Miami Neck Specialists is a team of doctors, physician assistants, orthopedic spine surgeons and pain management specialists who specialize in neck pain.

 

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WHAT WE DO | SPINE SPECIALISTS

We evaluate patients right away and obtain appropriate imaging. The patient follows up and is given a proper diagnosis and treatment plan.




DR. SETH KAUFMAN
INTERVENTIONAL PAIN SPECIALIST
Learn More About Dr. Seth Kaufman

Dr. Seth Kaufman specializes in non-surgical and minimally-invasive approaches to neck pain. A physiatrist who is board-certified by the American Board of Physical Medicine and Rehabilitation, he attained his medical degree from New York College of Osteopathic Medicine in Old Westbury, New York. After receiving his medical degree, Dr. Kaufman completed two medical internships. Following the completion of a rotating internship, his second internship was completed at St. Barnabas Medical Center in Livingston New Jersey. After this training, he finished his residency at The Boston University Medical Center in Physical Medicine and Rehabilitation.
In addition to this extensive education and training, Dr. Kaufman also gained experience at Harvard Medical School’s Spaulding Rehabilitation Hospital, where he worked alongside and gained praise from some of the top medical professionals in his field. A fellowship in Annapolis, MD at the Kahan Center for Pain Physiatric Rehabilitation followed, where he was under the direct tutelage of top doctor Dr. Brian Kahan himself.





DR. GEORGIY BRUSOVANIK
MINIMALLY INVASIVE SURGERY SPECIALIST
Learn More About Dr. Georgiy Brusovanik

When therapy and injections fail to help or if the effect doesn’t last, motion preservation and minimally invasive surgery may be an option. We refer our patients to Georgiy Brusovanik, MD. Dr. Brusovanik trained at Duke University with both orthopedic and neurosurgical departments. He is the spine consultant for the Miami Dolphins, the Miami Heat and Sony Open Tennis. He is the official physician for the United States Kickboxing Association and the head of spine surgery for the Miami Medical Center. He is affiliated with the Baptist, HCA and Tenet hospitals as well as Jackson Memorial health system. He is a specialist in motion preservation, minimally invasive approach, robotic and computer assisted spine surgery.




Disc Herniation

If you are suffering from a case of disc herniation and living in Miami, you are fortunate enough to have access to the Miami Back & Neck Specialists center. Here, you will receive the cutting-edge therapies to help your ruptured disc(s) heal on their own. If no improvement is shown within 4 to 6 weeks or certain aggravating factors call for immediate intervention, we can also reactivate nerves and help your body heal with minimally invasive surgical techniques. We offer a full range of care that is based firmly on the belief that less is more. Our advanced erudition and investment in the leading medical equipment and technologies make our techniques precise and effective.

Diagnostic Methods

When you are suffering pain that appears to emanate from your back, neck, or even your extremities, a herniated disc may be the cause. A disc is herniated when it bulges over or slips out of place and puts pressure on a nerve. Your doctor will first conduct a full physical exam and carefully consider your medical history before ordering any tests. Beyond X-Rays, our expert spinal center has a number of tools to help confirm and pinpoint the problem. This will also help us gauge the progression and healing of any injuries.

Magnetic resonance imaging (MRI) – MRI scans provide some of the clearest images and are the preferred method of diagnosing herniated discs. The MRI machine uses radio frequency waves and electromagnetic fields to build an extremely detailed and accurate image of your vertebrae. This goes far beyond an X-ray and provides enough detail to perceive prior injuries and the different elements of the injured vertebrae: the annulus, nucleus, and disc. The annulus is the thin membrane that covers the disc. The nucleus is a shock-absorbing jelly-like substance that fills the disc.

Computerized tomography (CT) – The CT equipment creates digital 3D X-ray images that can help build evidence of a ruptured disc before the more expensive MRI tests may be required. Because the scans are three dimensional, an initial diagnosis of a slipped disc is easier than with two-dimensional X-Rays.

Myelogram – This type of X-Ray uses a special medical-grade dye to inject pigment into your spinal fluid. This makes it easier for other X-Ray equipment such as CT scans to pick up more details. These two methods are, therefore, often used in combination.

Nerve Conduction Studies/Electromyogram (NCS/EMG) – The final method is to determine the health of the nerves. NCS and EMG tests can map the electrical activity in the muscular system to detect nerve compression and deterioration.

