Ask the Expert: Dr. Alexander Hughes, Orthopedic Surgeon, Answers Your Questions on Cervical Spine Conditions

by Dr. Alexander Hughes
Dr. Alexander Hughes, Spine Surgeon

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.

Topics: Facebook Notes, Orthopedics
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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

Brad Morris says:

I have a question. I had a ime for a work injury for my neck and shoulder. I had my own MRI done and the doctor they sent me to was only certified to be a knee and hip orthropedic doctor at his office. He said nothing was wrong after looking at my MRI I had done. I got my own doctors look at it an it had tons of stuff. Spinal Ostenosis herniated disc athritus all of these at multiple disc levels. The fake hip and knee so called neuro surgeon he claimed to be did a emg test. He said my emg is fine and like I said to him all my left side is screwed. And he said the result for neck and left shoulder are fine. I looked at his result and all my readings for my left side are much lower to a result of lifting all left handed and not able to you my right side cause I had a cast on my right hand. I couldn”t. Alance my self lifting stuff and not being able to support my weight with my right side cause the cast. He told me it was peripheral N europathy only. but it”s only effecting my left side. My question is wouldn”t peripheral neuropathy effect both sides equally and wouldn”t it be considered cervical radiculopathy which he wouldn”t considered it cause he is lying for my company and saying nothing is wrong with my spine? Cause I”ve had 8 actual spine and shoulder doctors all agree I have problems. So again question is does peripheral neuropathy affect both arms equally? Thank you for any response my email is pmorris33@hotmail.com

HSS on the Move says:

Hi Brad, thank you for your question. It is difficult for a physician to provide a response to your question without seeing you in person. We recommend that you see a neurologist for an evaluation. To make an appointment, please call Physician Referral Service at 877-606-1555 or visit them online at https://www.hss.edu/secure/prs-appointment-request.asp

Zulema Landenberger says:

Can I simply say what a relief to discover somebody who actually understands what they””re discussing on the net. You actually understand how to bring a problem to light and make it important. More and more people really need to check this out and understand this side of the story. I was surprised you are not more popular since you most certainly possess the gift.

HSS on the Move says:

We”re thrilled you found this so helpful and hope you”ll keep coming back for more perspective. Thanks so much!

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The NHL playoffs are underway, and having a strong abdominal and core muscle strength is important for keeping players in top form. Gregory Reinhardt, HSS Physical Therapist, says: "While skating, the activation of a hockey player's oblique muscles is crucial for their ability to constantly push off from their skates." To read more about core strength for hockey players, visit http://hss.edu/onthemove/core-strength-for-hockey-players/.

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