Neck pain is second only to lower back pain as the most common musculoskeletal disorder. Recent surveys indicate that as much as 18% of the general population experience chronic neck pain. Fortunately, there is strong new evidence that more aggressive non-surgical therapies, in particular, radiographically guided injections using ultrasound and fluoroscopic imaging, can effectively treat many forms of severe neck pain.
Many individuals with neck pain will develop “cervical radiculopathy.” A nerve branch or “root” is compressed or pinched as it exits the cervical vertebral column.
“The cause can be either a sudden protrusion or pimple of a cervical disc, or simply inflammation and swelling of the nerve root in a narrowed exit hole of the spine called the intervertebral foramen”, says Dr. Alex Simotas, department of physiatry at the Hospital for Special Surgery in New York City who specializes in neck pain.
He further adds that “in both situations the individual may experience neck pain extending down the arm, often into the hand, along with numbness and often weakness of the arm.” Sometimes the symptoms will resolve rapidly using a combination of anti-inflammatory medications and immobilization of the neck with a cervical brace or collar. Other patients may respond to gentle intermittent traction on the neck by a medical professional or self-administered traction with a take home device.
New studies suggest that even patients who have not responded to initial therapies may respond to the use of x-ray (fluoroscopically or ultrasound guided) transforaminal epidural steroid injections. Simotas further comments that “some investigators believe initial treatments often fail in patients with cervical radiculopathy because adequate doses of anti-inflammatory medications cannot reach the compressed area of inflammation around the nerve.” Under careful monitoring and x-ray imaging a needle is directed into the troubled narrow spot of the spine. Radiographic contrast can be used to verify a safe and effective placement of medication. A concentrated steroid solution serving as a powerful anti-inflammatory is injected and the patient is sent home within hours of the procedure. Most patients will experience a sudden dramatic relief and improvement of their condition. As many as 80% seem to respond with one or two treatments and avoid unnecessary surgery.
Many neck pain sufferers do not have “radiculopathy.” The cause of their pain may be attributed to strained muscles, ligaments, or simply “cervical arthritis.” “When these patients fail to respond to initial therapies, surgical treatment is rarely advised since successful outcomes are difficult to predict”, says Dr. Simotas. Guided cervical facet injections can provide significant relief of recalcitrant neck pain. The physician will place needles into small joints between the vertebrae known as facet joints. Relief is provided by administering small doses of a corticosteroid solution in carefully selected facet joints. For some patients, such therapy is adequate to bring about complete recovery. Some more severe presentations may not respond to initial therapies and surgical treatments will be advised. Dr. Simotas remarks that “while a variety of techniques and approaches are available, the goal of surgical therapies is to alleviate the condition by decompressing the nerve at the site of impingement”.