FAQ Category: Cervical Spine

It’s not clear yet why decompression surgery for cervical myelopathy isn’t more successful. Studies done by surgeons with years of experience and good results for other surgeries report very little improvement after this operation.

It may be that patients with other problems are the ones with worse outcomes. Perhaps having heart disease, or diabetes, or a thyroid problem affects the results. Age may be a factor. Some studies show poor results in older adults.

Some surgeons say the type of surgery makes a difference. The amount of cord compression, alignment of the spine, and previous surgery to the area may make a difference. Worse disease is usually operated on from the back (posterior approach). Patients who require
more extensive surgery often have worse results.

Cervical spondylotic myelopathy (CSM) is a narrowing of the spinal canal through which the spinal cord passes. Pressure is put on the spinal cord causing many symptoms in the neck, arms, and hands.

Many surgeons say that surgery for this condition doesn’t improve patient’s symptoms. Since it’s a degenerative condition, over time, the problem may get worse and the symptoms can come back.

There are only two studies reported comparing patients who had surgery with patients who didn’t have surgery. The results of both studies were the same: there was no major difference in results for these two groups.

Doctors agree that more study is needed. It would be good to have a large group of patients and compare the results of various treatment options.

The placebo effect could explain your self-assessed improvement. In simple terms, just having surgery made you feel better. Once you feel better you start to do more. You
may have had the strength to do those things before surgery but held back because of pain or fear of pain.

It’s also possible the tests given don’t measure things that changed after the operation. There are a variety of tests available to measure results in patients treated for cervical myelopathy. Some go just on the basis of the patient’s symptoms. Others look at the ability to walk, work, climb stairs, or use a knife and fork.

Compare the tests done and the improvements you notice. Do they match? Does it seem like the tests were measuring the very things you’ve seen changes in? If yes, wait six months
and take the tests again. You may see a difference with a little more time.

Studies show that increased neck pain, headache, and dizziness are common after manipulation. Patients treated by a physical therapist can have these symptoms but they occur much less often (6.8 percent).

Patients under the care of a medical doctor are affected about 5 percent of the time. Often these symptoms are drug-related. Patients who aren’t taking any pills also report similar symptoms.

It seems that some patients have worse symptoms after treatment no matter what kind of treatment they get. This may be more common in patients with neck trauma. High levels of pain, severe headaches, and nausea are also linked with poor response to chiropractic
care.

In some cases, a lack of confidence or a lack of expected benefits may lead to an adverse response to treatment. For other patients it’s possible that short-term side effects are the price to pay to get better in the end.

These and other symptoms are very common after neck manipulation. In fact one-third up to one-half of all patients treated with chiropractic manipulation report some symptoms during the first 24 hours. They usually go away in the next 24 hours.

Most reactions are not serious enough to consider a problem. In fact, it’s possible that minor side effects are “normal” and a necessary part of the body’s response to healing.

You may not get the full benefit if you go back expecting problems. Lack of confidence in your health care provider may also prevent a good result. Talk to your chiropractic doctor and let him or her know about your symptoms. A different treatment approach may be
used next time with fewer symptoms.

Stroke within 24 hours of neck manipulation has been reported. It’s not common. There are an equal number of cases of stroke in patients treated with nonforce in a neutral position. In other words the neck isn’t rotated or extended during the treatment.

Risk of serious complications after neck manipulation is being studied. A recent report from California shows that mobilization has fewer side effects than manipulation. Mobilization is a movement of the joint through part or all of the range of motion. There is no thrust and no high velocity motion.

Studies estimate the chances of stroke after neck manipulation range from one in 500,000 to one in six million. Based on malpractice claims it appears the risk is very low.

Muscle pain on one side of the body often points to two possibilities. First, you may be doing an activity over and over using one side of the body. This could be something like vacuuming, painting, filing, or even a sports activity like tennis or golf. Try to think back over the last week about any activities that would increase the use of one arm over the other.

Muscle pain can also be referred from somewhere else. Often the neck is the culprit. Pressure on the spinal nerves as they leave the neck can cause muscular tenderness or pain in the neck, upper back, or upper arm. Are you having numbness, tingling, or other changes in sensation on that same side? Have you noticed any weakness of the shoulder, arm, or hand on that side?

