Dr. Robert Harper on relief for cervical spine (neck) pain
- Category: General, Orthopedics
- Posted On:
- Written By: Boulder Community Health
If you experience neck and arm pain, you know how much it can put a damper on life. The pain may run down the side of your neck and radiate out to your shoulders. It may occur when you bend your head down, extend your head up, or turn your head one way or the other, making even simple activities — such as washing your hair — difficult or even impossible.
“The most common reasons for neck pain are muscle spasm, arthritis and nerve pinching,” said board-certified, fellowship-trained orthopedic spine surgeon Robert Harper, MD, during a free online health lecture. "Luckily, there are several non-surgical and minimally invasive surgical treatments for relieving the pain.”
____________________________________________________________________________
Watch: “Relieving painful cervical spine (neck) problems”
______________________________________________________________________________
Muscle spasm
Muscle spasm is often caused by constant tension. Dr. Harper said, “The spasm may be just on one side of the neck, or it may extend all the way down to the back.”
Basic self-help takes care of most routine neck spasms:
- Pain relievers
Take over-the-counter pain relievers such as acetaminophen (Tylenol), ibuprofen (Advil or Motrin), or naproxen (Aleve). - Heat or ice
Apply ice for the first 48 to 72 hours, then use heat. You can use a heating pad, hot compresses or a warm shower. Apply heat or ice for 10 to 20 minutes at a time, several times a day.
If the spasm continues, a health care provider may prescribe these other treatments:
- Physical therapy
“The first place our providers start with is physical therapy to work on your neck, which includes stretching your strengthening your range of motion.”
- Dry needling
A trained health care provider inserts thin needles into the muscle fibers of the neck on either side or in the back. The needles are similar to those used in acupuncture but there is no injected solution or medicine.
“Dry needing is an excellent treatment to relieve neck spasm. It breaks up all the adhesions of the muscle fibers where they're tensed.”
- Massage therapy
Massage therapy can help relieve neck knots and spasms by improving circulation and relaxing tense muscles.
- Botox injections
“Botox can be used for certain types of pathological muscle spasm such as torticollis.”
Facet arthritis
Dr. Harper explained, “Facet arthritis occurs when the cartilage that cushions the ends of bones in your facet joints of the spine wear out and gradually deteriorate, causing the bones to rub together.”
He added, “It causes severe pain when you're trying to turn your head, when you try to look up, when you try to move your head back or forth. It can also cause pain that runs up down the head and possibly your shoulders. Sometimes people get severe headaches because of it. There also is inflammation with this type of arthritis.”
Like muscle spasm, a health care provider may prescribe pain relievers, physical therapy, dry needling and massage therapy. In addition, they may prescribe the following:
- Prescription medication
“A prescription called meloxicam or Celebrex® does a wonderful job of treating the inflammatory component of the pain.”
- Chiropractic treatment
Chiropractors are trained to perform adjustments to help relieve pain and inflammation and restore normal motion to the joints.
- Radio frequency ablation
A physiatrist — a non-surgical specialist with a focus on rehabilitation and non-operative treatments — performs this procedure.
“It initially involves two injections, where a physiatrist will inject the nerve to the joint that causes pain with a local anesthetic. If you get a significant response, meaning you have significant reduction in pain over the course of the next day, that injection is repeated. If once again you get a significant response, in terms of reduction of pain, the physiatrist inserts a needle into the neck to guide a probe that delivers radio waves to the nerve that causes pain. The radio waves create heat that destroys the nerve, preventing them from sending pain signals to the brain.”
Cervical Radiculopathy
Cervical radiculopathy is a compression of a cervical nerve root, also known as a pinched nerve. This condition occurs when a nerve root in the spine is damaged or irritated.
“There's an electric-like sensation, with pain, tingling or weakness that travels from the neck down the arm. It goes often to the hand or the fingers, or sometimes just out to the shoulder and into the shoulder blade,” said Dr. Harper.
A health care provider may prescribe physical therapy, dry needling and taking over-the-counter pain relievers such as acetaminophen, ibuprofen, or naproxen. In addition, they might prescribe one of the following treatment options:
- Ice, heat
“Usually I prescribe ice when the compression first starts and heat later, because there's a lot of muscle spasm that goes along with cervical radiculopathy.”
- Epidural steroid injections, gabapentin, oral steroids
A cervical epidural steroid injection is a treatment that involves injecting anti-inflammatory medication into the epidural space around the spinal nerves in the neck. A physiatrist typically performs this procedure.
Dr. Harper stated, “We often use gabapentin to slow down nerve conduction, which helps with that severe nerve pain and tingling. And, a short course of oral steroid therapy, over six days, is highly effective in reducing pain. Oral steroid therapy can help suppress that acute inflammatory phase.”
- Surgery
If you've had months of cervical radiculopathy that's been unresponsive to conservative care – meaning you’ve tried steroid injections, physical therapy for over weeks, oral steroids and gabapentin — surgery can often help.
“The goal of surgery is to relieve pressure on the nerves by removing bone or soft tissue, and to stabilize the spine.”
Some common surgical options include:- Anterior cervical diskectomy and fusion (ACDF): This is the most common surgery for cervical radiculopathy. The surgeon removes the problematic disk or bone spurs through the front of the neck (anterior). “The anterior procedure tends to work the best and, unless there's a reason that we can't go into the front of the neck. We usually prefer to go in this way, because the recovery is so much easier than going through the back of the neck, which is a posterior technique.”
- Laminoforaminotomy: This is a minimally invasive posterior technique that involves creating a small opening in the bone to decompress the exiting nerve.
- Arthroplasty: The disc and bone spur are removed through the front of the neck. An artificial disc replacement is placed that maintains normal movement.
Cervical Myelopathy
Cervical myelopathy is a chronic condition that occurs when the spinal cord in the neck is compressed often from degenerative change, including the gradual degeneration of the spine, narrowing of the spinal canal, bulging or herniated discs and bone spurs in the neck.
This is a chronic spinal cord injury with slow deterioration in function. If left untreated, cervical myelopathy can lead to significant and permanent nerve damage, including paralysis and death.
Dr. Harper explained, “You get slow severe compression of the spinal cord. Over time, it damages the spinal cord through pressure and reduced blood flow.”
Symptoms include:
- Difficulty with balance “feel drunk"
- Trouble with hand fine motor tasks
- Upper and lower extremity numbness
- Hyperreflexia
- Weakness of arms and legs
At one point in time, mild disease was managed conservatively with a movement-restricting collar, physical therapy and medication. “However, new thinking is to operate early to avoid irreversible decline. Moderate to severe disease needs surgery to stop the progression.”
Surgical treatment includes ACDF, posterior-decompression techniques and laminoplasty, which involves opening the lamina, the bony covering of the spinal canal, to create more space for the spinal cord and nerves.
Schedule an appointment
If you have any questions or would like to schedule an appointment with Robert Harper, MD, at BoulderCentre for Orthopedics & Spine – a BCH strategic partner – call 303.449.2730.
Click here to view/download a PDF of slides shown during the lecture.
Want to receive notification of special events and lectures?