Diagnosis & Treatment Neck Pain (Cervical & Cranio-Cervical)
Neck Pain DiagnosisDiagnosis
There are many types and causes of neck pain. The team at Och Spine at NewYork-Presbyterian offers all exams and tests needed to learn what is causing your discomfort. When you visit us, we may take the following steps to find out what is causing your discomfort:
- Review medical history to learn about your symptoms and what makes them feel better or worse
- Physical exam to assess your range of motion, pain, sensation, reflexes, and the strength of your arm muscles
- Imaging exams such as x-rays, computed tomography (CT) scans, and/or magnetic resonance imaging (MRI), help show the bones, discs, and nerves in and around your spine
Neck Pain Treatment Without SurgeryNonsurgical Treatment
Whenever possible, the doctors at Och Spine try to relieve your neck discomfort without surgery.
Medications may be useful to relieve neck pain in some patients. In addition to over-the counter medicines like ibuprofen, prescription medications are often used in people with neck discomfort. Some antiseizure medicines can control extreme nerve pain due to a herniated disc. Certain antidepressant drugs are also valuable for treating people with chronic pain.
Physical therapy for neck pain and is often used as an important part of post-surgery care. Physical therapists help patients learn about proper alignment of the cervical spine and approaches to move safely, while teaching ways to improve strength, posture, and flexibility. Components of physical therapy may include:
- "Passive" techniques during a physical therapy session, such as applying heat or ice, massage, electrotherapy (applying tiny electrical currents to affected muscles), and cervical traction to gently stretch and align the neck.
- Home exercises to stabilize your spine, correct body mechanics, strengthen your core, improve posture, and stretch tight muscles.
- Neck braces and collars are useful in some people to provide support after an injury or surgery. They are intended only for short-term use.
Acupuncture from a licensed acupuncturist has helped many people with neck pain. It involves the placement of very thin sterile needles into specific energy points in the body to unblock energy pathways and encourage the flow of "qi," the body's life force.
Steroid spine injections provide short-term relief from neck pain and can allow you to engage more fully in physical therapy. The pain relief may be immediate or gradual and can last up to several months. A physiatrist often performs the injection, guided by an x-ray technique called fluoroscopy, to inject cortisone into the epidural space around the spine.
Nerve blocks are a form of regional, or local, anesthesia (numbing medication). With this treatment, the nerve supply to the painful part of the neck can be blocked temporarily.
Radiofrequency ablation (RFA) is a same-day procedure performed under light sedation or an anesthetic. The doctor first performs a nerve block to determine the exact source of the pain. A needle is then inserted to target the nerve causing the pain and heat is applied. This heat creates a lesion that blocks pain signals between the affected nerve and the brain.
At-Home Treatments for a Stiff NeckAt-Home Treatment
In many cases, there are steps you can take to relieve the discomfort of a stiff neck at home. You may try:
- Stretches such as gently bending your neck forward and up, looking right to left, and tilting from side to side to extend your neck muscles and improve flexibility.
- Warm compresses or ice packs to relieve pain, depending on the cause of your discomfort.
- Over-the-counter medications such as acetaminophen, ibuprofen, or naproxen for short-term use. If the pain does not go away, see a doctor rather than continuing to use these medications.
- Arranging the set-up of your workstation to ensure the top of your computer monitor is at eye level and your knees are slightly lower than your hips when sitting.
- Ensuring your neck is well-supported when you are sleeping by using the type of pillow most appropriate for your sleep position (ie, whether you sleep on your side, back, or stomach). Ideally, your neck should not be turned or tilted to one side for a long duration of time or compressed in any way.
Surgical Treatment for Neck PainSurgery
Cervical spine surgery is an option for people with pinched nerves (cervical radiculopathy), spinal cord compression (cervical myelopathy), instability, or pain that cannot be effectively treated using nonsurgical therapies.
If you need neck surgery, your team at Och Spine will discuss options with you and tailor a surgical plan to meet your needs. We offer every type of neck surgery and, use minimally invasive spine surgery whenever appropriate.
Anterior cervical discectomy and fusion (ACDF). During this procedure, the surgeon enters the front of the neck to repair or remove a cervical disc (the rubbery pads between vertebrae) that is causing neck pain by compressing a nerve. More than half of minimally invasive cervical surgeries are completed using the anterior approach. The surgeon may fill the space with an artificial disc replacement (ADR) made of plastic or metal. Some patients who need more stability have the nearby vertebrae joined together (with titanium plates or screws, so that the bones eventually fuse together over time. Spinal fusion reduces the range of motion of the neck but also reduces the chance of future cervical spine complications.
Posterior cervical microdiscectomy. With this approach, the cervical spine surgeon enters through the back of the neck to repair an affected cervical disc, without performing spinal fusion. This operation may be more challenging because the spinal cord may obstruct the surgeon's full view of the disc space and removing the disc can be more difficult. It may therefore be best suited for people with large soft disc herniations along one side of the spinal cord.
Posterior cervical laminectomy. This technique is a treatment for spinal stenosis of the cervical vertebrae. The surgeon enters through the back of the neck and removes the lamina (the section of bone that covers the spinal canal), thereby relieving pressure on the spinal cord.
Correction of cervical spine deformities. Abnormal or excessive curvature of the cervical spine may be corrected with spinal fusion, inserting titanium plates and screws to bring the spine closer to normal alignment.