyngeal tendinitis) occurs most often in adults over 30 years old.

There may be a genetic link and possibly metabolic reasons for the formation of calcium deposits. Chronic trauma to the muscle, tendon degeneration, and inflammation for any reason seem to trigger calcium deposits.

Patients may not even know there’s a problem until the deposits rupture. Inflammation results in acute symptoms such as fever, sore throat, neck stiffness, and pain. Treatment with an antiinflammatory medication usually resolves both the symptoms and the calcium deposit.

X-rays are a useful and fairly inexpensive diagnostic tool to screen for a wide variety of problems that can cause pain, swelling, and loss of motion. As you probably saw from your own X-rays, calcium deposits often (but not always) show up clearly. Thickening of the surrounding soft tissues can also be seen on X-ray.

More advanced imaging studies such as CT scanning and MRIs can offer additional information to guide treatment. In the case of calcific tendinitis of the neck muscles, the additional tests will help rule out infection as a cause of any swelling. Infection and inflammation are two separate problems that are treated with different medications.

An abscess from infection in the neck can be a potentially dangerous problem. CT scans and MRI can help pinpoint the exact location of the problem. The results also show the doctor what’s going on in the soft tissue structures.

Doctors are usually very conservative when it comes to ordering extra tests. Given the added cost of these more advanced imaging studies, they are only suggested or ordered when the information gained is important to your care and treatment.

Foraminotomy is a procedure used to relieve pressure on nerves that are
being compressed or pinched by the intervertebral foramina. The foramen is an oval or round opening in the vertebral bone. The spinal nerves go
through this hole on their way from the spinal cord to the muscles of the arms
and legs.

Anytime the name of an operation ends with otomy, it refers to the removal of something. In this case, the surgeon removes any disc material that
may be pressing on the nerve. The opening in the bone may also be enlarged by shaving or cutting away bone around the nerve.

The procedure can be done from the back of the neck. A tiny incision is made. The small incision makes this a minimally invasive surgery (MIS). The muscle is then peeled away so that the surgeon can see the bone underneath. A small hole is cut into the vertebra itself. The foramen can be seen through
this hole. The bone or disc material that is pressing on the nerve can be
removed.

The operation is usually very successful. Long-term studies report
good-to-excellent results for up to 96 per cent of the patients. Your father
can expect pain relief and return to normal activity and work status.

Laminectomy is a surgical procedure for relieving pressure on the spinal cord. The lamina is an arch of bone that forms a circle around the spinal cord. During a laminectomy, the lamina is removed or trimmed to widen the spinal canal. This creates more space for the spinal nerves.

Foraminotomy is another operation used to relieve pressure on nerves. In this case, the nerves are being compressed or pinched by the intervertebral foramina. The foramina is an opening in the bone through which the spinal nerves pass to leave the spinal cord and travel to other parts of the body.

Instead of cutting out a large segment of bone (like in the laminectomy), the opening is just made larger during a foraminotomy. This allows more space for the nerve without loss of motion or stability in the spine.

The lumbar vertebrae are much larger and stronger than the cervical bones. A laminectomy in the lumbar spine usually doesn’t result in an unstable segment. Removal of the lamina in the cervical spine must be accompanied by fusion afterwards or problems can develop with instability and collapse.

You raise some interesting and very good questions. There may not be a single answer that fits every patient. Spinal fusion for any reason is not considered lightly, especially for the older adult.

The surgeon is the best one to advise you on this question. Patient age and general health are two important factors. The patient’s symptoms (especially severity of symptoms) and function are also considered. Bone density and the presence of osteoporosis in older adults are also evaluated.

Many older adults are coming through spinal fusion surgery with good results. Keeping mobile and active is a key factor in living longer with better quality of life.

The decision must be made carefully weighing all the factors. The patient should rely on family and the physician to offer guidance. Ultimately, the decision should be left up to the patient.

You may be suffering from a condition called chronic whiplash syndrome (CWS) or chronic whiplash disorder (CWD). Patients with CWS/CWD report chronic pain, loss of motion, and disability.

There may also be a fear of movement or reinjury. This can cause a patient to become overalert or hypervigilant about pain and movement. If you think extending or rotating your neck is going to hurt, you stiffen up to avoid pain or discomfort.

A combined program of physical therapy (PT) and cognitive behavioral therapy (CBT) may help. The program can help restore full (painfree) motion, strength, and function. You will be given cues to breathe, relax, and focus throughout motion.

At first you have to tell yourself to use these techniques whenever you start to feel threatened by motion or certain positions. Over time, you should be able to retrain yourself to move freely without thinking about it.

Cervical osteotomy is a procedure used to help improve head, neck, and upper spine position in patients with a severe kyphosis. Kyphosis is the term used for a flexed or curved spine.

In the case of AS, this procedure is done to improve vision, hugiene, and function. With severe kyphosis the field of vision can be decreased considerably. Patients may not be able to lift the head enough to see in front of them. It can be difficult to open the mouth, brush the teeth, and for men, to shave.

