A cervical spine MRI scanWhen do you need neck surgery?

When do you need surgery for your neck? Every person’s case is specific to them, but I can provide some general guidelines for surgical necessity and some specific examples that I think you’ll find helpful in better understanding when and why people may need surgery. Also, be mindful that surgeons don’t always agree on when someone needs neck surgery. Some surgeons are more conservative and some are more aggressive in their surgical recommendations.

The first thing any doctor wants to do in evaluating neck pain is to determine if the neck pain is benign or malignant, i.e. cancer, which is, of course, a very rare cause of neck pain. This is usually easy enough to figure out based on medical history, a history of your neck pain, examination, and whatever diagnostic imaging is available to review, e.g. x-rays or MRI scan, or CT scan.

Once that is ruled out, there are still several other causes that can be of considerable concern. And keep in mind that the neck contains the spinal cord, which makes it of greater concern than the low back because the spinal cord does not exist beyond the upper part of the lower back, i.e. the L1 vertebra for those of you familiar with spinal anatomy.

The next causes of concern in the case of neck pain are also uncommon and include things like infection, dislocation, fracture, benign tumors, and instability. These are also usually fairly easily excluded with the same history, exam, and diagnostic imaging.

Excluding those things leaves us with the most common, and less dangerous, causes of neck pain, although these benign causes can, and because of their prevalence, do result in the most surgeries. But surgery in these cases is still uncommon. And these causes of neck pain include disc degeneration, joint degeneration, pinched nerves, narrowing or stenosis of the spinal canal (where your spinal cord is located), and bulging and herniated discs.

In many other articles, I have explained why the spine, including your neck and low back degenerate as we age, and I have described it as a progressive, degenerative, compressing process, which is best treated with non-surgical spinal decompression treatment because it partially reverses this process and in my clinical experience is much more effective than any other treatment I have seen and used.

So all the above causes of neck pain are only going to need surgery about 2% of the time. All surgeons will tell you that surgery is a “last resort”. However, there are times when surgery is appropriate and the best solution to neck pain. Generally, a person with neck pain should have tried some or all non-surgical treatments first, including physical therapy, chiropractic, acupuncture, and injections. Most patients will not try all of these and probably don’t need to try all of them, but a spine specialist should review all the treatments that have been done and determine if there are any others that should be tried, given the specific cause of the neck pain, and the probable efficacy of any untried treatments.

For degenerated discs, herniated and bulging discs, pinched nerves, and non-specific neck pain, i.e. pain without a certain cause, I think spinal decompression treatment is the most effective at avoiding surgical treatment. Failing that, injections are worth trying.

There is one interesting problem in the neck that often does not cause neck pain, yet may require surgery. And it is called central spinal stenosis. In this problem degeneration of the bones and ligaments and discs cause the spinal canal to become too small and it squeezes the spinal cord, which can cause eventual problems with finger dexterity, your gait, i.e. the way you walk, and even urinary problems. It may seem odd to patients that sometimes the person doesn’t even have pain in their neck, but they need surgery in order to save their spinal cord and function. Also, some people are born with small spinal canals which means that any additional degeneration can cause this problem at a younger age.

If a patient has any of the disc and nerve problems noted above, and they try non-surgical treatments, and they are still having severe pain, then neck surgery can be a reasonable and proper thing to do. I have referred many patients to surgery over the years and I am grateful to work with excellent surgeons to whom I can refer patients when indicated.

If you have neck pain and want to avoid neck surgery, I can provide you with the most effective non-surgical neck treatment with Decatur physical therapy and Decatur chiropractic treatment. Call me at 404-558-4015 or go to www.backstrong.net


Craig Castanet, D.C.
Backstrong Non-Surgical Rehab Clinic