Non-Invasive Treatments

We recommend a variety of non-invasive treatments that have been proven to be effective in many cases. These alternatives save you from having to undergo surgery and should always be explored unless the symptoms are unbearable. We may recommend:

  • Acupuncture
  • Bed rest
  • Physical therapy
  • Spinal alignment
  • Posture correction
  • Steroids
  • OTC pain relievers
  • Muscle relaxants
  • Epidural Injections

The good news is that symptoms of the ruptured disc will likely abate in less than 2 months without any surgery. We firmly believe in homeostasis and the body’s natural ability to heal itself, in most cases, by providing it a gentle nudge in the right direction.

If the results of these methods prove to be less than expected, our team of specialists can discuss a full range of more intensive options such as other therapies, methods of coping with pain, and minimally invasive neck surgery if necessary. The reality is that very few patients require surgery. Surgery is the last resort when patients have difficulty walking, bladder incontinence, or are suffering from unbearable pain.

Alternative Therapies

As stated, acupuncture is sometimes suggested to help relieve the pain and tenseness of disc herniation in Miami because hot compresses may be uncomfortable. However, acupuncture is not the only alternative therapy. Yoga can help build strength and aids in the recovery process. It also helps you stretch and regain mobility. It is proven to help chronic back pain and will help take the pressure off joints. You will also be able to manage pain better with meditation and tranquility as your body begins to heal.

Chiropractic care may be suggested if your symptoms involve lower back pain, or you are suffering from posture and alignment issues that are compounding your slipped disc issue. And like chiropractic care, massage therapy has the potential to momentarily relieve lower back pain and aids in the healing process.

Home Care

Anyone can find some solace when they are suffering from a slipped disc in the neck by taking OTC pain relievers. However, patients should be aware of how these medicines interact with other medications that they are taking and chronic health problems such as hypertension. People who suffer from high blood pressure may see blood pressure spikes if they take Ibuprofen because it can interfere with the ability of your kidneys to filter out salts.

Tylenol may be recommended for people who suffer from hypertension. Yet, they should be aware that Tylenol presents its own problems with liver toxicity, and that they should not drink alcohol or take any other medications that can affect liver function.

Although bed rest is recommended, these rest periods should be limited to 30-minute intervals to prevent atrophy of the muscles and weakening of the joints. In addition, hot and cold compresses can also be used to reduce pain and inflammation.

What are the Benefits of Minimally Invasive Spine Surgeries?

If you are experiencing neck and back pain in Miami or the surrounding area, contact the Miami Neck Specialists. When we treat you for spinal pain, you first receive an accurate diagnosis of the cause of the spinal pain. After a comprehensive diagnosis has been made, our neck and spine specialists will prescribe medications and other types of non-surgical treatments for your spinal pain.

Our office always suggests non-surgical treatments before they recommend any surgery. Neck rest, physical therapy, and injections remain three frequently recommended options we indicate to many of our patients. In many cases, these non-surgical treatments work well for our patients. But in some cases, additional treatment must be used to alleviate our patient’s continuing neck and spinal pain.

Minimally Invasive Spine Surgery
In recent years, advances in spinal surgery technology have allowed spinal pain problems in the back or neck to be treated using minimally invasive spinal surgery (MISS). MISS techniques began being used in the 1990s and used for laminectomy and spinal fusions since that time. A laminectomy is when the lamina is removed from a vertebra to enable the nerves and blood to flow freely through the spine. A laminectomy is also used to treat nerve pain and numbness caused by compressed nerves in the spine.

Minimally Invasive Spine Surgery was created to treat spine issues with minimal injury to skin and muscles as well as to the structures of the spine. MISS procedures use smaller incisions, which makes it possible for the surgeon can see exactly where the issues remain located. MISS uses a smaller surgical field, plus four times magnification is used along with excellent lighting to enable the surgeon to correct the spinal problem at hand.

The Advantages of MISS
Little to no muscle is cut during the procedure, making post-operative recuperation much faster than it would be during a traditional surgical procedure. Also, less rehab time is required to heal from MISS surgery. A less invasive operation makes for less pain, and a smaller amount of pain medication is needed, too. Finally, there is a reduced chance of infection when a smaller incision is used during surgery.

