Ask the Expert: Dr. Alexander Hughes, Orthopedic Surgeon, Answers Your Questions on Cervical Spine Conditions
Q1. What’s the best position to sleep in if you have neck problems? Is your back, side, or stomach better, or is any position fine so long as your head is supported and your spine is neutral?
As a general rule, the best position for sleeping to avoid neck pain (or exacerbating neck) is a ‘neutral’ position. In this position biomechanical stresses are at their lowest. This has been associated with a lower incidence of waking headache and/or neck pain. That can be achieved sleeping face down, up, or on one’s side. There are many different factors in determining a neutral position for each person. Body dimensions and sleep position enter into the equation. For instance, for an individual with wide shoulders a more sustentative pillow would be required to achieve neutral.
Q2. If you have a herniated cervical disc that needs surgery (after trying all conservative treatments), how would you choose between the anterior cervical discectomy and fusion and the posterior microdiscectomy? Is one procedure/approach better than the other? How would you know which of these operations would work best for your herniated disc?
There are a multitude of factors that enter into the equation to make this decision. Factors such as overall level of degeneration of the cervical spine, presence of instability, presence of neck pain along with arm pain, lateral alignment of cervical spine, level of herniated disc, duration of symptoms/ age of herniated disc, morphology of herniated disc (e.g., location, size, presence of calcifications) among many other things determine recommending an anterior versus posterior approach. The decision making process is tailored to the specifics of the individual patient and requires an in depth conversation with your treating surgeon.
Q3. I have two slipped discs in my neck and it was suggested that surgery would be the most likely option to ease the problem; is there any other form of therapy that could be tried or a possible option before resorting to surgery?
To answer this question depends on the intended meaning of ‘slipped discs’. I’ve heard patients refer to herniated discs and instability as ‘slipped discs.’ In the case of herniated discs without instability (abnormal motion with flexion or extension of the neck) and without neurologic deficit (for instance weakness in the arm) symptoms tend to get better over time. Once patients have plateau’d or cannot tolerate the symptoms surgery can be an option. In the setting of instability, symptoms can be progressive and may require surgical intervention earlier. In either case, when neurologic symptoms are present (e.g., difficulty walking, weakness, or bowel/ bladder dysfunction) typically surgery is recommended immediately. For pain-only syndromes of the cervical spine associated with disc degeneration, conservative modalities should be exhausted. Examples include activity modification, physical therapy, gentle massage, and sometimes acupuncture. Steroid injections inside the cervical spinal canal are controversial and require individualized decision making.
Q4. My wrists have been bothering me and all this time I thought it was carpal tunnel syndrome after being a court reporter for so many years. Friends have been pushing me to get it checked out since carpal tunnel can be confused with a cervical spine issue – is this true?
That is true. Peripheral neuropathy (dysfunction of nerves outside of the spine) can often overlap in symptoms with cervical radiculopathy (pinched nerve in the cervical spine). One of the most common overlaps is carpal tunnel syndrome and C6 radiculopathy. Likewise capital tunnel syndrome (entrapment of the ulnar nerve at the elbow) can overlap with a C7 or C8 radiculopathy. If there is clinical concern about any of these overlapping entities (in other words, it can’t be distinguished on history and physical exam), an EMG/ NCS test can be helpful.
Q5. I’ve been told I have a herniated disc (L5). I’ve been doing physical therapy for pain management but it doesn’t seem to be making much difference. Are there other options? Does it differ cervical to lumbar?
As long as a herniated disc presents as a pain syndrome only and not with neurologic deficit, patients and their treating physicians have time to try conservative (non-surgery) interventions to seek relief of symptoms. Non-operative options for herniated disc include physical therapy, oral anti-inflammatory medications, oral steroid medications, injections of steroids into the spine, massage, and others. These modalities borrow time with usually short term symptomatic treatment as the body resorbs the herniation slowly over time. Cervical spine disc herniations without neurologic deficit are similar, but epidural steroids (injections of steroids into the spinal canal) are controversial.
Q6. I have pain in my neck and in between my shoulders that tends to act up when the humidity kicks in. I think its whiplash from a car accident a few years back. Sometimes I feel pain radiating up, down and in my arms – could it be something worse? Not sure if the arm pain could be related to the spine but it happens at the same time.
When someone experiences radiating pain from the spine into the scapula, shoulders, and arms, the cervical spine may very well be the culprit. This is especially true following any cervical spine trauma. If the symptoms are intrusive, worsening, or interfering with activities of daily living, then this should certainly be evaluated formally. Furthermore, dangerous narrowing around the spinal cord can sometimes be present and should be professionally evaluated.