A doctor or physical therapist can conduct a screening exam to find the problem. Tests of reflexes and strength may point to a pinched nerve, a condition called cervical radiculopathy. If your symptoms don’t go away in one to three days, seek the opinion of a health care specialist.

Doctors and therapists know that pain can be referred from somewhere else. This could be the result of nerve root irritation in the neck. Such a condition is called cervical radiculopathy.

If tender spots in the neck, shoulder blade (scapula), or arm are referred from the cervical spine, then treatment must address the problem. In this case, the spine should be the focus of treatment and not the tender spots.

Anytime muscles are tender or sore from cervical radiculopathy, other tests can be done to confirm the therapist’s suspicions. Ask your therapist to explain his reasons for treating the neck. You’ll likely find out the results of these tests.

Worrying is considered a passive coping strategy. It doesn’t really lend any practical ways to deal with or change a situation.

Many experts suggest that 99 percent of the things we worry about never happen. The opposite may be equally true: the things we don’t worry about DO happen.

Worrying is thought to cause a state of preoccupation with bodily symptoms. This sets up a vicious cycle of worry, pain, disability, and more worry. Studies show a poor outcome in neck and back pain patients who worry.

Good general health is a predictor of recovery. If you are in good health but have some neck or back pain, you can expect to do well. A history of past neck or back pain is more likely to delay your recovery. The same is true for waiting too long to get help for your problem.

The doctor is probably basing his or her diagnosis on your symptoms and any findings from the physical exam. Clinical cervical spine instability (CCSI) is a fairly common problem that doesn’t always show up on standard X-rays.

Most patients report clicking, popping, or a clunking sensation with neck motion. Neck pain is a key feature. Headache pain is less predictable. Abnormal neck motion is more common than hypermobility (too much motion).

All structures around the head and neck work to hold the spine stable. The goal is to allow normal control of posture and movement without pain or dysfunction. With CCSI the spine is unstable under normal loads, forces, or movements.

There may be increased shearing forces at the joints. Pressure on the nerves can cause shoulder and/or arm pain. Muscle weakness can also occur with pressure on spinal nerves.

OCS stands for Orthopaedic Certified Specialist. It means the therapist has taken a special test and passed. The American Physical Therapy Association (APTA) gives the test. It’s used to identify “experts” in orthopedic problems like neck and back pain.

FAAOMPT stands for Fellows of the American Academy of Orthopaedic Manual Physical Therapists. This group of therapists has done extra training in the area of orthopedic manual physical therapy.

A residency or fellowship program is required. Manual therapy is a hands-on approach to restoring joint motion especially in the spine.

When looking for a physical therapist to meet your needs, don’t be afraid to ask about years of experience and level of training. This doesn’t always guarantee a level of expertise but it helps.

Training is one thing but bedside manner is still very important to many people. Once you find a therapist with the kind of training needed for your problem, then you can narrow down the one you can work with based on your personality and goals.

You may be describing a symptom of a problem called Clinical Cervical Spine Instability (CCSI). One or more spinal segments don’t move in a smooth, coordinated manner. The need to snap or pop one or more joints is commonly reported with this condition.

It makes sense that if the snapping or popping is part of an abnormal condition it’s best to address the underlying problem. A physical therapist can assess your motion. He or she
will also test for integrity of the joints and soft tissue structures.

Retraining the muscles around the joints and restoring normal neuromuscular control are
the goals. This can be done with a series of hands-on treatments. A home program of movement and exercises for postural control is also important.

Look for a therapist with special training in manual therapy. Various schools offer different models such as the McKenzie method, Upledger approach, or Cyriax mobilization. Other names you might hear include Kaltenborn, Paris, or Grimsby.

Some may have followed more of an osteopathic approach with training by Loren “Bear” Rex, Jim Jealous, or Frank Chapman.

There is strong support from scientific study that early active movement and mobilizing exercises is best. This is true even in the acute phase of injury.

