Cleveland_Clinic_Host: Neck pain and symptoms caused by cervical (neck) spine disorders are very common among adults. In fact, studies show that nearly 50 percent of adults have evidence of degenerative changes in their cervical spine by age 50. The different parts of the cervical spine, including the muscles, bones, ligaments and joints, are normally well balanced and able to handle the stresses and strains of daily movement. However, when injury to the cervical spine occurs, the neck can be a significant source of pain and discomfort.
Thomas Mroz, MD, a board-certified spine surgeon in the Departments of Orthopaedic Surgery, Neurological Surgery and the Center for Spine Health at Cleveland Clinic chats today about neck pain and treatment options. He specializes in all aspects of spinal surgery, and has a dedicated interest in minimally invasive surgery and cervical spine surgery, including radiculopathy, myelopathy, stenosis, disc herniations, cervical disc replacement, revision cervical surgery, cervical infections, cervical tumors and cervical deformity.
Dr. Mroz graduated from Case Western Reserve University and Case Western Reserve University School of Medicine in Cleveland, Ohio. Thereafter, he completed his residency in orthopaedic surgery at the George Washington University Medical Center in Washington, D.C. Dr. Mroz completed two spine fellowships before joining Cleveland Clinic and is active in clinical research to improve treatments. He has lectured nationally and internationally on minimally invasive surgery and cervical spine surgery. He has also authored numerous research articles and textbook chapters, and serves as a reviewer for several peer-reviewed journals.
He is a member in good standing in the North American Spine Society and the American Academy of Orthopaedic Surgeons, and is a Diplomat of the American Board of Orthopaedic Surgery. He continues to have a very active role in the education of medical students, residents and fellows.
Cleveland_Clinic_Host: Today, join us as Dr. Thomas Mroz discusses a variety of questions regarding neck pain and treatment options. To make an appointment with Dr. Thomas Mroz, or any of our spine specialists within the Center for Spine Health at Cleveland Clinic, call 216.636.5860 or toll-free at 866.588.2264. Visit us online at www.clevelandclinic.org/spine.
Cleveland_Clinic_Host: Welcome to our Online Health Chat with Dr. Thomas Mroz. We are thrilled to have him here today for this chat. Let’s begin with some of the numerous questions we have received.
Causes of Neck Pain
mlp: Can disc issues in cervical and thoracic spine cause ringing in ears, dizziness and vision issues ( ie: black spots)?
Speaker_-_Dr__Thomas_Mroz: NO! These symptoms may be indicative of other issues and need to be addressed with a physical exam by your physician.
sally: What are the possible effects of letting neck pain go untreated?
Speaker_-_Dr__Thomas_Mroz: Neck pain is a common problem, and surgery is not indicated for the treatment of chronic neck pain. If the neck pain is persistent, then consult your physician to ensure it is not due to something serious like a fracture, infection, or tumor. In the absence of the latter, then letting neck pain go untreated is of little consequence. Physical therapy with daily neck exercises and intermittent use of anti-inflammatory medications may be beneficial.
pitterpat: Is it bad to crack your neck? Will that eventually lead to arthritis of the neck?
Speaker_-_Dr__Thomas_Mroz: Painless cracking is nothing to be concerned about. If it is associated with pain, then you should consult a spine specialist for evaluation. There is not evidence to suggest that it will lead to arthritis.
silverbird: Can you have numbness in the bottom of your feet from herniated neck discs & bone spurs?
Speaker_-_Dr__Thomas_Mroz: This is not a typical presentation and likely is not caused by a neck problem. I would recommend seeing a neurologist to determine the cause of the numbness.
FrankieB: I've heard that when a person goes through a cervical fusion there is a high possibility that their adjacent level discs will go bad as well, I read it's called "adjacent level disc disease." Is there a practice or an implant that can help stop or digress "adjacent level disc disease?"
Speaker_-_Dr__Thomas_Mroz: The chance of symptomatic degeneration of adjacent discs following fusion is thought to be 26% in 10 years. Cervical disc replacement was designed to help prevent this problem but the data published to date does not support it. The cervical disc replacements are at best equivalent to fusion at this time.
plat2: What would be the indications of serious neck problems/pain, versus just stress or overuse?
Speaker_-_Dr__Thomas_Mroz: It the pain does not go away in two weeks, or if it is associated with any arm numbness, weakness, tingling or difficulty walking - then you should see your physician. Typically stress or overuse tight discomfort subsides in a matter of days.
Diagnosing Neck Pain
dan111829: I can only turn my neck 45 degrees in either direction. Have not had it looked at. Suggestions?
Speaker_-_Dr__Thomas_Mroz: If you are having trouble turning your neck in either direction dues to stiffness or due to pain, I would recommend seeing a spine specialist for an evaluation.
DeeDee5: I frequently get sharp pain on the right side of my neck. It can last for several minutes, or sometimes just a fleeting pain. I have had this for 4-5 years and the pain comes almost daily. Is this arthritis?
