Neck Pain Treatment

Choices to Reduce Your Neck Pain
Treatment for any back condition should involve two goals:
• Relieve pain
• Reduce the risk of re-injury

The treatment of neck pain can range from the reassurance that nothing is wrong to very delicate surgery. Treatment is always based on the individual and his or her symptoms. In general, treatment for neck pain falls into two broad categories: conservative treatment (non-surgical) and surgical treatment.

Conservative Treatment
Non-Surgical Treatment for Your Neck Pain

Medications are commonly used to control pain, inflammation, muscle spasm, and sleep disturbance.
Some general tips about treatment with medication:
Medication should be used wisely! Take all medications exactly as prescribed and report any side
effects to your doctor.
Some pain medicines are highly addictive!
No pain medicine will control chronic pain if used over a long period.
No medication will cure neck pain of degenerative origin.

Cervical Collar
A cervical collar is often used to provide support and limit motion while an injured neck is healing. It also helps keep the normal alignment. Cervical collars can be soft (made of foam) or hard (made of metal or plastic). Because these collars can restrict the movement of your head, you may need help with eating and other activities. The skin under the collar needs to be checked every day to prevent blisters or sores.

Cervical Pillow
A cervical pillow is sometimes recommended for people who have problems with neck pain at night. The cervical pillow is designed to hold the neck in the best position to prevent excess stress on the cervical spine during sleep.

Physical Therapy
Your doctor may have a physical therapist work on an exercise program developed just for you. The physical therapist will teach you ways to prevent further injury to your neck.
For a complete description of the rehabilitation of neck pain, you may wish to review the document:

Neck Rehabilitation
Epidural Steroid Injection (Nerve Block)
If other treatments do not relieve your back pain, you may be given an epidural steroid injection (ESI), or a cervical nerve block. An ESI places a small amount of cortisone into the bony spinal canal. Cortisone is a very b anti-inflammatory medicine that may control the inflammation surrounding the nerves and may ease the pain caused by irritated nerve roots. The ESI is not always successful. This injection is often used when other conservative measures do not work, or in an effort to postpone surgery.

Surgical Treatment
Common Operations Used for Neck Pain
Surgery is only necessary for a few people. However, no single type of surgery works for every neck pain problem. If your doctor thinks surgery will improve your neck pain, he will suggest the type of surgery he thinks is the best for you. Numerous surgical procedures have been designed to treat each type of neck pain. The following section describes different surgical treatments in a very general way, and gives an overview of what each type of procedure tries to accomplish. Surgical procedures are generally done for one of three reasons:

To remove pressure from the nerve roots caused by bone spurs or herniated disc material (for cervical
To remove pressure from the spinal cord (for cervical myelopathy)
To stop the motion between two vertebrae - or a spinal segment (for degenerative disc disease)

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One of the most common surgical procedures for problems in the cervical spine is an anterior cervical discectomy. The term "discectomy" means "remove the disc". A discectomy relieves the pressure on a nerve root by removing the herniated disc causing the pressure.

In the cervical spine, the disc is usually removed from the front. An incision is made in the front of your neck right beside your trachea (windpipe). The muscles are moved to the side. The arteries and nerves in the neck are protected as well.

Once the spine is reached from the front, each disc and vertebra are identified using an X-ray to make sure that the right disc is being removed. Once this is determined, the disc is removed all the way back to the spinal cord. Any bone spurs that are found sticking off the back of the vertebra are removed as well. Great care is taken to not damage the spinal cord and nerve roots.

In the cervical spine, a discectomy is usually combined with a anterior spine fusion, where the two vertebrae on either side of the removed disc are allowed to heal together, or fuse. The cervical fusion is described in detail below.

Cervical Fusion
Once the disc has been removed between the vertebrae, a cervical fusion is performed. This procedure allows the surgeon to fill the space left by removing the disc with a block of bone taken from the pelvis. Placing a bone graft between two or more vertebrae causes the vertebrae to grow together, or fuse. If your neck problem is caused by segmental instability, a spinal fusion may also be recommended - even if you do not have a cervical radiculopathy.

The bone graft is usually taken from the pelvis at the time of surgery, but some surgeons prefer to use bone graft obtained from a bone bank. Bone graft from a bone bank is taken from organ donors and stored under sterile conditions until it is needed for operations such as spinal fusion. The bone goes through a rigorous testing procedure, similar to a blood transfusion. This is in order to reduce the risk of passing on diseases, such as AIDS or hepatitis, to the recipient.

