| |
 |
|
| Medical Edge |
|
|
|
Medical Edge Newspaper Column from Mayo Clinic
TREATING A PAIN IN THE NECK WITH RESPECT
DEAR MAYO CLINIC: I have spondylosis of the cervical spine (neck) and need more information about a procedure to lessen the pain associated with this condition. An orthopedic surgeon suggested (after an MRI was taken) that a neck manipulation under anesthesia be done. I am quite hesitant to have this procedure because I’m aware there might be complications, especially stroke. How successful is it in reducing the pain of spondylosis? — Dauphin, Manitoba
ANSWER: Spinal manipulation, which involves a thrusting maneuver to the vertebrae in an attempt to improve motion between them, appears to relieve some patients’ neck pain. Yet your hesitancy is understandable, as stroke is indeed a risk from this procedure. That risk is very small when performed on a conscious patient — maybe even on the order of one in a million — but the consequences are profound. Such a stroke could affect life-sustaining parts of the brain — those, for example, that control your ability to swallow or breathe. On a more mundane level, the procedure can at times aggravate your pain.
The risks are probably greater when done under anesthesia, however, because there is less muscle tone to absorb the energy from the manipulation and a greater chance that the blood vessels or nerves will be stretched and injured. Thus, while I sometimes prescribe spinal manipulation for certain patients with cervical-spine problems — when more conservative approaches do not suffice — I would not recommend that they undergo spinal manipulation under anesthesia.
Cervical spondylosis is a chronic degeneration of the neck’s vertebrae and the disks and joints between them. This degeneration, mostly caused by wear and tear as you age, can include bulging disks and abnormal bone growth (spurs) that may cause pressure on the spinal nerves and sometimes on the spinal cord itself. The result can be neck pain that at times radiates to the shoulder, arm, hand and fingers or even causes headaches.
A diagnosis of cervical spondylosis means that such degeneration, quite common in individuals older than 50, has been spotted. But it is not necessarily the cause of the patient’s neck pain, which may relate to muscular rather than disk or joint problems or to some other condition altogether.
Problems with the spine in general and the neck in particular elude easy diagnosis and often are poorly understood. That reality, together with the fact that different patients show very different responses to any given therapy, means that treatment is often a trial-and-error affair. It makes sense to start off with the least risky and least expensive alternatives, and then move up the ladder as needed.
The most conservative medical option is acetaminophen (Tylenol), which can be useful for easing pain caused by irritated joints. Next come nonsteroidal anti-inflammatories, such as aspirin or ibuprofen (Advil, Motrin). These drugs can be effective at reducing pain and inflammation, but they pose risks such as gastrointestinal bleeding. Tricyclic antidepressants and muscle relaxants may be helpful. And in the more unresponsive cases, corticosteroids injected directly into the vertebral joints or around the nerves may provide relief.
Meanwhile, a more modest approach — and an essential part of treating neck pain — is physical therapy and a regimen of regular exercises, coordinated between therapist and patient. Such activities are typically designed to improve the range of motion between vertebrae, strengthen local muscles, and, above all, maintain good posture. If posture correction, associated exercises, and other simple options (such as heat application) make little difference after a month, spinal manipulation or mobilization (without thrusting) — on an alert patient only — may be tried.
The best “treatment” for recurring neck problems, however, is prevention — often through the commonsense process of noting the kinds of activities that worsen symptoms and avoiding them whenever possible. For example, if excessive looking-up movements produce neck pain, you shouldn’t paint the ceiling. And if you spend a great deal of time in front of a computer, it’s important to properly adjust screen height and take frequent breaks.
— Ralph E. Gay, M.D., D.C., Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minn.
Additional Resources:
Cervical Spondylosis
Appointment Information
More Information on Cervical Spondylosis
- - -
Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave.,
Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2006 TRIBUNE MEDIA SERVICES, INC.
|
|
