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

What You need to Know About Herniated Cervical Discs

Movements in all parts of the spine, including the seven bones that make up the neck, are cushioned by spongy discs. When gel-like inner disc material pushes outward through the tough outer shell of a disc in the neck, it’s referred to as a herniated cervical disc. If a nearby nerve root is compressed, it could produce pain that’s felt in the neck, arms, shoulders, and even as far down as the wrist and fingers. Most people dealing with disc herniation in Miami respond well to conservative (non-surgical) treatments, although there are minimally invasive surgical options worth considering if symptoms persist.

What Exactly Is a Herniated Cervical Disc? 
A disc in the neck becomes “herniated” when a weak spot develops in the tough disc wall, called the annulus. Material in the center of the disc (nucleus) sometimes breaks through that weak spot. When it does, the gel-like material may irritate nerves. As nerves become irritated, they get inflamed, or swollen.

In some cases, the protruding disc material will shift or shrink. If this occurs, related discomfort may become less noticeable, or go away entirely. If a disc is going to self-correct itself over time, this process usually happens within a month or so after symptoms first become noticeable.

Some people use the terms “bulging disc” or “slipped disc” to refer to a herniated disc. However, a true herniated disc is what happens when inner disc material pushes through a crack in the outer disc wall. Oftentimes, the inner disc material will remain attached to the disc. If enough disc material pushes through, it may break free from the affected disc and move around within the cervical spine (neck) area.

What Causes Discs In the Neck to Become Damaged? 
Degenerative disc disease (DDD) is a frequent cause of cervical disc herniation. DDD is a general term for age-related changes to discs within the spine. A common change with discs is a loss of hydration. Spinal discs are meant to be spongy so they can provide sufficient cushioning. However, the level of hydration within discs gradually decreases over time, which means discs in the neck no longer provide as much cushioning as the neck moves.

When discs dry out, they also become harder. This makes the outer disc wall more likely to develop weak spots that could allow inner disc material to push outward. Genetics can also play a role in the setting up conditions that could make discs susceptible to damage.

Contributing factors can include, posture (especially excessive neck craning, referred to as tech neck”), smoking, and level of activity. For instance, you may be more likely to develop cervical disc herniation if you play contact sports on a regular basis or have a job that involves frequent neck movements.

What Are Symptoms Associated with a Herniated Disc?
Symptoms associated with a cervical herniated disc will vary based on the specific area of the neck affected. A herniated disc at the C4-C5 level, for example, can affect the deltoid muscle in the upper arm and cause shoulder pain. A C5-C6 disc herniation, on the other hand, tends to cause radiating discomfort that’s felt along the thumb side of the hand. Symptoms may also include:

• Muscle spasms in the neck area
• A weakened hand grip
• Pain that’s triggered by certain neck movement
• General weakness in the neck and shoulder area
• “Pins-and-needles” sensations in arms

How Are Cervical Herniated Discs Diagnosed and Treated? 
The first attempt at diagnosis is usually a medical exam and a review of medical history, If initial treatment isn’t effective or severe disc damage is suspected, you’ll likely be referred to a neck specialist for further evaluation. Diagnostic testing to determine if a disc in the neck is damaged may involve:

• A CT or MRI scan to view soft tissues in the neck
• A CT scan with the injection of myelogram dye to identify subtle instances of nerve irritation
• An EMG (electromyography) to measure nerve and muscle responses to stimulation

Pain related to a cervical herniated disc is usually due to the pinching of a nerve root and inflammation associated with the affected disc. Unless symptoms are severe or debilitating, conservative treatments are typically recommended first. Options usually include anti-inflammation medication, rest (for a short period of time), massage therapy, various forms of physical therapy, and home exercises.

In addition to NSAIDs (non-steroidal anti-inflammatory drugs), muscle relaxants, acetaminophen (Tylenol), and oral or injected steroid medications may help manage symptoms. Cervical traction is sometimes recommended to limit neck mobility and allow inflamed nerves and tissues to heal.

More than 90 percent of patients with arm pain related to a herniated cervical disc typically notice improvements with conservative treatments after about six weeks. Should symptoms continue beyond this point or get progressively worse, a neck specialist may suggest surgery. Many of the procedures performed today involve less invasive techniques that often present fewer risks and shorter recovery periods for patients considered good candidates for such operations. Specific surgical options include:

• Anterior cervical discectomy and fusion (ACDF)
• Artificial disc replacement
• Minimally invasive micro-endoscopic discectomy

Practicing proper lifting techniques, maintaining a healthy weight, paying attention to posture and head-neck alignment, and regularly exercising and stretching neck muscles are among the steps you can take to reduce your risk of experiencing a herniated cervical disc. The good news is that only about 8 percent of herniated discs occur in the neck area. But if you are experiencing neck and arm pain in Miami that may be related to a herniated cervical disc, it’s important to seek medical care so the right treatment recommendations can be made. Contact Miami Neck Specialists to schedule an appointment.