Dr. Brusovanik and the rest of our staff have been well trained in neurosurgery, and orthopedic surgery of the spine and remains well versed in using minimally invasive spinal surgery techniques.

Classic Spine Surgeries
Traditional spine surgeries are done using an open method. That means that the area of the spine worked on is opened with a long incision to allow the surgeon to get a good view and access to the area of the spine they are repairing. Also, traditional spine surgeries may damage the back or neck muscles due to the pulling of these muscles. More blood may be lost, and conventional spine surgeries require a more extended stay in the hospital and an increased amount of recovery time, as well as increased pain after the procedure occurs.

Disc Herniation MISS Treatment in Miami
The cervical disc of the spine provides a cushion between the spinal bones or vertebrae. A herniated disc can push on the nerves of the neck and irritate or compress these nerves, causing pain along the forearm, index finger or thumb. Also, muscle spasms may occur as the neck muscles attempt to stabilize the herniated disc. Our doctors use minimally invasive techniques to repair the herniation in the neck and get the nerves working appropriately again.

Minimally Invasive Scoliosis Treatment at Neck Doctor Miami
The traditional treatment for scoliosis, or curvature of the spine, used to be surgery. Now, due to recent technological advancements, a less severe, less invasive method is used. This method includes an MRI image, a smaller incision, and the placing of screws through tiny holes near the area repaired. Also, if spinal fusion is required to relieve the pain of scoliosis, the procedure may now be done using a much smaller incision. Such a tiny hole heals much more quickly than does a larger incision, plus, less blood loss occurs during the surgery.

Miami Spinal Stenosis Treatment at Neck Doctor Miami

As a person ages, the bones and disks of the neck and back may change their shapes and leave little room for the nerves of the spine and spinal cord to function properly. If the spine doesn’t line up correctly, a person may develop myelopathy or spinal cord disease. This pressure causes pain in the neck that shoots down to the shoulders, arms, and hands, and makes picking up small objects very hard to do. Patients might get better over time and with more conservative treatments such as physical therapy and injections. Otherwise, health issues are treated with minimally invasive surgery.

Other minimally invasive techniques Neck Doctor Miami used to assist a person in pain with spine problems include:

• Cervical Laminoplasty. A cervical laminoplasty makes more room in the spinal cord and enable the nerves to work correctly in the case of spinal stenosis due to arthritis.
• Anterior Cervical Decompression and Fusion. This procedure removes a disc with a disease or a herniated disc.
• Artificial Cervical Disc Replacement (PCM). This procedure remains under investigation at present and isn’t commonly used. The purpose of implanting an artificial cervical disc remains to relieve pinched nerves in the spine by using the new technology of a spinal disc implant.

For more information on MISS, please contact us at www.neckdoctormiami.com.

Understanding Spinal Cord Compression

The spinal cord and the spine are important structures in the body. The is made up of twenty-four irregularly shaped bones called vertebrae that run down the back. In humans, the spine holds the body upright and protects the spinal cord. The spinal cord is a collection of nervous tissue that helps direct nerve impulses. It sends messages from the brain to the rest of the body, and it sends messages from the rest of the body back up to the brain. Without either of these structures, life would be very different.

Spinal Cord Compression: Introduction and Symptoms
Spinal cord compression is also called cervical spondylotic myelopathy. As humans age, the spine also ages. The bones wear down and begin to come together too closely. When this happens, they may begin to place pressure on the spinal cord. The progressive deterioration of the spine can lead to spinal cord compression. Most commonly, the deterioration occurs between the intervertebral disks, which is called spondylosis.

Cervical spondylotic myelopathy is accompanied by a few symptoms. One of the symptoms may be a pain in the back and neck as the spinal cord is compressed. One may also experience pain in the arms and neck. The pain experienced largely depends on where the spinal cord is being compressed. A person with spinal cord compression may notice that there is a deficiency in fine motor skills, balance, and coordination. These symptoms result from the reduction in the ability of the spinal cord to send messages to the body and brain.

Spinal Cord Compression: Causes and Treatment
The degeneration of disks can cause bone spurs to form. The bone spurs are formed to help reinforce the support lost as the disk deteriorates, but they can also narrow the spinal canal, compressing the spinal cord. A herniated disk can also cause spinal cord compression. When the disk herniates, it may squeeze into the spinal canal and push against the spinal cord. Of course, things like rheumatoid arthritis and injuries from work can also lead to cervical spondylotic myelopathy.

