The cervical disc acts as a shock absorber between the bones in the neck. The disc degenerates, typically around age 30- 40 years and older. The normal gel-like shock absorbing center of the disc dehydrates gradually, and as this happens the space between the vertebral bodies collapses. This causes the disc space to narrow, and as a result added stress is applied to the facet joints of the spine. This causes neck pain as a result of further wear and tear. With time this leads to cervical arthritis, and degenerative disease. In addition to the ongoing degenerative process the cervical disc can also protrude and put pressure on the spinal cord or nerve roots when the rim of the disc weakens. This is known as a herniated cervical disc/disc bulge.
The cervical spine (neck region) consists of seven bones (C1-C7 vertebrae), which are separated from one another by shock absorbers, or intervertebral discs. Your neck is part of your spine which serves as a long flexible column which supports your body.
The spinal canal is a continuous hollow longitudinal space, which runs along the whole length of your back. The spinal cord and nerve bundles pass within the spinal canal. The spinal cord is bathed in cerebrospinal fluid (CSF) and surrounded by three protective layers called the meninges (dura, arachnoid, and pia mater).
At each vertebral level, a pair of spinal nerves exit through small openings called foramina (one to the left and one to the right). These nerves serve the muscles, skin and tissues of the body and thus provide sensation and movement to all parts of the body. The delicate spinal cord and nerves are further supported by strong muscles and ligaments that are attached to the vertebrae.
Common Causes of Neck Pain
Many patients see Dr. Pablo Pazmino for a spinal consultation because of pain in their neck or shoulder, or tingling and numbness in their arms. Some may also have experienced some weakness in their arms or hands, dropping items, or difficulty with their handwriting.
Neck pain may be caused by disc degeneration, narrowing of the spinal canal, arthritis, and, in rare cases, cancer or meningitis. For serious neck problems, a primary care physician and often a specialist, such as a spinal surgeon, should be consulted to make an accurate diagnosis and prescribe treatment.
Age, injury, poor posture, or diseases such as arthritis can lead to degeneration of the bones or joints of the cervical spine, causing disc herniation or bone spurs to form. Sudden severe injury to the neck may also contribute to disc herniation, whiplash, blood vessel destruction, vertebral injury, and, in extreme cases, permanent paralysis. Herniated discs or bone spurs may cause a narrowing of the spinal canal or the small openings through which spinal nerve roots exit. Pressure on a nerve root by a herniated disc or a bone spur may result in:
- Pain in the arm and neck
- Numbness or weakness in the arm or forearm
- Tingling in the fingers or hand
Pressure on the spinal cord in the cervical region can be a very serious problem because virtually all of the nerves to the rest of the body have to pass through the neck to reach their final destination (arms, chest, abdomen, legs). This can potentially compromise the function of many important organs.
If you are experiencing any weakness or numbness in your arms or legs, you should seek medical advice. If you have had any trauma and are now experiencing neck pain with weakness or numbness, you should consult with Dr. Pablo Pazmino sooner rather than later.
During your consultation, Dr. Pablo Pazmino will take a complete medical history to rule out other conditions that can cause symptoms similar to cervical herniations. Dr. Pablo Pazmino will also perform a complete and thorough physical examination. Radiography (X-rays) and other diagnostic imaging tests (MRI) will then be reviewed so that Dr. Pablo Pazmino can evaluate your bony quality, any instabilities, herniations causing any neural compression, bony spurs or other abnormalities to reveal the extent of damage to your cervical spine.
At Santa Monica Spine we pride ourselves in our duty to educate our patients. Dr. Pablo Pazmino uses his background as a teacher to ensure that you understand your pathology, imaging and treatment options completely during each visit. Our patients often comment on their amazement at the amount of time and effort we take to review their studies, often in a manner which they have never seen before. We want our patients to be involved in every step of the process and we feel that education is the first step towards achieving that goal together.
At Santa Monica Spine / Beverly Spine we are very thorough. Dr. Pablo Pazmino will rely on you to provide us with a complete history of any and all medical illnesses, hospitalizations, surgeries, or chronic conditions which you may have had in the past, or for which you have seen other physicians in the past.
More specifically we will require a history of your neck and arm pain itself. What is the exact location of the neck pain? Arm pain? When did the problem begin? What does the pain feel like? Has your neck been injured before? Have you previously been treated for neck pain?
