Video: Treatments for Neck and Back Pain

The spine and pain center at Baltimore Washington Medical Center is a collaborative effort between a variety of people to take care of people who have neck and back problems. It involves surgeons, physical medicine rehabilitation specialists, physical therapists, and it involves the nursing staff who help take care of the patients; an entire group of people who work together as a team to provide patients with the best care possible.

"Neck and arm pain can be caused by a variety of different problems. The vast majority of those problems can be treated without surgery. Even though I'm a surgeon, it's my goal and the goal of the entire center to try to get patients better first without surgery and only use surgery as a last alternative. There is a list of many things that can cause neck and arm pain. Probably the most common thing we see is arthritis or degenerative conditions that occur in the spine.

The spine is composed of discs and vertebrae. If you look carefully, you'll see them on this model of the entire of the entire spine. Starting here at the skull, the cervical vertebrae are the vertebrae in your neck, and there are 7 of those. And between each of those vertebrae, which are the bones, are the discs. The best way to think about discs is that they are shock absorbers.

Unfortunately, those shock absorbers start to degenerate for us at about 18. The shock absorbers, the discs, contain water, and they start to lose their water content--that's a normal process of aging. But as we get older, certain times the discs can get tears from twisting. That can cause pain, and as we get older, the body forms bone spurs.

Everybody thinks bones spurs are bad, but bone spurs are the way that nature tries to stabilize a bad shock absorber. most of the time, that process happens very slowly, but occasionally, it happens that it can pinch a nerve or it can irritate other vertebrae. If you get that combination of two things, generally think of the bad shock absorbers as causing neck pain, and if that shock absorber along with a bone spur, can pinch the nerves. These yellow structures that come out from the spine at each level are nerves, and they come out at little holes called ""foramen"". A nerve can be pinched from the front, or it can be pinched from bone spurs on the side.

For the vast majority of problems, if you have an acute pain, probably 80 percent of those are going to go away in 4-6 weeks on their own. You can take anti-inflammatory medications, and restrict your activities a bit, but the natural history is such that most of these problems will go away on their own within 4-6 weeks. Once something persistently lasts beyond that point of time, and it's affecting your daily activities so that you can't do what you want, that's the time to go in and see your doctor.

I generally tell patients that we try to divide the treatments into three phases. Phase 1 is generally medication and physical therapy or chiropractic care, which I do think can help people. If they're still having significant discomfort in their neck or arm, at that point, then most people are afraid that if they come to see me, I'm going to recommend surgery because I'm a surgeon, but that's not true.

The second phase of treatment that we use on a routine basis is referring them to one of the non-operative pain specialist, such as an anesthesiologist who specializes in non-operative care, or a physiatrist, who is a specialist in rehabilitation and physical medicine. Those doctors can fine-tune a number of medicines, and they can use a variety of injections, often with cortisone, that can settle down an acute inflammation. On average, 40-50 percent of patients who are still having problems after 8 weeks can go see one of those non-operative specialists, have their medicines fine-tuned, and get some sort of injection therapy that can settle their symptoms down, so they can function better.

Once patients have gone through phase 1 and phase 2, we're often several months down the road. If they persistently have pain or weakness in their grip or arm or shoulder, then I usually am called in to begin to evaluate the patient to see if we can help them surgically.

Once we talk about surgery to a patient, there are a variety of ways to treat neck problems. We spoke earlier that neck problems can come from problems with the disc, they can come from problems with the nerve, they can come from problems with bone spurs. And we have to use a variety of tests to determine where the biggest problem is. That's generally when we will order an MRI scan, along with X-Rays and sometimes a CAT scan, which is best for evaluating bone and bone quality. The surgical procedures, we try to determine where the problem is. Is the problem really a bad disc, a bad shock absorber, which is generally in the front of the neck. Is it a problem with the nerve being pinched, coming out the side, or is it a bone spur or a narrowed space where the nerves are coming out in the back.

The most common surgical procedure we do today is called anterior cervical discectomy infusion. That is generally a procedure where a disc is bad and we can make a small incision in the front of the neck. I can make a one-inch incision in the front of the neck, go down, removed the disc, put a spacer in that can be made of bone or plastic, and then put a small plate on the front of the spine to stabilize it. That operation has been done for 50 years, but it's gotten dramatically better. Patients on average go home the next day. And because our means of fixation with a plate (that's made usually of titanium) is so much better, the patient wears a soft collar for comfort for about two days, and after that, they don't have to wear anything. They have virtually no restrictions on driving, on walking around, and they are basically able to do almost anything. That' s one of the reasons our recent push has been to develop an artificial disc that enables the spine to still move.

The artificial disc is made of metal, and often plastic- some of the same components that one uses when they make an artificial hip or knee. There are several companies that are making artificial cervical discs now. One has been released by the FDA for use. The best patients who are candidates for an artificial discs are younger, basically only have problems at one level in their spine, and someone who does not have a lot of bone spurs. If a patient has a lot of arthritis and a lot of bone spurs, then it's more difficult to make the artificial disc work reliably.

There aren't any great studies out now that show that the immediate result from the artificial disc is dramatically different than the traditional fusion operation we talked about. The hope is, if you can maintain motion in your neck, you won't put stress at the other level, and they will not degenerate. We know that there is a distinct rate of degeneration at levels next to fused levels. And that's really the problem that we face.

I'm often asked, how long will it take me to recover, and how much time will I need to take off work. That varies a bit between procedures. But generally, if you're talking about an operation in the front of the neck, at only one or two levels, people are feeling quite good usually within a couple of weeks. And certainly by six weeks they're able to go back to work with virtually no restrictions. If the operation involves going in the back of the neck and involves a lot of levels, the period of time that they are off work is more, but generally, they're getting back to their normal activities somewhere between six weeks and three months. The advantage of the cervical spine operations we do is they seem to have an immediately better outcome than some of the low-back operations we do. That's presumably because there's less stress on your neck than there is on your low back.