Neck Paincauses and Treatments

David J. Rolnick, M.D.

Neck Pain

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Neck PainCauses and Treatments

David J. Rolnick, M.D. ~ MedEx, LLC

Key Driving Factors

oAdversarial Scheme Framework

oWrong Incentives

oLack of Knowledge

Wrong Incentives Encourage:

oClaimants to stay sick

oMedical over-servicing

oLegal intervention

oProcess driven (not outcome focused) performance by insurers

Why doesn’t whiplash exist in countries without access to compensation?

Why don’t demolition derby drivers sustain whiplash injuries?

Vertebrae

o33 spinal bones (vertebrae), most with a disc separating them

o3 important, noticeable curves

Cervical Vertebra and Facet Joints

Purposes of the Spine

oProvide mobility

oProvide stability

oProtect the nerves and spinal cord

oAct as a shock absorber

Intervertebral Disc

oPermits free motion

oTransmits shock

Annulus Fibrosis

oConfines the nucleus pulposus

Nucleus Pulposus

oDistributes forces

oActs as a ball bearing

Nerves

oSpinal Cord

oNerve Roots to the arms and hands

Ligaments

Muscles of the Neck

Muscular Pain

oOveruse and Postural Problems:

Long hours and poor posture fatigue muscles which eventually become strained.

oAcute Trauma

Whiplash-type injuries”

Whiplash

oAnnual cost of $29 billion

oHerniation of a degenerated disc occurs frequently without injury

oTwo thousand volunteer collisions have never produced chronic neck pain

oPsychological and social factors create the setting for chronic pain

Disc Problems

oDegenerative Changes

oDiscs lose water content causing tears in the outer annulus and narrowing of the intervertebral space.

oAnnular tears occur frequently without injury or symptoms

oAcute Trauma

Disc Herniation

Arthritis

oJoint deterioration and inflammation related to age, overuse, and injury

Cervical Radiculopathy

Diagnosis

oPatient History

oPhysical Examination

oX-rays

oMRI

oCAT Scan

oMyelography

Patient History

oDoes the pain go down your arms or legs?

oWhat increases/decreases your pain?

oBowel/bladder problems?

Physical Examination

oHow well do you move your neck?

oTenderness/muscle spasm?

oNumbness/Reflexes/Strength

Major Peripheral Nerves

oC-5 Level

oC-6 Level

oC-7 Level

oC-8 Level

oT-1 Level

X-rays

Magnetic Resonance Imaging(MRI)

Computer Assisted Tomography(CAT Scan)

Myelography(Myelogram)

Electromyogram(EMG)

oTesting the speed at which nerve roots send signals.

Treatment

oRelieve Pain

oImprove Function

oReduce the likelihood of re-injury and chronic pain and conditions

Non-surgicalTreatment

oMedications

oCervical Collar

oCervical Pillow

oPhysical Therapy

oCervical Traction

Conservative Treatment

oIn one study, patients who received active treatment in the form of neck exercises within 96 hrs of injury onset fared better in terms of pain and cervical motion than did control patients who were told to rest the neck for 2 weeks.

Common Surgical Procedures

oDiscectomy

oCervical Fusion

oLaminectomy

oEpidural Steroid

Discectomy

oDone for disc herniation

oUsually done along with a single level fusion

oOften done from an anterior approach

oReasonable for a single nerve root compression from a disc herniation

oNon-operative treatment often successful

Cervical Fusion

oDone for degenerative disc disease

oMost degenerative disc disease is asymptomatic

oOften multiple levels are fused

oThe remaining mobile levels are at risk

oDifficult to tell what level is causing symptoms: MRI and Discography

Laminectomy

oDone for spinal stenosis, a degenerative progressive condition

oOften associated with fusion

oNot usually done for traumatic neck pain

Epidural Steroids

oNo value for axial pain

oNo value for degenerative discs

oNo value for uncovertebral osteophytes

oMay help radicular pain from a herniated disc

Cervical Spine Manipulation

oAn aggressive, non-invasive procedure; Potential for serious complications

oRadiculopathy

oMyelopathy

oVertebral artery occlusion - Stroke

oSpinal cord injury

Caring for Your Neck

oPositioning and Posture

oProper Lifting – Not just for your back!

oSimple Exercises

Questions?

Thank you!