Nonsurgical treatment is effective in treating the symptoms of neck pain. Symptoms of neck pain may last for days, several months, or become chronic. If symptoms are mild, Dr. Pablo Pazmino may recommend a variety of nonsurgical treatments.
- Rest. A soft cervical collar or neck brace may be used to limit neck motion and relieve irritation.
- Medication. Dr. Pablo Pazmino may prescribe nonsteroidal anti-inflammatory medications (NSAIDs) or other non-narcotic pain relievers to relieve your pain and reduce swelling. Muscle relaxers, analgesics, and anti-inflammatory medications are also helpful.
- Cold compresses or ice can also be applied several times a day for no more than 20 minutes at a time.
- After any spasms settle, gentle heat applications may be used.
- Acupuncture. Dr. Pablo Pazmino works with a team of Acupuncture specialists and may recommend this if indicated for your symptoms.
- Physical therapy. In some instances a specifically guided course of Physical Therapy is all that is required. Dr. Pablo Pazmino works hand in hand with a small group of therapists. Any physical activity should be slow and controlled, especially bending forward and lifting. This can help ensure that symptoms do not return-as can taking short walks and avoiding sitting for long periods. For the neck, exercises or traction may also be helpful. To help avoid future episodes of pain, it is essential that you learn how to properly stand, sit, and lift. A cervical traction device, hot and cold therapy, or active exercise program may help relieve symptoms. Exercises may include neck strengthening, neck and shoulder stretching, and aerobic exercises. Patients may also receive gentle massage and perform activities to improve posture.
- Injections: A series of selective nerve root blocks or epidural injections of a cortisone-like drug may lessen nerve irritation and allow more effective participation in physical therapy. These injections are given on an outpatient basis over a period of weeks. Dr. Pablo Pazmino only works with a small group of physicians who he trusts to perform these injections. Click here to see some of the recommendations Dr. Pablo Pazmino makes in regards to injections and pain management physicians.
Nonsurgical treatment may take away most of the symptoms, but it does not treat the underlying structural cause. Follow-up visits are necessary so Dr. Pablo Pazmino can check if symptoms have gotten better, worse, or have stayed the same.
When Surgery is Necessary
There are several surgical treatments available to treat cervical spine disorders. Factors that help determine the type of surgical treatment include the specifics of your disc disease, and the presence or absence of pressure on the spinal cord or spinal nerve roots. Other factors include your age, how long you have had the disorder, other medical conditions you have, and whether you have had previous cervical spine surgery.
When conservative treatment for neck pain does not provide relief, surgery may be needed. You may be a candidate for surgery if:
- Conservative therapy is not helping
- You experience progressive neurological symptoms involving your arms and legs
- You experience difficulty with balance or walking
- You are in otherwise good health
There are several different surgical procedures which can be utilized, the choice of which is influenced by the severity of your case. In a small percentage of patients, spinal instability may require that spinal fusion be performed, a decision that is generally determined prior to surgery. Spinal fusion is an operation that creates a solid union between two or more vertebrae. Various devices (like screws or plates) may be used to enhance fusion and support unstable areas of the cervical spine. This procedure may assist in strengthening and stabilizing the spine and may thereby help to alleviate severe and chronic neck pain.
The benefits of surgery should always be weighed carefully against its risks. Although a large percentage of neck pain patients report significant pain relief after surgery, there is no guarantee that surgery will help every individual.
If conservative treatment fails to relieve your pain over the course of 6 to 12 weeks, Dr. Pablo Pazmino may recommend a surgical option. The surgical procedure Dr. Pablo Pazmino recommends depend on the underlying condition, and he will discuss your options with you. In most instances, surgery not only relieves the pain, but also improves functioning and movement of the affected areas.
Surgery may be necessary for patients with progressive neurologic symptoms or severe pain that does not improve with other treatments. Surgery may be required if a disc fragment lodges in the spinal canal and presses on a nerve, causing significant loss of function. Surgical options in the neck are varied and depend entirely on the patient, the symptoms and the pathology. For some patients, a smaller surgery may be performed on the back of the neck that does not require fusing the bones together. These posterior approach options can include a microdiscectomy or posterior procedure like a minimally invasive microscopic Foraminotomy (see attached lecture), depending on the size and position of the disc herniation.