Speaker_-_Dr__Thomas_Mroz: This is likely due to spondylosis which is a medical term for arthritis. If it is persistent as it sounds that it is, I would recommend seeing a spine specialist for an evaluation.
wanca: How do you diagnose neck pain? What kind of doctor should do the diagnosis? My neck movement sounds like glass breaking/crunching. Sometimes it tingles. What does that mean?
Speaker_-_Dr__Thomas_Mroz: Neck pain is diagnosed after careful consideration of the history, physical exam and consideration of the radiographic studies. Painless 'cracking' in the neck is typically not something to be concerned about. Tingling is not a normal symptom and if it is persistent I would recommend an evaluation with a spine specialist.
greg: Are there tests to determine if low back pain is associated with nerves, muscles or skeletal problems?
Speaker_-_Dr__Thomas_Mroz: There is no single test that can differentiate between these 3 things when it comes to lower back pain. Lower back pain is evaluated after careful consideration of the history, physical examination and radiographic studies.
A1N144: What are the treatment options for neck pain? What are the criteria for determining the need for surgery for neck pain?
Speaker_-_Dr__Thomas_Mroz: Generally, surgery for neck pain is not indicated because the results in the literature demonstrate insufficient improvement in outcomes. If the neck pain is severe and persistent, I would recommend seeing a spine specialist.
dsheinman: I have severe cervical osteoarthritis. My doctor wants to do facet injections but I prefer a more conservative approach, i.e.: exercises. I read that facet blocks are not necessarily helpful. Any suggestions? I am a very active person.
Speaker_-_Dr__Thomas_Mroz: Prior to any invasive therapy I would recommend a course of physical therapy with daily exercise and the intermittent use of anti-inflammatory medications.
dale4td: My 78 year old mother suffers from spinal stenosis and is considering an operation called a lumbar laminectomy with transforaminal interbody fusion. Does laser surgery correct this problem and is its success rate higher than traditional surgery?
Speaker_-_Dr__Thomas_Mroz: Laser surgery is not a validated surgery for the treatment of lumbar stenosis. We do not have the literature to support that type of treatment.
mlp: Can craniosacral therapy really help relieve pain from mild-moderate bulging and degenerative discs in both the cervical and thoracic spine?
Speaker_-_Dr__Thomas_Mroz: Craniosacral therapy another type of therapy that is not a validated form of treatment of this problem. We do not have the literature to support that type of treatment.
jj5225: What are your feelings on the X STOP® Procedure for one area of spinal stenosis?
Speaker_-_Dr__Thomas_Mroz: There is mixed data in the literature to support the use of X STOP®. Generally about 76% of patients will improve the X STOP®. We do this procedure on select patients at the Cleveland Clinic.
scoff: Why is it necessary to quit smoking before spine surgery?
Speaker_-_Dr__Thomas_Mroz: Smoking causes fusion surgery to fail because the chemicals that are in inhaled while smoking interfere with bone formation, a necessary part of fusion. Smoking therefore needs to be stopped prior to and after fusion surgery.
bri: After surgery, will there be any activities I have to stay away from?
Speaker_-_Dr__Thomas_Mroz: It depends on the type of surgery that you have had. For most fusion procedures in the neck, patients are maintained in a cervical collar for 6 weeks. We tell patients to avoid driving while wearing a neck collar and to avoid any heavy lifting during the 6 week period.
Radlick: I am recovering from a herniated disc. My right leg was impacted but is now coming around after a 3rd steroid treatment. The numbness in the ankle to knee area is greatly diminished, but my right leg remains weak and somewhat emaciated despite regular exercise. I am counseled to remain patient as the nerve takes time to heal. What is a reasonable time to expect to wait for improvement?
Speaker_-_Dr__Thomas_Mroz: This depends on how severe the nerve injury was. Generally neurologic recovery occurs on the order of several months up to 1-2 years. I would recommend continuing to do the exercises daily to optimize the strength.
mitch: The rehab after surgery says it may take several months to several years. During this time may I return to work?
Speaker_-_Dr__Thomas_Mroz: Yes, you can return to work as soon as your physician clears you to do so. This typically will occur in 4-6 weeks, but this will vary depending on several factors. These factors may include the type and extent of surgery that you have had. It truly varies for each individual patient.
salvo: Is there any risk of nerve damage after cervical spine surgery?
Speaker_-_Dr__Thomas_Mroz: Nerve damage during surgery is vary rare, and occurs less than 1% of the time.
costalot: After researching Cleveland Clinics web site, I learned that the risks of surgery for a degenerative neck condition include nerve injury, infection, bleeding, and stiffness. How likely am I to experience these symptoms?
Speaker_-_Dr__Thomas_Mroz: Nerve injury from neck surgery is rare and occurs in less than 1% of patients. Excessive bleeding is also a rare problem. Infection from anterior neck surgery is less than 1% and from posterior surgery is approximately 4%. Stiffness may occur after surgery and it depends on how many levels are involved and how many levels are fused, and what type of procedure is performed.
highanddry: I am pregnant and experiencing severe neck pain, what are my treatment options?