In some cases, treatment can be nonsurgical. A soft cervical collar can be worn to limit the movement of the neck, which may help decompress the spinal cord. Physical therapy can help by improving the strength of muscles near the spine and improving endurance so the pain is less noticeable. There are also many medications ranging from ibuprofen to narcotics that can help reduce pain and other symptoms that may arise from spinal cord compression.

In most cases, the spinal cord compression is too severe to be treated nonsurgically. Surgical procedures are often followed up with the previously described nonsurgical methods for at least a brief period. Regardless, there are many surgical options available, and the surgeon will create a plan after thoroughly assessing the patient’s needs and symptoms. Of course, surgical procedures are extremely risky, especially when involving the spine and spinal cord.

Spinal Cord Compression: Diagnosis and Doctors
The diagnosis of cervical spondylotic myelopathy will begin with a discussion of symptoms and medical history. After, the doctor will perform a physical examination focusing on the neck, spine, and shoulders. If the doctor finds it necessary, x-rays and/or MRIs may be ordered to further understand the patient’s symptoms. An x-ray will look at the alignment of the vertebrae in the affected area, and an MRI will show more accurately where the spinal cord is being compressed and if a disk is involved in the compression.

Really, before diagnosis and treatment can begin, a doctor must first be found. For spinal cord compression, one should look for someone who specializes in spine and neck health issues. Additionally, the doctor should be compassionate and respectful of the patient, never downplaying or invalidating the patient’s feelings. The doctor should also provide polite and prompt care so that the issue can be resolved as soon as possible. To find these traits, the internet is a great place to find reviews. Additional information can be obtained by asking friends or even a primary care doctor.

In Miami, the Miami Neck Specialists are able to provide this type of care. The focus of this practice is on neck pain and injury, so the physicians here are all extremely qualified to handle spinal cord compression problems. The practice is composed of pain management specialists and orthopedic spine surgeons, so a variety of treatments are available to patients, allowing them to best fulfill their needs.

All of the physicians at the practice have undergone extensive training in their areas of specialty, so a patient will have no need to worry about a doctor with insufficient experience handling the case. These physicians have also had extensive experience with patients, so they are able to use appropriate bedside manner. When looking for a physician to treat spinal cord compression, one should look for a physician who qualities like those of the Miami Neck Specialists.

Spinal Cord Compression: Conclusion
Spinal cord compressions are caused by some sort of malfunction in the spine, and they are usually accompanied by pain and deficits in motor skills. A physician can properly diagnose and treat this problem by using the proper techniques. Of course, the physician’s diagnosis and treatment are only as good as the physician. Due to this, it is extremely important to find a qualified, empathic doctor to handle one’s needs.

Getting the Best Spinal Cancer Treatment

Usually, when your doctor first informs you that you have cancer, many emotions begin to arise. You are scared and anxious, not knowing exactly how you will begin to treat the diagnosis or if the prognosis is a good one or a bad one. Cancer of the bones is usually some of the toughest cancers to treat because you have so many bones in your body. The cancer has the option to spread literally everywhere inside of your body. When cancer enters into your cervical vertebrae, there is an escalated level of danger.

Types of Spinal Cancer
There are only two types of cervical vertebrae cancers – osteosarcoma and metastatic tumors. These two cancers can wreak havoc on your spinal area. Osteosarcomas are the least common of these two types of spinal cancers. This type of cancer is also the less dangerous of the two as well. When a person is diagnosed with osteosarcoma, they will have little tumors that grow very slowly. These tumors may not cause the individual any pain at all.

However, Metastatic tumors are another story. These tumors spread very rapidly throughout the body and usually cause a large amount of pain. Metastatic tumors are really hard to treat, making them so much more dangerous than osteosarcoma tumors. Both of these types of tumors begin during cell reproduction when the process of mitosis fails to correctly transform. The errors in the transformation process do not get properly, causing the cancer to begin to form on accident.

Symptoms of Spinal Cancer
Depending on which type of spinal cancer that you have, especially if the cancer is osteosarcoma, you may not know that you have the cancer until you are at a doctor’s visit. However, with metastatic tumors, your first symptom that something might be wrong would be experiencing pain. The pain will most likely be coming from the tumors attendance in the spinal column area. Usually, when this happens, the tumor will be pushing on nerve endings that might be sensitive, which would cause jolts of sharp like pains in your spine. When your spine is out of alignment, other symptoms become noticeable too, like the presence of a hump on your back (which some people refer to as hunchback).

