The Cervical Center.

Most neck pain improves with non steroidal anti inflammatory agents such as Motrin, Aleve, Advil, and Tylenol. If your pain is persistent for more than a few weeks, you should consult your primary care physician about whether you should see a specialist and obtain imaging studies. Any patient with numbness or weakness is a more urgent matter and should undergo an MRI of the cervical spine regardless of pain level.

Any patient with persistent and worsening symptoms beyond four to six weeks is a candidate for a cervical spine evaluation. Most patients undergo an MRI to pair a diagnosis with their clinical presentation. If the diagnosis is arthritis or cervical degeneration without any nerve root or spinal cord compression, they are a good candidate for an initial course of physical therapy. Most providers send patients to therapy for six to eight weeks and continue only if they improve after the initial course. If symptoms worsen, the patient may be referred to pain management or a surgeon.

An epidural injection can help a pinched nerve, or cervical radiculopathy. Most pain management providers try a selective epidural on the compressed nerve for relief, and may attempt up to three injections to achieve improvement. If there is no improvement while a nerve remains compressed, they may refer you to a surgeon.

Acupuncture can be very helpful for someone with persistent muscle spasm, when there is no nerve root compression and no myelopathy. Constant neck pain can keep the muscles of the neck and shoulders in spasm, and acupuncture helps in that particular situation.

Patients with any neurological deficit are candidates for surgery sooner rather than later. That includes severe weakness in the arms from a pinched nerve, or progressive cervical stenosis causing cord compression. Patients with mild to moderate symptoms are evaluated based on the extent of any deficit, how long the symptoms have lasted, and overall function.

Most patients who undergo anterior cervical surgery at one, two, or three levels are not required to wear a collar. As recently as ten years ago surgeons routinely mandated one, but that is no longer the case, thanks to higher fusion rates, better postoperative education, and improved fusion technology. A small number of patients, mainly those involved in a traumatic accident, may need a collar for instability, but that is fewer than five percent.

The vast majority of spine surgeons do not take bone from your hip. As the technology improved and allograft products became more available, the need for hip bone fell away. In fact, harvesting hip bone often hurt more than the cervical surgery itself. In our practice we only use bone harvested through the same incision.

No. Mobility is the key. Over the past twenty years the gold standard has shifted from immobility to movement. We often tell patients to follow the twenty minute rule, changing position every twenty minutes, since moving loosens the muscles and eases pain.

The risk of needing additional surgery after your first cervical spine procedure is roughly four percent over your lifetime. That means about four patients in one hundred return for more surgery, most often at the level just above or below the original one.

Both procedures work well, and neither is simply better. ACDF, the fusion procedure, is still considered the gold standard for cervical disc disease that causes radiculopathy or myelopathy. Disc replacement can offer more range of motion and may reduce the risk of adjacent segment disease over the long term. A ten year New York State study of single level cases, published in the Journal of Neurosurgery Spine in April 2023, found no significant difference in revision risk between the two. The disc replacement group had more postoperative swallowing difficulty, while the fusion group had a slightly longer hospital stay. Our main caution is that some patients report increased neck pain after disc replacement, so the right choice depends on your anatomy and symptoms.