Speaker_-_Dr__Thomas_Mroz: Physical therapy and daily exercises may be helpful. Anti-inflammatory medications or analgesics may also help, but you should consult your Obstetrician to determine which medications are safe to use.
betsy: I am experiencing severe neck pain. Due to the recent findings in acetaminophen (Tylenol) how many tablets should I take per day, I am an adult female.
Speaker_-_Dr__Thomas_Mroz: You can take up to 2600 mg per day. Anti-inflammatory medications may also be helpful for your neck pain.
needalot: Will local injections of cortisone reduce the pain I feel in my neck? Will it cause bone to deteriorate?
Speaker_-_Dr__Thomas_Mroz: Local injections are not associated with osteoporosis. The literature on local steroid injections for neck pain has mixed results.
superdad: I have heard that chiropractic therapy can sometimes help low back pain. As a person with severe arthritis in my neck and chronic pain, would chiropractic therapy be beneficial for me? How helpful is massage therapy?
Speaker_-_Dr__Thomas_Mroz: Chiropractic therapy has been shown to be effective for acute low back pain; however its benefit for chronic back pain sufferers is not well established. For severe arthritis in the neck, it may be helpful but there is not much literature to support it. Also, if the arthritis is associated with cervical stenosis, I would recommend not having any manipulation of the neck. Massage therapy is fine if it provides relief of pain, but there is no literature to support it.
superdad: What is the role of biofeedback in pain control and how does it work? Are there trigger points in the neck? Would acupuncture have a role in pain management?
Speaker_-_Dr__Thomas_Mroz: The role of biofeedback is best addressed with a medical spine specialist as is the role of acupuncture and trigger point injection. I would recommend seeing Dr. Daniel Mazanec at Cleveland Clinic.
superdad: I have knots and arthritis in my neck. Is massage ever covered by Medicare or other insurance? Is that the best treatment? Traction and ultrasound did not work.
Speaker_-_Dr__Thomas_Mroz: Again - an evaluation with Dr. Mazanec would be best to determine these answers.
greg: Dr. Mroz, what type of cervical fixation do you believe in and why?
Speaker_-_Dr__Thomas_Mroz: There are various types of cervical fixation devices and the choice of which device is used depends on several factors. Consideration must be given to the type of surgery being performed, the objectives of the surgery and the region of the cervical spine being addressed.
calla: If you end up getting a cervical (neck) fusion due to arthritis, does this mean that when you need to turn and look at something you will need to turn your entire body? It just would look so unnatural. Are there any other treatment options besides fusion?
Speaker_-_Dr__Thomas_Mroz: The extent of loss of cervical motion is entirely dependent on the number of levels fused. For 1-3 level fusions patients do not need to turn their whole body to look at something. For degenerative single level disease an alternative to fusion is an artificial disc replacement.
hobbybobby: For neck pain, what is better to apply, cold or heat?
Speaker_-_Dr__Thomas_Mroz: It does not make any difference - whatever makes it feel better.
Erik: What type of neck procedures do you perform?
Speaker_-_Dr__Thomas_Mroz: There are anterior procedures (access through the front of the neck) done which would include Discectomy and fusion, Corpectomy, tumor resections, total disc replacement and surgeries for infection. Posterior procedures include Laminectomy and fusion, Laminoplasty and Foraminotomy.
countdown: Could you please talk about cervical epidurals?
Speaker_-_Dr__Thomas_Mroz: The evidence related to cervical epidural injections is mixed. They are useful, I think, for the treatment and diagnosis of Cervical Radiculopathy (inflamed nerve.)
how815: What is the purpose of electrical stimulation in the neck for pain?
Speaker_-_Dr__Thomas_Mroz: Typically, this form of treatment is used for patients who have not responded to any form of other traditional therapies. Its benefit for chronic back pain is controversial.
newtonm: What is the role of physical therapy in the treatment of neck pain?
Speaker_-_Dr__Thomas_Mroz: Physical therapy has a well established role for patients who have neck pain. The goals of physical therapy are to increase range of motion, increase neck muscle strength and flexibility and reduce pain. It is very important to maintain the daily exercise on your own once the therapy ends.
Research and Clinical Trials
nystrom: Are there any types of new treatments being developed?
Speaker_-_Dr__Thomas_Mroz: At the Cleveland Clinic we have finished reviewing data on a new form of Laminoplasty that preserves all normal anatomy. The results demonstrate that patients maintain their range of motion and alignment.
We are also evaluating the role of stem cells for cervical fusion.
Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Mroz is now over. Thank you again Dr. Mroz for taking the time to answer our questions about neck pain and treatment options today.
Speaker_-_Dr__Thomas_Mroz: Thanks for submitting all of your questions. We are happy to evaluate any cervical issues. Feel free to contact my office with any questions.
- For more information about the Center for Spine Health at Cleveland Clinic, call 216.636.5860 or toll-free at 866.588.2264. Visit us online at www.clevelandclinic.org/spine.
- To make an appointment with Dr. Mroz , or our Center for Spine Health at Cleveland Clinic, call 216.636.5860 or toll-free at 866.588.2264. Visit us online at www.clevelandclinic.org/spine.
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This chat occurred on July 10, 2009.
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