• What causes neck pain?
• When do I need surgery?
• Why is surgery often done through the front of the neck?

• Does whiplash cause herniated discs?
• Should I have an MRI if I have pain?
• What can I do to avoid surgery?

What causes neck pain?

A variety of factors come into play when trying to clarify the cause of neck pain. The cause of neck pain may be as benign as a cervical strain or whiplash injury or as severe as a fracture, which may render the spinal column unstable. The most common causes of neck pain are cervical strains, facet-related pain, cervical arthritis and herniated discs. 

When do I need surgery?

If you have symptoms of spinal cord compression and a diagnostic test such as an MRI or CAT scan reveals that the spinal cord is compromised, you may need surgery. If you have persistent pain or weakness in the arms or legs or difficulties with bowel or bladder function, you also may require cervical spine surgery.

Why is surgery often done through the front of the neck?

The anterior approach to the cervical spine is a safe and easy dissection to provide excellent exposure to the cervical vertebrae and the intervening discs.  This anterior approach does not involve the dissection through extensive musculature, and thus the post‑operative pain associated with the anterior approach is less than that associated with a posterior procedure.  The anterior approach also allows for complete exposure and dissection of the cervical discs without resulting in any significant compression or displacement of the spinal cord.

Does whiplash cause herniated discs?

If severe enough, a whiplash injury could certainly cause a disc herniation. This would often present with a combination of neck pain and, more commonly, pain radiating down one arm.

Should I have an MRI if I have pain?

MRI scans have a high false positive rate, meaning that these sensitive tests can often show abnormalities that occur in asymptomatic patients.  An MRI is most useful if radiating arm pain, numbness, tingling, or weakness exists in a very specific distribution suggestive of a particular nerve that may be irritated.  An MRI scan can serve as a confirmatory study.  Typically, if pain exists for more than six weeks, an MRI scan may be obtained to look more closely at the quality of the discs and whether or not there exists any spinal cord or nerve root compression.  In the setting of an acute trauma, an MRI scan may be helpful in identifying the existence of a subtle fracture or even a ligamentous injury.

As long as the patient’s pain is well-controlled and there are no neurologic deficits that I am concerned about, we try to avoid surgery at all costs. Patients may also partake in physical therapy or chiropractic care to try to avoid surgery. Other conservative treatments such as anti-inflammatories, injections or even acupuncture also may provide enough relief to avoid a trip to the operating room.