What causes neck pain?
Neck pain has a variety of causes. Poor body mechanics, herniated
discs, spinal fracture, muscle spasms, spinal deformity, and osteoarthritis
are a few reasons. Your physician will determine if the pain is
mechanical, (coming from the joint or the disc); radicular, (coming
from a nerve or nerve root); or myelopathic, (coming from the spinal
cord) and determine a treatment plan.
What is a herniated disc?
A disc is the fibrous cartilage pads that lie between the spinal
vertebrae; each is made up of two parts: a jelly-like center (the
nucleus pulposus) that loses moisture with age, and a tough outer
ring (the annulus fibrosus) that can split with age or injury A
herniated disc occurs when the disc's jelly-like center (the nucleus
pulposus) ruptures the tough, fibrous outer ring (the annulus fibrosus)
oozing through small openings in the vertebrae where nerves enter
the spinal column.
What is the difference between a herniated disc and a bulging
A bulging disc is a slight protrusion of the center of the disc
(nucleus pulposus) into the spinal canal. In a bulging disc, the
annulus fibrosus (outer ring) has not been ruptured.
A disc herniation is a large protrusion of the nucleus pulposus
(center of the disc), which has burst through the annulus fiborsus
(outer ring of the disc) into the spinal canal, invading the surrounding
nerves and causing pain in the neck, shoulders or arms.
Are bulging or herniated discs normal?
No, they are not "normal" in that we are not born with
herniated or bulging discs. They are very common and occur with
age and natural dehydration and degeneration of the disc. MRI studies
of asymptomatic patients showed that approximately 40% of the population
has herniated or bulging discs.
Does whiplash cause herniated discs?
Your physician will determine is an MRI is necessary. Generally,
an MRI is ordered for patients that have failed conservative therapy,
or have persistent pain in the neck, shoulder, or arms, or exhibit
weakness in the arms.
What can I do to avoid surgery?
The best way to avoid surgery is to keep physically fit, maintain
a healthy weight, avoid smoking, avoid repetitive motion, and use
proper body mechanics. Alternative therapies may relieve the symptoms
and allow patients to avoid or delay surgical intervention.
Alternative therapies such as light traction, acupuncture,
Pilates, anti-inflammatory medication, a short course of steroids,
or trigger point injections are often treatment options for neck
pain. While these may relieve some symptoms, there is not a "cure" for
When do I need surgery?
Surgery is only indicated if conservative therapy fails, the patient
becomes dysfunctional, or the patient should experience progressive
Will I have irreversible damage if I delay surgery?
Your physician will advise you based on your condition. In general,
if there is severe spinal cord compression or a nerve is compressed
over a period of time there may be irreversible damage. If a patient
experiences an increase in weakness, weakness in the legs, loss
of balance, or loss of bladder or bowel control, they should be
reevaluated by their spine specialist immediately.
When do I need a fusion?
The treatment plan is individualized for each patient. A fusion
becomes necessary when there is instability in the spine. This
may occur because of degeneration of the disc, a spinal deformity
such as spondylosis, or during as a result of removing a disc during
surgery. A fusion is performed to reconstruct the spine's natural
balance and lordosis (curvature). Instrumentation such as screws
and plates may be used to stabilize the spine while the boney fusion
The BRYAN® Cervical Artificial Disc or Prestige
Artificial Cervical Disc may be an alternative to fusion for some
patients. To find out if this is an option for you, please call
Why is surgery often done through the front of the neck?
The anterior (front) approach is preferred because the muscles
in the front of the neck naturally part and offer direct access
to the disc while the spinal cord is protected by the vertebra.
Because the muscles naturally part rather than being cut, there
is less trauma and a faster recovery.
What effect does a fusion have on the rest of the cervical spine?
That is an excellent question. In a one level fusion, there is
little impact on the spine.
In a multilevel fusion, the major concern about performing a fusion
is adjacent segment degeneration. The discs act as shock absorbers
between the vertebras. When the spine is fused, the levels above
or below the fusion may absorb the sheer force from every day motion,
and thus wear out the discs. When the fusion is performed with
the appropriate size bone graft, the balance of the spine is maintained
and the adjacent segments are at less risk of degeneration.
Should I have allograft or autograft bone?
This is decided on an individualized basis. In general, I use
an allograft (donor bone) in single level fusions, and autograft
(bone graft taken from the patient's hip) for multilevel fusions.
Under some circumstances in a single level fusion, and in multilevel
fusions, using bone harvested from the patient's hip may have a
higher fusion success rate.
Will the surgery lessen my mobility?
A one level fusion does not greatly limit a patient's mobility.
In a multilevel fusion, a patient may have some decreased motion.
Will I have pain after my surgery?
Most patients have minimal pain following an anterior fusion surgery.
The first few days following surgery are the most uncomfortable,
and patients often experience a sore throat. The pain is well tolerated,
and easily managed with pain medication.
What are my chances for success?
The success of the surgery is determined by the reconstruction
of the balance of the spine and the reduction/elimination of the
patient's symptoms. The outcome is dependent on the condition of
the spine and surgeon performing the surgery.
What are my risks?
There are risks associated with any surgical procedure. The risks
for a cervical surgery include but are not limited to: inter operative
complications, infection, bleeding, hardware failure, hoarseness,
paralysis, and death.
Will I have to wear a collar
the majority of cases, a collar is not necessary.
When will I be back to my normal activities? Driving?
Patients resume normal activities when they have
recovered full coordination and experiencing minimal pain.
Will my surgery be photographed or video taped?
Occassionally Dr. Pashman
will take interoperative pictures for educational purposes. The
photos or video do not show any identifying features (such as
name or your face). This is covered in your surgical consent
form. If you have a preference about being photographed, please
let Dr. Pashman know when you sign the consent form.
Can I have an MRI after having
an Anterior Cevical Discectomy and Fusion?
MRI or CT scans are perfomed
on patients that have had spinal fusion with titanium instrumentation
to rule out re-herniation or to aid the physician in diagnosing
a new problem. Always inform the imaging technician perfoming
the MRI or CT scan that you have spinal instrumentation.