Many folks who log on to our web site write us because they’re concerned that the development of chronic neck pain seems to affect their general quality of life. This correlation is intuitively obvious since anyone who has chronic pain would by the nature of that pain have an overall sense that the quality of their life is less than it should be.
This association was recently documented in a very interesting study by Nolet and associates from the Department of Health at the University of Alberta, Canada and Lakehead University in Ontario, Canada. The primary authors were chiropractors who routinely work with the patients with neck pain.
This study included 1100 randomly sampled Saskatchewan adults with new onset of neck pain. When participants were interviewed six months after the onset of neck pain and asked to take a test called the health-related quality of life test (HRQoL), it did in fact document that chronic neck pain is a predictor of poor physical quality of life. This study was published in the Spine Journal this year (2015).
Anterior cervical discectomy and fusion (ACDF) is popularly regarded as one of the most successful surgeries performed on the spine. You can learn a great deal about this procedure by watching this video from my partner, Dr. Seth Neubardt.
ACDF demonstrates not only a high success rate in improving preoperative symptoms but also has a very favorable safety/complication profile. Patients tend to tolerate the procedure well with relatively little postoperative pain and increased mobility when compared with some other commonly performed spinal operations. In an important article in a recent issue of Spine Journal, Dr. Burneikiene and associates asked and attempted to answer an important question: Is there an optimal timing to further perform surgery?
The findings of this study are instructive and important for Dr. Neubardt and myself as we routinely care for patients with this diagnosis.
That study suggests that patients who have surgery within six months of the symptom onset were associated with much better relief of their radicular, i.e. arm pain, but there was not a significant difference in the resolution or diminution in their neck pain. The criticism of this study is clear in that they did not distinguish between patients who had pure radicular, i.e. arm pain and those who had arm pain with neck pain or those who had neck pain alone.
Our suspicion is that those patients with true radicular symptoms will do best with earlier surgery, particularly if they develop evidence of weakness or loss of sensation or the pain is of such severity that it has limited their ability to function.
Patients who present with cervical myelopathy, in the context of multiple sclerosis, may have overlapping symptoms that result from or are accentuated by both conditions. In fact, I recently had such a patient in my office and the question arose as to what is the impact of surgical intervention and the prognosis for meaningful recovery among individuals with concurrent multiple sclerosis and cervical myelopathy. Unfortunately this data is not well known.
A recent article by Daniel Lubelski and associates published in The Spine Journal discussed just this problem. They followed 48 patients over a 15-year period and unfortunately the majority of patients who had surgery demonstrated no significant improvement in a variety of long-term scores.
Dr. Neubardt and I discussed this issue and it is our goal to better understand the occasional patient who has cervical myelopathy with both these diagnoses in the hopes of helping patients improve their symptoms.