When the tumor begins to press further on the spinal cord, there may be some moments where you begin to feel a tingly sensation in your legs, or possibly even lose all feeling in your legs completely. When this happens, you may experience times of clumsiness because you have lost the feeling in your legs and you cannot feel them. As the cancer begins to get worse and worse, you will eventually not be able to move your legs at all, which would then result in the individual being paralyzed for the rest of their lives. Other symptoms of spinal cancer to look for are muscle weakness, not walking normally, loss of sensation, trouble using the restroom (bowels and bladder), and spinal deformities.

Treatments of Spinal Cancer

Chemotherapy
There are several different types of treatment options for spinal cancer. The number one treatment option is usually chemotherapy. The chemotherapy drugs can be given to the patient in the form of a pill or they can be injected into the vein. There are some spinal tumors, depending on how severe they are, the drugs may have to be directly injected into the cerebrospinal fluid. With chemotherapy, you can receive the therapy alone or in combination with another spinal cancer treatment or even with surgery as well.

Radiation Therapy
Sometimes after completing a removal surgery, your doctor may still recommend radiation therapy. Radiation is commonly used when the tumor is aggressive and the doctor wants to be sure that there are no traces of microscopic tumor cells left behind from the removal surgery. Radiation can be used on metastatic tumors to prevent them from spreading to other parts of the body, which they are so famously known for doing. Your radiation will be determined by several different factors of your tumor. Depending on the type of tumor that you have, the size of the tumor, and just how aggressive the tumor is will affect how your doctor recommends radiation. Usually, external radiation is used for spinal cancer. During the treatment, the entire area, including the tumor and the area that surrounds the tumor will be radiated. If the tumor in question is an aggressive metastatic tumor, radiation is usually given to the entire spine to prevent any more likelihood for spreading to other parts of the body.

Surgery
Surgery is definitely an option for patients with spinal cancer. Many times when doing surgery on the spinal areas, many surgeons will use the same surgical strategies for brain tumors on the spinal tumors, just because they are so closely related. The spinal surgery will depend on several different factors to determine if this is a safe treatment route. For example, the location and grade of the tumor are definitely taken into consideration because if either of those is deemed too dangerous, the surgeon will not try to complete the surgery. If the tumor is only near one part of the spinal column area, the surgery will usually be completed and most of the time, the cancer is completely gone. Spinal cancer surgery is performed as well to remove any cancerous tissues pressing against the spinal cord area and nerves to stop any unwanted pain from happening.

If left untreated, there are several things that spinal cancer can do to your body. Not only can the cancer spread to the rest of your body, but in your spinal region, the tumor can cause compression fractures. Compression fractures happen when there is too much pressure on the bone and it literally causes the bone to break. When this happens, the bone is either shattered or crushed and it is extremely painful. At Miami Neck Specialists, we also treat compression fractures as well.

A Pain in the Neck

Every human has a neck, and nearly every human uses that neck. It helps people move their heads to stretch, to see, or to get comfortable. When injured, the neck can become quite a nuisance. It can cause discomfort and pain, or even more serious problems. When such a problem occurs, people should seek help from a doctor before more damage from setting in.

Cervical Disc Herniation
Cervical herniated discs are slipped discs that occur in the neck. People from age 30 to age 50 are more likely to suffer from a disc herniation than other people. The pain from a herniated disc comes from the disc pinching down on a nerve. The pain may also radiate down a person’s arm if the injury is in the neck. There could also be tingling and numbness along the arm.

Although cervical discs are small, they can cause a lot of pain because of the concentration of nerves in the neck. A spinal disc has a hard-outer piece and a soft inner part. Sometimes the annulus, the outer part, weakens and tears. When this happens, the nucleus, the inner part, leaks out. The nucleus is what pinches nerves and causes pain.

A herniated disc may be caused by neck trauma. The trauma could come from a hit to the neck or a fall. Symptoms may begin spontaneously and without warning. The only way to know if the issue is a herniated disc is to seek attention from a physician. In Miami, the neck and back specialists are physicians that use intelligence and care to handle disc herniation.
Cervical Compression Fractures
Another issue that could plague the neck is compression fractures. Compression fractures are not as common as some other neck issues, such as a herniated disc. People with osteoporosis, which is a disease that causes bone loss. People with type II osteoporosis are more likely to have a compression fracture because type II causes more loss in spongy bone, which makes up vertebrae.

