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.
Is there a role for discography? One of the issues that comes up quite frequently is whether patients can be selected for cervical fusion or for artificial disc based on discography.
Discography is a procedure where a needle is inserted into the disc space and two things are evaluated.
1. Does the injection recreate the patient’s normal neck pain?
2. After the injection, with just using a dye, a CAT scan is done to see where the dye went giving an indication of whether the fibers in the disc material itself are torn.
The reasoning here is that when liquid dye under a little bit of pressure is injected into a the disc that is causing pain, it will recreate that pain. Likewise, if injected into a disc that is not intrinsically painful, the injection will not cause pain.
This topic is very controversial. So to answer the question, Dr. Randhawa and Dr. Raab reviewed the subject matter in the July-August issue of SpineLine, a journal where I had been until recently one of the editors. It is published by the North American Spine Society.
The conclusion is really quite interesting and states that the available evidence supporting cervical discography remains controversial and limited.
On the basis of their review of the available evidence, they conclude that routine use of cervical discography as a tool for recommending anterior cervical discectomy and fusion or an artificial disc in those patients with chronic neck pain may not be warranted particularly in those patients with normal imaging and no neurological deficit.
So, if your physician is recommending that you have a cervical discogram, I suggest that you discuss this SpineLine article and the results I discussed with your surgeon.
Jack Stern, M.D., Ph.D., F.A.C.S.