There are two basic types of spinal fusion:
Anterior Interbody Fusion
This type of fusion is much more common in the neck. This type of fusion is described above. In the interbody fusion, a bone graft is placed between two vertebrae and replaces the removed disc. During the healing process, the vertebrae grow together, creating a solid piece of bone out of the two vertebrae.

Posterior Fusion
You may hear the term posterior fusion as well. In the posterior fusion, the bone graft is placed on the back side of the vertebrae. During the healing process, the vertebrae grow together, creating a solid piece of bone out of the two vertebrae. This type of fusion is only rarely used in the cervical spine, generally only for fractures of the spine. If surgery is necessary, the anterior interbody cervical fusion is used to treat most problems in the neck caused by degenerative disc disease. These include unrelieved neck pain and pressure on the nerve roots caused by bone spurs or a herniated disc.

The goal of spinal fusion is to stop the motion caused by segmental instability. This reduces the mechanical neck pain caused from excess motion in the spinal segment. The anterior cervical fusion may also be done in a way that spreads the vertebrae apart a bit, trying to

restore the space between them. Increasing the distance between the vertebrae also makes the foramen larger in the back part of the spinal column. This may reduce the pinching and irritation of the nerve roots by bone spurs around the foramen.

Instrumented Cervical Fusion

When doing a cervical fusion, the bone graft may simply be wedged in between the vertebra. It is held there simply because it is wedged in tight. In recent years, there has been an increase in the use of metal plates, screws, and rods to try to increase the success of helping the spine to fuse. Many different types of metal implants are used; all try to hold the vertebrae in position while the fusion heals. Bone heals best when it is held still, without motion between the pieces trying to heal together. The healing of a fusion is no different than healing a fractured bone, such as a broken arm. However, the neck is a difficult part of the body to hold still.

In the past, casts and braces were used in an attempt to reduce the motion in the neck and to increase the success rates of a spinal fusion. In most cases, these braces and casts were simply too cumbersome to wear for three months, and did a poor job of actually holding the neck still enough to allow the fusion to heal.

In the cervical spine, the most common form of internal fixation is using a metal plate and screws. The plate sits on the front of the vertebrae and the screws go backwards into the vertebral body to help hold the plate in place and to help keep the bone graft from slipping out of place.

By using metal plates and screws, the vertebra can be held rigidly in place while the fusion heals. Braces and casts are not needed.

Neck Pain- Laminectomy Laminectomy
If spinal stenosis is the main cause of your neck pain, then the spinal canal must be made larger and any bone spurs pressing on the nerves must be removed. One way that this is done is with a complete laminectomy. Laminectomy means "remove the lamina". Remember from the anatomy section, the lamina is the back side of the spinal canal and forms the roof over the spinal cord. Removing the lamina gives more room for the nerves and allows the removal of bone spurs from around the nerves. A laminectomy reduces the pressure on the spinal cord and the irritation and inflammation of the spinal nerves.
In the cervical spine, removing the lamina completely may cause problems with the stability of the facet joints between each vertebra. If the joints are damaged during the laminectomy, the spine may begin to tilt forward causing problems later. One way that spine surgeons try to prevent this problem is not to actually remove the lamina. Instead, they simply cut one side of the lamina and fold it back slightly. The other side of the lamina opens like a hinge. This makes the spinal canal larger giving the spinal cord more room. The cut area of the lamina eventually heals to keep the spine from tilting forward.

Corpectomy and Strut Graft
Perhaps a more popular procedure for removing the pressure on the spinal cord causing spinal stenosis and cervical myelopathy is to remove the front of the spinal canal. This means that the large part of several of the vertebrae must be removed - the vertebral bodies and the discs between. This procedure is called a corpectomy. "Corpus" means body and "ectomy" means remove. Once the vertebral bodies have been removed, the space must be filled with something. Again, just as in the anterior cervical fusion, this space is usually filled with a bone graft. Some type of internal fixation is usually required to hold the vertebrae and the bone graft in place. You will probably also need to be placed in a halo jacket to hold your head perfectly still while the healing occurs and the vertebrae fuse. This is a very uncommon procedure.

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