Neck Pain and Cervical Radiculopathy

Dr. Felix Roque, is a specialist in pain management, director of the department of pain management at Saint Mary’s hospital, scientific advisor for Vida Medical Center, lecturer and educator of other physicians nationally and internationally and companies about their innovative techniques; specializes in spinal surgical procedures and minimally invasive laser surgery for the treatment of diseases of the spine and their triggering pain.

This is a summary of a recent Dr. Roque’s conference in reference to the new techniques which have changed and revolutionized the treatment of neck pain and low back pain.
 
“Two-thirds of the population have neck pain at some point in their lives
and affects about 330 million people globally.”
 

neck painNeck pain (or cervicalgia) is one of the most common medical problems, with two-thirds of the population having neck pain at some point in their lives. It has been estimated that neck pain affects about 330 million people globally as of 2010 (4.9% of the population). It is more common in women (5.7%) than men (3.9%).
Neck pain, although felt in the neck, can be caused by numerous other spinal problems. Neck pain may arise due to muscular tightness in both the neck and upper back, or/and pinching of the nerves emanating from the cervical vertebrae. Joint disruption in the neck creates pain, as does joint disruption in the upper back. It is in the setting of the pinching of the nerves that the term Cervical radiculopathy is derived and in definition, it is a damage to nerve roots that is caused by inflammation and compression of cervical nerves located in the neck area. Patients suffering from this condition generally experience pain in the neck and upper extremities, along with motor problems, muscle weakness, a loss of sensation in different upper body regions, and numbness and tingling of the hands, fingers, or skin. Regions in which pain is typically felt in addition to the neck include the arms, chest, shoulders, and upper back.

Initial forms of treatment typically involve a combination of physical therapy and pain-relieving medication, such as anti-inflammatory medicine (e.g., oral or injected steroids) or non-steroidal pain medicine (NSAIDs). If chronic pain is present due to significant compression of the nerves, more intensive procedures such as steroid injectionsCervical facet medial nerve radiofrequency ablation, Laser Discetomies, and/or nerve blocks may be recommended.  

 What are the Causes of Cervical Radiculopathy?


cervical radiculopathyOne of the most common conditions that cause cervical radiculopathy is cervical disc herniation. However, there are additional causes such as spinal disc degeneration (e.g., spondylarthrosis), arthritis, nerve injuries, and ruptured discs, cervical facet disorders, as well as tumors and spinal infections, which are the least common causes. Smoking has even been indicated as a potential risk factor for cervical radiculopathy.
Diagnosis of this condition can be determined by several methods such as magnetic resonance imaging (MRI) and electromyography, which helps clinicians rule out other potential problems. Tests such as the shoulder abduction test (SAT), the Spurling test (ST), and the upper limb tension test (ULTT) are also being increasingly used to diagnose cervical radiculopathy. These tests are used to evaluate nerve root pain.
Some of the most common causes of Cervical Radiculopathy are stress, fatigue or lack of sleep, hormones, food, medical problems, and trauma.
    

What is the Treatment for Cervical Radiculopathy?

epidural

 The most common forms of treatment for cervical radiculopathy include:

    • Opioids
    • Nerve block
    • Laser Disc Surgery (Performed for a Herniated Disc)
    • Laminectomy (Commonly Performed for Spinal Stenosis)
Opioids are pain-relieving medications such as morphine, oxycodone, and codeine that are stronger than pain medications such as ibuprofen or acetaminophen. If the pain and inflammation that is caused by cervical radiculopathy becomes chronic or is unresponsive to high doses and even prescription strength doses of ibuprofen or acetaminophen, opioids may be prescribed instead.
Opioid treatment is generally short-term as prolonged consumption may lead to dependence, drug abuse, or even overdose. Furthermore, the administration of opioids is closely monitored, and different treatment options are recommended if pain continues to reemerge during opioid treatment.

The cervical steroid infiltrations and epidural steroid infiltrations are similar techniques that involve using a needle to inject medication into the region where affected nerve roots are located. For a cervical injection, medication is administered between vertebrae in the neck region, while medication can be administered in different locations for epidural injections, such as through the middle of the back, the lower back, and the side of the spinal vertebrae. Both procedures entail injecting a steroid that reduces inflammation, and an anesthetic that leads to the reduction or elimination of pain.