Patients with this problem may be able to drive longer than they can safely walk. Sitting down helps bring them into a more upright posture. But when driving is no longer possible, osteotomy and fusion can help restore field of vision and function.

The surgeon will correct the deformity in a position that will allow the person to look ahead when standing and walking. Overcorrection is avoided so that the person can still work at a desk or drive a car.

Treatment for neck pain depends on the underlying cause and whether the symptoms are acute or chronic. Exercises are often the best choice for chronic pain. Exercises are not the first choice for pain caused by infection, tumor, or fracture.

Acute pain describes recent symptoms, usually from trauma or overuse. Chronic pain is usually defined as pain lasting three or more months. Chronic pain continues after the six-to-eight weeks normally needed for tissue healing.

With acute symptoms, treatment centers on reducing inflammation. Antiinflammatory drugs and/or analgesics (pain relievers) may be used. Rest, ice, and gentle motion are often advised during acute episodes.

Chronic pain is treated more often with exercise and activity. Sometimes people with chronic neck pain do have acute flareups. This may describe your situation. At times like these, the patient may need treatment to calm down the acute symptoms before progressing to the exercise program.

It’s best to make a follow-up phone call or visit to your doctor. You may need to see a physical therapist to help with pain management. A different set of exercises may be needed during acute flareups. The therapist can guide you through the acute and chronic phases of neck pain.

The goal of conservative care such as physical therapy (PT) is to reduce your symptoms and increase your function. You want to be able to meet the physical workload and daily activities required each day.

A specific exercise program is often needed at first. Such a program takes into account the underlying problem as well as your general health. For the fastest rate of recovery and to avoid making a problem worse instead of better, safe, prescriptive exercise is best.

The PT understand the effects of different types of exercise. The same is true for how much exercise and the intensity of each exercise needed for each specific problem.

Once you get past the first step, then a group program or even just a home program may be the best next step. Your therapist can help you find the right group or activity for your individual situation.

The treatment of chronic neck or back pain remains a challenge for patients and physicians alike. Treatment with prescription drugs remains the most relied upon option. But it’s clear that less than a third of the patients treated this way get any real pain relief.

Radiofrequency used to heat up and destroy the offending nerve tissue hasn’t been all that successful either. Studies just don’t show the positive long-term benefits needed.

More recently, scientists are studying the effects of pulsed radiofrequency (PRF). Short-lasting pulses of electrical currents are delivered to the nerve. The current used is high enough voltage to reach the radiofrequency range but not high enough to destroy tissue.

Short-term results are promising but not refined enough to recommend for everyone. For now, pain management from a multidisciplinary approach remains the gold standard for this type of problem.

Learning to manage the symptoms while increasing activity and function are the main goals. A combined effort of physical therapy, behavioral counseling, drugs, and alternative medicine help many people while waiting for a better approach.

In the last 10 years, neurodestructive procedures using radiofrequency (RF) have gained in popularity. Studies don’t support this level of enthusiasm yet. The combined results of many studies showed there is no long-term benefit in terms of pain relief.

New findings may change the way neuropathic pain is treated. For example, we used to think that pain signals were relayed from the body through the nerve to the brain. Treatments like RF destroy the nerve and therefore stop the painful signals from getting through.

But this may not be the case at all. It appears that the complex nervous system increases its own circuitry to make up for the loss of the one nerve. The end-result may be more pain than the patient started with.

Some surgeons suggest a second RF treatment is worth the effort. Six months of pain relief is better than none. Some patients do get the desired effects making it worth the effort. See your doctor and find out what are the best options for you at this time.

Studies comparing normal, healthy adults with chronic pain patients do report differences in reaction time, task performance, and attention span. In fact, chronic pain patients are slower in performing tasks during baseline conditions in most studies.

This slowed-down performance may be what you are observing about yourself. Researchers suspect that cognitive processes are impaired. Your attention is divided between the task and your pain or discomfort.

Attentional performance can occur as a result of interference by pain or just the threat of pain, other symptoms, or disability. Different people are threatened by different factors. Some whiplash patients are more threatened than others by certain positions and activities.

Acupuncture is an ancient Chinese treatment that involves inserting very thin, sterile needles into the skin. The needles are placed at different depths and angles. Various points are used along meridians including points on and in the ear. The goal is to bring the body’s energy fields into balance thereby helping your body to self-regulate. Improved circulation and healing can result in reduced pain.

Acupuncturists see the body as a network of interconnected systems. An energy flow called Qi moves through energy channels called meridians. These complex energy patterns are closely linked with the central nervous system (brain and spinal cord) and the spinal nerves. Acupuncture points along these meridians are matched to problem areas of the spine and the neuromuscular structures that support it.

A recent study from Spain compared the results of using acupuncture for chronic neck pain with a placebo TENS treatment. TENS stands for transcutaneous electronic electrical nerve stimulation. It is a way to deliver low-voltage, electrical impulses to the spinal cord and brain to switch off pain messages.

The patients receiving acupuncture got much better results in terms of pain reduction and improved quality of life. Other similar studies have come to the same conclusion: acupuncture is safe and effective for the routine treatment of chronic neck pain.