Download Neck Pain Webinar 2009

Neck Pain
Merle S. Rust, M.D.
Neurosurgeon
Mercy Institute of Neuroscience &
Mercy Regional Neurosurgery Center
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
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
Neck Pain
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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
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)
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?
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
Traumatic (major trauma)
• Motor vehicle accident, falls, sports injuriessignificant 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
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
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
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)
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
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
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)
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
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
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
Thank you for your
participation
Merle S. Rust, M.D.
Webinar on Neck Pain
Mercy Regional Neurosurgery Center