Neck compression fractures occur when the bone collapses in one of the cervical vertebrae. There may be no symptoms associated with a compression fracture, but it is common for one to cause pain in the region where the fracture is found. Compression fractures have been known to occur in multiple vertebrae at once, causing a shorter height and kyphosis, which happens when the spine curves forward and forms a hump.

Treatment for a neck compression fracture should address pain and the fracture. Pain can be handled with pain medication or something like bed rest. The fracture is often treated non-surgically, but there are times when surgery is the best option. The Miami neck specialists are doctors that have plenty of experience in treating compression fractures caused by many different things.

Spinal Cancer
Cancer is a word patients across the world respond to with fear and uncertainty. When it comes to bones, some of the most aggressive cancers begin within the bones. When in the cervical vertebrae, cancer can be even more dangerous. There are two possible vertebral types: osteosarcoma and metastatic tumors.

Osteosarcomas are the least common of these two and also the least dangerous. They grow slowly, may not cause pain, and do not pose a large danger. Metastatic tumors spread through the body and may cause a lot of pain. These are much more dangerous tumors to deal with. Both types begin when processes in mitosis fail to function correctly. Errors get transferred to the new cell, and this can cause metastatic cancer or osteosarcoma to form.

An osteosarcoma may require treatment; although, a metastatic tumor will definitely need treatment. Treatments might be in the form of radiation or chemotherapy. There are also surgical options that may be needed to slow down or get rid of the tumor. In Miami, the neck specialists are skilled in finding and working with other doctors to treat spinal cancers.

Spinal Stenosis
Cervical spinal stenosis is often shortened to cervical stenosis. Cervical stenosis occurs when the spinal canal narrows. The narrowing can happen from degenerative changes or repetitive trauma to the cervical vertebrae. When the damage becomes too extensive, it can begin to damage the spinal cord and cause neurological deficits. This condition is called myelopathy. Both of these neck issues are more likely to occur as age increases.

Cervical stenosis can cause many symptoms to appear. Pain and numbness may be present in the area where the stenosis is occurring and/or in the limbs associated with the area where stenosis is happening. The movement may be restricted in that region of the neck as well. When the symptoms of the stenosis, issues with just the neck, and the symptoms of myelopathy, more widespread problems, occur together, the problem is called cervical spondylotic myelopathy.

Pain medication may be prescribed if there is too much pain. A change in activity may be necessary for some people. Activities may include the position of the neck and sleep position. Physical therapy can also help relieve symptoms by making the neck stronger and more flexible. The neck physicians in Miami are experienced in treating and recommending action to combat spinal stenosis.

Red Flags of Neck Pain

Neck pain is very common. Most of the time, neck pain is muscular and gets better on its own; but sometimes it does not. As a spine surgeon, I will always be on the aggressive side with regards to diagnostic modalities. I believe that in 2018, we have an opportunity to know instead of just think. With the use of advanced imaging and other diagnostic tools, one can be certain that neck pain is not a sign of something scary. Something scary is rare but when it happens, it needs to be addressed as quickly and efficiently as possible.

Some things to look out for include:
Recent Unwanted Weight Loss: I always ask this question of my patients and 99% of the times, the answer is laughingly, “I wish”; but if you are not trying to lose weight and you find that your pants are becoming loose or that your face is changing in the mirror, I would seek medical advice.

Nighttime Pain:
Nighttime pain is generally a sign of inflammation, but so can cancer. I would perform advanced imaging on any patient who complains of nighttime pain.

Fevers and Chills:
This is a common sign of infection and when it occurs in conjunction with neck pain, I would have it further evaluated.

Incontinence is a very common finding and it is important to note that at most times, incontinence is not associated with spinal pathology. However, when incontinence is associated with groin numbness or when incontinence occurs suddenly in association with neck pain, that is a big red flag that should be evaluated right away.

Red flags in association with neck pain are rare but when they are there they should not be ignored. This includes again, recent unwanted weight loss, fevers and chills, incontinence and nighttime pain.

Georgiy Brusovanik, M.D.
GB/st

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