New England Spine Care

Your spine is divided into four major sections.  Your neck (cervical spine), mid back (thoracic spine). Lower back (Lumbar spine) and the sacral /coccyx region.  Each segment is constructed from bones, discs, supporting muscles, and tendons. Your spinal cord travels through the bony tunnel within the vertebrae and exits on either side from the space in between the vertebrae.

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Neck pain is common in almost all age groups, but the reason for pain varies from person to person.  In some, it is related to a natural aging process of the discs or the joints (facets).  In others, it is associated with a work injury, car accident, fall, sports injury, or repetitive stress from specific activities such as sports. Forcefully stretched ligament or  muscles results in strain.  Good stretching and warm-up before explosive sports such as weightlifting or CrossFit reduce the risk.

 

Below we discussed some of the common causes of back pain.

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Neck strain / Myofascial Neck Pain

Strained muscles are painful. The area of neck pain may swell, and you may notice muscle contraction/spasm and reduced range of motion (stiffness). This is a clinical diagnosis, and no imaging is necessary.  Most muscle strains are self-limiting, and the symptom will go away within several days. You may have to ice the area, take ibuprofen/Tylenol or apply Benngay for the pain to subside. If you see a specialist for this, your spine doctor will prescribe Physical Therapy and may advise Trigger Point injections or acupuncture and topical medication to resolve the symptoms.

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FACET JOIN-NECK PAIN 

Every two adjacent vertebrae will connect with pair of Facet Joints .  There is one facet to the left of the center, and one facet is to the right of the center at each segment of your neck.  When you bend forward or extend and rotate your neck, your facet joint allows for that motion.  The facet joints can become painful due to aging (arthritis)  or injury (fall, work injury, whiplash injury, …).Facet pain is triggered by  twisting and turning the neck, particularly extending (looking up) or turning/tilting the neck to the affected side. Neck pain from facets is often steady and moderately painful. Symptoms may fluctuate

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Diagnosis: 

Your spine doctor will combine history, physical exam, and imaging for diagnosis. The initial test is an X-ray, but MRI may become necessary if physical therapy is not helpful. The most accurate diagnosis is made by injecting anesthetic into the facet joint or the nerve adjacent to it (Medial Branch Nerve )

 

Treatment:

Conservative care:   Physical therapy and anti-inflammatory medications are the starting point for treatment.  Some patients benefit from chiropractic adjustments and soft tissue massage.  

 

Procedures:

If the pain does not subside, facet joint steroid injection (Cervical Facet Injection) , facet joint medial branch RF ablation  (Cervical MBB/RF​), and facet joint PRP injection can be offered.  The outcome of the facet treatments is often satisfactory, with reduced pain and improved function.    Surgery is not indicated for facet-generated pain

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DISCOGENIC NECK PAIN

Discs separate adjacent vertebral bodies.  It allows you to move your spine in every direction, particularly bending forward, and they function as shock absorbers.  We need healthy disks to be able to move freely.    Over time: Discs become dehydrated and are more prone to small tears and herniation.  As a result, it could be a source of neck pain with or without arm pain. Degenerated or desiccated discs can result in stiffness, pain, and inability to do daily activities. Neck pain from the Disc is called "Discogenic."  Discogenic pain is approximately 40% of all spinal pains. The first episode of Discogenic pain is often memorable, severe, associated with a bending-lifting injury (for example, moving furniture), and may land the patient in the ER.  Primarily because of pain, you may not be able to function, bend to brush your teeth, work on the computer, and may feel worse with coughing and sneezing.  It takes several days for this acute phase to subside, but it may recur and become episodic.  

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Diagnosis

The initial diagnostic test is X-rays, but in persistent cases, MRI is ordered (gold standard) . Physical examination help with diagnosis and also determines if there could be another source of pain besides the discs. A neurologic exam may reveal numbness or weakness, which could point to degenerative disc disease

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Conservative Care

Improving lifting techniques, throwing mechanics (in athletes), and ergonomics (bed surfaces, pillow, desk setup) are key to prevention and successful treatment.  Physical therapy, Neck muscle strengthening, and NSAIDs are the first line of treatment.  Sometimes a soft color can help during the acute phase.  Soft tissue treatments such as acupuncture, trigger point injection, and therapeutic messages can help with associated muscular pain.

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Procedures:

Discovering pain can be challenging to treat, but some procedures can be helpful such as  Trigger point injection, Cervical Epidural injection. Chronic cases may need Surgery (ACDF), but before that, other sources are pain such as Facet joints should be ruled out by Cervical MBB

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CERVICAL SPINAL STENOSIS

Narrowing in your spinal column is called spinal stenosis.  Cervical Spinal stenosis may be due to herniated Disc, facet joint arthritis, uncovertebral arthritis (only in neck) and malalighment such as spondylolisthesis.

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Symptoms

Spinal stenosis in your neck may lead to neck pain, arm pain, numbness/tingling, and poor balance. In severe cases, cervical spinal stenosis may lead to clumsy hands, poor dextrretity, and weakness due to cord compression ( myelopathy). Myelopathy may cause falling, injury, and loss of function and needs to be evaluated by a spine specialist.

 

Diagnosis:

Cervical Spinal stenosis may be due to herniated discs, facet joint arthritis, uncovertebral arthritis (only in the neck), and malalignment such as spondylolisthesis. A physical examination combined with an MRI will confirm the diagnosis. In rare cases, your spine specialist may order an EMG to differentiate the causes of arm pain/numbness

 

Treatment:

Conservative care includes physical therapy to strengthen, balance training, home safety evaluation, and evaluation for using a cane or walker. 6 weeks of physical therapy is often adequate. Physical therapy is not prescribed for pain relief, but patients often report pain relief while going through PT

 

Procedures

Cervical Epidural Injection  can help with pain and improve function. It is a pain management treatment. Contrary to the lumbar spine, minimally invasive treatments such as MILD are not designed for  

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Surgery:

Laminoplasty and ACDF are surgical options reserved for Cervical Spinal stenosis with progressive loss of function or in resistant cases to conservative care and injections.

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Cervical Post Laminectomy Syndrome 
Unfortunate outcome of back surgery can be failed back syndrome (post laminectomy syndrome).  It means that patient has persistent Neckpain or armpain despite excellent surgical care.  Exact reason for this is not very well-known but it can be contributed to scarring in the surgical area.  Patients are often challenged by chronic pain .  FBS It is difficult condition to treat.

 

Failed back syndromeis clinicaly diagnosed by your spine specialist , and he/she may consider physical therapy, and medication management as the primary way of treating this condition.  To improve neckpain, some patients may benefit from procedural treatment which includes Cervical RF ablation.  In rare cases, epidural injection, and epidural lysis of adhesions may be effective in reducing pain. Neuromodulation such as a spinal cord stimulator is an option for treatment with reasonable success.

To read more about the back pain choose one of the following to explore:
1.  Spinal stenosis
2.  Myofascial pain
3.  Laminectomy
4.  Failed back syndrome
5.  Spinal cord stimulator

6.  Cervical Epidural Injection

7.  Cervical MBB/RF

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