I hurt my neck in a skiing accident this year. How do we determine whether my persistent neck pain and limited range of motion can be treated through non-surgical care, minimally invasive spine surgery, or, motion preservation disc replacement?
Fortunately, most pain after a sports-related injury, like a skiing injury, is not going to require surgery. Depending upon the velocity, severity of the trauma, and the mechanism of the trauma, these injuries can nevertheless be very painful and cause significant distress and even time away from work. In the absence of any weakness in the upper or lower extremities, numbness in the hands, or difficulty with using one’s hands for fine motor activities, such an injury should be managed conservatively. A soft or hard collar on the neck may provide some temporary relief as the muscles can sometimes be quite irritated and go into spasm. This is usually what causes the most pain. Anti-inflammatory medication and muscle relaxants can be helpful in providing relief. If pain persists after a couple of weeks, your doctor may choose to obtain x-rays of your neck with bending and extending postures to evaluate for any abnormal motion; a CT scan would better visualize any fractures that could be present, although this is not always necessary.
If you are developing symptoms such as weakness, pain down the arm, or numbness in your hands or feet, it would probably be wise to have a physician evaluate you and consider obtaining an MRI scan of your neck. Injuries could range from a simple pulled muscle to irritation of the discs or joints in your neck. On the other hand, a fracture is an injury that we would not want to miss. If your pain continues to worsen or you develop new symptoms, some injuries may be treated with medication alone; sometimes physical therapy is necessary to strengthen the muscles and provide additional support to an irritated neck.
The most common scenario is an individual with some underlying degeneration in their neck who suffers some sort of trauma like a skiing accident. This could irritate a nerve that is already under some minimal pressure and cause it to become symptomatic. Medication can sometimes relieve that nerve irritation and surgery can be avoided completely. Conversely, surgery is an option when all of these other non-surgical treatments fail. When the disc is the problem, it may be treated by minimally invasive procedures such as a microdiscectomy, decompression, or even a total disc replacement. In a disc replacement procedure, no motion is lost in the neck and other joints are preserved from having accelerated degeneration that may occur if a fusion procedure is performed instead.
Dr. Brent Kimball
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