In the neck, an anterior approach may be required. Anterior approaches can be either an anterior cervical discectomy and fusion or an arthroplasty. This involves removing the entire disc to take the pressure off the spinal cord and nerve roots. The procedure for both an arthroplasty and a fusion are similar up to this point. A fusion, (ACDF, an Anterior Cervical Discectomy and Fusion), is the current gold standard for treatment of a degenerated or herniated disc. With this procedure after the discectomy is performed, a spacer is placed in the disc space and a metal plate may be used to stabilize the spine. This eliminates painful motion from the involved area through a cervical fusion. Final fusion occurs at 12-16 months. Patients are not required to wear a soft collar, unless needed for comfort while driving.
A Cervical artificial disc replacement is the new treatment for a degenerated or herniated disc. With this procedure after the discectomy is performed, an artificial disc replacement is placed in the disc space and either spikes or a keel are used to stabilize the spine. This eliminates painful motion from the involved disc and eliminates the comorbidities associated with a fusion. Complete range of motion is achieved within 2-12 weeks. Patients are not required to wear a soft collar, unless needed for comfort while driving.
A Cervical hybrid artificial disc replacement is the new treatment for a degenerated or herniated disc in a patient with a prior fusion. With this procedure after the discectomy is performed, an artificial disc replacement is placed in the disc space and either spikes or a keel are used to stabilize the spine. At a prior level there has already been a fusion performed or can be performed during our procedure. This combination of arthroplasty and fusion eliminates painful motion from the involved disc and eliminates the comorbidities associated with a fusion. Complete range of motion is achieved within 2-12 weeks. Patients are not required to wear a soft collar, unless needed for comfort while driving.
We have done research on our initial outcomes with cervical arthroplasty and presented these findings at national and international meetings. If you are interested in our outcomes please read our findings in the research section.
Each of these surgical procedures is performed with the patient under general anesthesia. They may be performed on an outpatient basis or require an overnight hospital stay. You should be able to return to work in 2 to 6 weeks after surgery.
Newer Cervical artificial disc replacements are on the horizon as a new treatment for a degenerated or herniated disc in a patient with a prior fusion. Dr. Pablo Pazmino is the Principal Investigator for the Discover Cervical Arthroplasty from DePuy. This is an ongoing clinical trial and we are currently recruiting patients with cervical pathology for entry into the study. With this procedure after the discectomy is performed, an artificial disc replacement is placed in the disc space and spikes are used to stabilize the new disc to the spine. The arthroplasty eliminates painful motion from the involved disc and eliminates the comorbidities associated with a fusion. Complete range of motion is achieved within 2-12 weeks. Patients are not required to wear a soft collar, unless needed for comfort while driving. To find out if you qualify contact us via telephone or email.
When Should You Seek Medical Care?
You should consult with Dr. Pablo Pazmino for neck pain if:
- It occurs after an injury or blow to the head
- Fever or headache accompanies the neck pain
- Stiff neck prevents you from touching your chin to your chest
- Pain shoots down one arm
- There is tingling, numbness or weakness in your arms or hands
- Neck symptoms associated with leg weakness or loss of coordination in arms or legs.
- Your pain does not respond to over-the-counter pain medication
- Pain does not improve after a week
If severe pain occurs following an injury (motor vehicle accident, diving accident, or fall), a trained professional, such as a paramedic, should immobilize you to avoid the risk of further injury and possible paralysis. Emergent medical care should be sought immediately.
Immediate medical care should also be sought when an injury causes pain in the neck that radiates down the arms and legs.
Radiating pain, or numbness in your arms or legs which causes weakness in the arms or legs without significant neck pain should also be evaluated.
If there has not been an injury, you should seek a Spinal Evaluation with Dr. Pablo Pazmino when pain is:
- Accompanied by pain that radiates down the arms or legs
- Accompanied by headaches
- Accompanied by numbness, or tingling
- Accompanied by weakness!
Many patients seek care for Neck Pain by Dr. Pablo Pazmino because as an Orthopaedic surgeon he is specifically trained to diagnose, treat, and help prevent problems involving the muscles, bones, joints, ligaments, and tendons. Although Dr. Pablo Pazmino confines his practices to Spinal pathology he also treats a wide variety of diseases, injuries, and other conditions, including Artificial Disc Replacement.