Written by Michael J. Musacchio, Jr., M.D.
For those of us who follow professional football, a lot of attention has been directed to Indianapolis Colts’ quarterback Peyton Manning and his recent neck surgeries. While we at the Center for Spine Care are not at all involved in Peyton Manning’s surgery, we certainly have a lot of patients who suffer from similar neck conditions and think this is a great time to share some general thoughts on neck injuries and treatment options.
Similar to the low back, the neck is subject to repetitive motion and trauma that lead to aging and wear and tear. The aging process may be accelerated in athletes or other activities that involve excessive physical strain. Wear and tear makes the spine and its components more susceptible to injury, and patients can develop significant neck pain or radiating nerve pain as a result. This may present as general aches and pains or more specific radiating nerve pain and deficits, particularly in the arms and hands.
When these symptoms become severe or persistent, an evaluation by a spine specialist can help determine the problem and the treatment options. Fortunately, up to 90% of neck and arm pain will be self-limited and improve without surgery. Physical therapy and anti-inflammatory medications and injections can sometimes make the recovery period more tolerable.
Surgery is typically reserved for one of 4 scenarios:
- Patients who fail to respond to a 6-8 week course of conservative management.
- Presence of severe or progressive neurologic deficit, such as weakness or sensory loss.
- Severe, intolerable pain that does not respond to initial treatment measures.
- Severe pathology, such as large herniated discs or unstable fractures that threaten neurologic function.
For patients requiring surgery, there are a few options that may be considered. For isolated arm pain that has a distinct disc or bone spur impingement, it may be possible to pursue a minimally invasive posterior decompression that can be done as an outpatient and does not involve fusion. The main advantage of this approach is to decompress the pinched nerve while maintaining the patient’s normal motion to enable quicker return to sports and activities.
Other times, an anterior disc removal and fusion or artificial disc replacement procedure may be required to restore normal alignment in addition to freeing the nerve. Anterior and posterior approaches carry similar clinical effectiveness. However, fusion surgeries tend to delay return to sports and activities longer than minimally invasive posterior decompression.
Rarely will a minimally invasive decompression fail and require subsequent fusion. This is likely the case with Payton Manning, but a full recovery and return to activity after an appropriate course of physical therapy and rehabilitation is typically the norm.Michael J. Musacchio, Jr., M.D. is a Center for Spine Care minimally invasive neurosurgeon specializing in the spine.
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