These are brief procedures and some patients have reported experiencing immediate pain relief. It can also be repeated if necessary to improve the treatment outcome. The risks associated with steroid injections are minimal and include nerve injuries from the injection, minor bleeding, infection, and headaches. Side effects from the medication that is injected may also occur. The placement of the needle is typically visualized through imaging techniques such as fluoroscopy which minimizes the risk of injuries.

A nerve block is also similar to a steroid injection, in that it involves the insertion of a needle into regions where affected nerve roots are located to administer medication. However, in addition to injecting a steroid and anesthetic, an agent that disintegrates nerve tissue in the affected area may be administered to alleviate pain. This is a more long-term form of treatment. Risks involved with a nerve block include possible injury to arteries, veins, or nerve roots during needle insertion, but using imaging techniques such as fluoroscopy, ultrasound, or computed tomography (CT) during needle placement greatly reduces this risk.

Laser Disc Surgery (Performed for a Herniated Disc): Additional medical advances over the years have led to the use of lasers to perform surgery on patients who have herniated discs that are causing low back and leg pain. During laser surgery, a needle is inserted into the affected disc and several bursts of laser-generated heat are induced to vaporize the tissue in the disc. This procedure reduces the size of the disc, thereby relieving pressure on the nerves. Many patients who undergo laser surgery can return to their normal activities within three to five days after the laser surgery, but significant pain relief may not become apparent until several weeks or even months following the surgery.

facetendo

Patients who do not find conservative therapies effective may discover radiofrequency ablation (RFA) to provide significant relief. Radiofrequency ablation is the removal of the posterior nerve roots that are delivering the pain to the facet joints, which results in pain relief. Since the peripheral nerves are unable to regenerate, radiofrequency ablation is not a permanent treatment solution.

inj facets

 

Laminectomy (Commonly Performed for Spinal Stenosis): A laminectomy, also called a decompression laminectomy, is one of the most common surgical procedures that is performed to treat spinal stenosis. Similar to a foraminotomy, a laminectomy involves relieving pressure on the spinal cord and spinal nerves that may have been caused by age-related changes, trauma, or an infection. A laminectomy is different from a foraminotomy in that a large incision is made in order to remove the back portions of vertebrae (lamina) that cover the spinal cord, in addition to ligaments and bone spurs, which are extra bone fragments that form when the spine tries to repair itself. A laminectomy widens the spinal canal, thereby relieving pressure on nerves and is typically performed in conjunction with a spinal fusion. If both procedures need to be performed, a short hospital stay will be required, and physicians normally recommend physical therapy afterward to help the individual regain mobility and strength. Surgery for spinal stenoses, such as a laminectomy or foraminotomy, typically provides significant pain relief, and patients typically report a dramatic improvement within three months of the surgery. In addition, the pain relief usually lasts for up to four years, and in some cases, between eight to ten years.



Conclusion and Summary

neckfacet

Cervical radiculopathy is nerve root damage that is the result of inflamed and compressed cervical nerves in the neck region. This condition can cause pain in the arms, chest, shoulders, and upper back as well as motor problems, muscle weakness, a loss of sensation, and numbness or tingling in these regions. Typical causes of cervical radiculopathy include cervical disc herniation, spinal disc degeneration (e.g., spondylarthrosis), arthritis, nerve injuries, ruptured discs, tumors, spinal infections, and even smoking.

Initial treatment usually involves anti-inflammatory medicine or injections, non-steroidal pain medicine, and physical therapy. Chronic symptoms and pain that does not decrease in response to initial treatment may be subsequently treated through the short-term use of opioids and procedures such as a cervical or epidural steroid injection or a nerve block. Steroid injections and nerve blocks are brief procedures that quickly reduce pain, can be repeated if necessary, and generally produce long-term results.

If you or someone close to you suffers from neck pain or low back pain that negatively interferes with the physical emotional, socio-labor and family sphere, consult us in our pain clinic to offer you the most advanced medical treatments such as image-guided injection technology for the relief and pain management of your neck pain or low back pain; that you can recover the optimal physical and functional abilities quickly, allowing you reintegrate with all enjoyable experiences and your socio-occupational life.

Dr. Roque has a vast and extensive experience in the mentioned field; In addition, the Center for Pain Management, located at 543 45th St. Union City NJ - Telephone 201-766-6469 - is fully equipped with innovative cutting-edge equipment and technology required to practice this type of procedures safely and effectively

 

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