Neck Pain

1. Neck Pain Merle S. Rust, M.D. Neurosurgeon Mercy Institute of Neuroscience & Mercy Regional Neurosurgery Center

2. Neck Pain • Undergraduate study: Eastern Illinois University, B.S. Chemistry, Business minor • Medical school: University of Illinois College of Medicine • Residency: University of Illinois Neurological Institute • Area of interest: spinal trauma and complex reconstruction/stabilization surgery • Serve as the neurosurgery liaison to the new Level II Regional Trauma Center at Mercy Hospital, Janesville, Wisconsin

3. Neck Pain • Common condition, like back pain, may be associated with tension headache • In most cases, self-limiting, resolving with conservative efforts within days to a few weeks • Can be severe, developing over a few hours during the day or may “just wake up with pain” after sleeping “wrong” • Non-traumatic or “minor” injury versus traumatic or major injury after MVA, significant fall or sports incident • Neck pain only versus neck and shoulder/arm pain +/- numbness/tingling in arm/hand/fingers

4. Neck Pain • Can greatly diminish quality of life • May require time off work, loss of productivity • Varies in intensity and duration • Treatments range from home remedies to formal doctor recommendations, depending on the cause, severity, duration of the pain syndrome

5. Neck Pain: Traumatic (Major Injury) versus non-traumatic or Spontaneous • Trauma: significant fall, motor or recreational vehicle accident, sports injury (e.g., football) should be evaluated by exam and x-rays by primary care or emergency room personnel before any treatment is attempted • Non-traumatic (minor sprain injury included) or spontaneous • In either case: important to differentiate between neck pain alone or neck pain with shoulder/arm pain, numbness or motor weakness in arms or legs (spinal cord involvement-myelopathy)

6. Neck Pain • What to do? • How long is this going to last? • Should I call my doctor or go to the emergency room? • Do I need testing, x-rays? • Should I stay home from school or work? • Am I going to need surgery?

7. Non-traumatic or spontaneous (including minor injury or sprain) • Causes • Myofascial: muscle spasm, inflammation, sprain and strain syndrome • Degeneration or inflammation of the cervical disc • Degeneration or inflammation of the cervical joint or facet w/ or w/o instability • Loss of the normal “slightly lordotic” alignment of the cervical spine • Infection of disc space or spine (osteomyelitis) • Tumor or cancer involving the cervical spine

8. Traumatic (major trauma) • Motor vehicle accident, falls, sports injuries- significant forces or impact • Causes of resulting pain: • Disc herniation • Fracture • Dislocation of spine Early formal evaluation by primary care or emergency room personnel recommended to avoid potential spinal cord or nerve root injury (paralysis or weakness), progressive deformity, possible chronic pain condition

9. Evaluation of Neck Pain • History • Onset circumstances, duration • Location of pain- neck only (Para cervical, trapezoidal, rhomboid muscles) versus neck and shoulder or arm/forearm/hand pain +/- numbness/tingling (numbness often involves certain fingers) • What makes it better or worse • Past medical history

10. Evaluation of Neck Pain • Physical exam • Muscle tenderness/spasm, loss of range of motion (rotation or flexion/extension) • Objective weakness in arms or legs • Loss or increase of DTRs (reflexes) or of sensation • Abnormal signs indicating spinal cord involvement or myelopathy

11. Evaluation of Neck Pain +/- arm involvement: Testing • Plain x-rays: static, flexion/extension • CAT scan • MRI (recommended to evaluate discs, spinal cord, nerve roots) • EMG/nerve conduction studies • Blood work (if above imaging studies suggest possible infection or tumor)

12. Neck Pain: What Should One Do? • Cause? i.e., injury involved versus no significant injury or “spontaneous” • Experienced first time or had it before • Pain in neck only or shoulder/arm as well • Loss of function/weakness/numbness • Other medical issues

13. Neck Pain: Treatment Options • Bed rest • Immobilization • Anti-inflammatory medications: OTC (Advil or Aleve); prescription (Tramadol or Medrol) • Anti-spasmodic or narcotic type pain relievers • Physical therapy • Injections: trigger point, facet or joint, epidural steroids directed toward nerve root • Surgery

14. When is Surgery Appropriate? • Conservative measures fail to relieve neck and shoulder/arm pain condition (intractable cervical radiculopathy) caused by disc herniation and/or arthritis (spondylosis) affecting a nerve root exit area • Neck pain associated with spinal cord compression (cervical myelopathy)

15. When is Surgery Appropriate.2 • Neck fracture that has involved the spinal cord or that causes significant instability • Tumor involving the spine • Infection of the disc space or of the bone

16. Advancements in Spine Surgery • Further understanding of the pathophysiology of natural degenerative disorders as well as unnatural events (trauma) • Further understanding of spinal biomechanics • Improved imaging techniques (MRI) • Advancements in surgical implant devices and surgical techniques

17. Surgical Procedures • Biopsy for infection or tumor diagnosis • Anterior cervical discectomy with bone and plate fusion treating a significant disc herniation that involves the nerve roots and/or the spinal cord (ACDF) • Posterior laminectomy or foraminotomy to open the spinal canal or nerve root exit site (foramen); w/ or w/o fusion • Anterior cervical discectomy with artificial disc insertion • Anterior cervical corpectomy with strut graft and plating; used for fracture and tumor cases mostly

26. Thank you for your participation Merle S. Rust, M.D. Webinar on Neck Pain Mercy Regional Neurosurgery Center