This subject is very broad and many books are available to discuss this subject alone. Attempting to find the cause of neck pain can be very challenging with involvement of diagnostic studies. The process of diagnosis begins with history and physical examinations and continues to simple studies. If needed, and the cause is not discovered by these studies your spine specialist will resort to more invasive testing. With any test, the risks and benefits should be evaluated. For example, a patient complains of very mild neck pain that is present only occasionally and is relieved by Tylenol, invasive testing like a Myelogram (this test requires the placement of a needle into the spine) is probably not an appropriate test. Here we may resort to symptomatic treatment to resolve the issue without further testing. Below is an algorithm for guiding the patient to the appropriate sections of this web site. However, this is only a guideline and many different scenarios exist. Ultimately, your spine specialist should guide diagnostic and treatment options.
This very broad subject is categorized into different sections. First category is pain which is concentrated and localized just in the neck. This is called mechanical neck pain and includes diagnosis such as muscle strain, facet arthritis, discogenic neck pain, myo-fascial pain, pain of unknown origin. The second broad category is neurogenic pain which is the pain produced by pressure over neural structures. This category mainly includes herniated disc, foraminal stenosis, and Myelopathy. Of all these diagnosis, Myelopathy is the most important since it has the potential to progress with dire consequences. All other diagnosis has a relatively good outcome and their treatment is mainly based on the severity of symptoms.
The subject of mechanical neck pain is broad and confusing at times. This subject deals with the architectural structure of the neck. The history may lead us to faster diagnosis. For example was there an event leading to the pain like an automobile accident of a fall from height. In cases of trauma we carefully examine x-rays for any fractures. Fractures may be very obvious on X-rays or could be very difficult or impossible to see. If the suspicion is high for a fracture, your physician may decide to order other studies such as an MRI or a CT scan. If however, the pain began slowly, the diagnosis may not be obvious and the severity of the symptoms will dictate the plan of action. If symptoms are sever enough and leads to lifestyle dysfunction, neck pain can be investigated with injections into the area. These injections include Facet block, selective nerve root block, or a Discogram. All these are invasive tests and have low but definite risk to them. Careful consideration should be given prior to testing.
Pertinent question to your spine specialist can include:
- What is involved with this test
- Associated risks
- What will be done with the added information
- What other tests are available and the alternative treatment options if the tests are not performed
- Risks associated with your specific illnesses such as diabetes or hypertension
The new information produced by the diagnostic studies will be used to arrive at a treatment plan. In most cases conservative management will be the main treatment. This usually includes physical therapy, Anti-Inflammatory medications, and other supportive modalities. Bracing is controversial, yet it may provide support and allow the maintenance of better posture. Even though it may provide support it may also decrease muscle strength. We believe in patients with severe pain, the use of a brace may be beneficial for a short period until the pain is more manageable. The use of narcotic medication (Such as Vicodin and Norco) should be limited to only a few days. Other alternative medications are Ultram which has a less addicting potential.
Discuss these issues with your spine specialist. Surgery should be the last option for neck pain alone. The long term outcome from operative and non-operative treatment is very similar and the risks and benefits of any treatment option should be considered carefully.