Studies have also shown that results are best when patients have multiple sessions with direct instruction from a trained professional. This may be a medical doctor, chiropractor, or physical therapist.

The proper healing of soft tissues requires training in posture and movement. Re-training the neck joints to sense position change is also important. This type of program isn’t really a do-it-yourself project.

Ask your doctor for specific advice or visit another health care professional trained in soft tissue injuries.

You didn’t mention if you had an X-ray to rule out fracture or other bony injury. Assuming you have the usual soft tissue injury from a whiplash, here are a few tips.

There isn’t one treatment known to work best for painful symptoms after a whiplash. Research supports an early return to regular activities. Pain relief can be obtained from the use of over-the-counter or prescribed pain relievers.

Ice is often advised in the first 36 to 48 hours. Cold may help keep the swelling down. Some experts suggest alternating cold and heat during the subacute phase from day three to day 14.

A soft-collar may be used during the first few days. The idea is to rest the head and neck muscles during the early healing phase. Longer use of a collar isn’t usually recommended. Movement is much better to help with the healing process.

There are pathways up and down the spinal cord that deliver messages from the brain to the body and from the body to the brain.

Pressure on the spinal cord from a bulging disc can cause all kinds of unusual problems. Patients may report muscle weakness in the arms or numbness and tingling in the hands. Loss of bladder sensation can occur when neural pathways controlling the bladder are affected. An underactive or overactive bladder can also occur.

According to a recent study at least half of all patients with pressure on the spinal cord in the neck region have bladder problems. Surgery to remove the pressure gives relief from urinary problems in 90 percent of all cases.

Neurogenic refers to the nerves or nervous system that control the function of the bladder. Being able to hold your urine until you get to the bathroom depends on the proper function of the nerves and the nervous system.

Bladder control can be disrupted by anything that affects the brain, spinal cord, or spinal nerves. Stroke, cancer, dementia, or trauma are just a few examples of things that can impair the nervous system’s control of the bladder.

In the case of cervical myelopathy, pressure on the spinal cord in the neck is causing a bladder problem. This could be coming from changes that occur in the spine with aging. It might also come about because of pressure on the spinal cord from a bulging disc.

Your condition may be reversible. Early treatment of the myelopathy is important to prevent long-term or permanent bladder problems.

Pain and weakness from a bulging disc putting pressure on the spinal cord is called cervical myelopathy. Cervical refers to the neck, and myelopathy means spinal cord disease or problem.

Early treatment with surgery is often advised for this problem. Without surgery, neurologic function can get worse over time. Changes can even be permanent.

Besides muscle weakness and pain, bladder changes occur in up to half of all patients with cervical myelopathy. The bladder may become too active. In some cases the bladder has no sensation. Lifelong urinary problems can be avoided with early intervention.

Some doctors are removing the bones and replacing them with mesh cages. The cages are made of titanium and held in place with locking plates. Titanium cages give immediate stability to the spine. Each cage is filled with pieces of bone to give rigid support.

There are problems with this method. Other doctors suggest just removing the back portion of the bone. This operation is called a laminoplasty. This will take pressure off the spinal cord without losing the support of the bone.

Dysphagia or difficulty swallowing occurs in up to 60 percent of patients having anterior cervical spine fusion. Researchers say it’s very common and highly underreported.

From imaging studies it looks like the cause may be soft tissue swelling. Sometimes a pocket of blood called a hematoma puts pressure on the local nerves causing dysphagia.

Infection is another possible cause. Most of these problems are temporary. As healing takes place, the swelling or results of local bleeding are slowly resolved. Most soft tissue healing takes place in the first four weeks as you experienced.

Surgeons are starting to try spine surgery on an outpatient basis. Different types of operations are being studied.

Recently surgeons at the Monmouth Medical Center in New Jersey joined in this new research. They compared the results of 30 patients who had an anterior cervical discectomy and fusion (ACDF) as outpatients with 30 inpatients.

Patients were carefully selected for the outpatient operation. The results were better than for the inpatients. There were fewer problems during and after the operation.

In the last 10 years more and more orthopedic operations have been done successfully on an outpatient basis. You can expect to see more and more of this in the near future.