Houston Methodist. Leading Medicine

Neck FAQ

Question:

I have constant neck and back pain. Sometimes it's just my neck but other times it's both neck and low back. I had an X-ray and the doctor showed me there is disc degeneration all along my spine. I don't really want to have my whole spine fused. Is it possible to have just one or two of the worst levels replaced with one of those new artificial discs? Or is that like putting a finger in the dike to hold back the water? In other words, am I just doomed to a life of back pain?

Answer:

You ask some interesting questions that will probably get a more accurate response from the orthopedic surgeon who is treating you. Having the full case history along with a clinical exam and imaging studies to look at (X-rays, CT scans, MRIs) gives your current physician important information needed to make a decision like this. Certainly, spinal fusion at the most painful, unstable segment(s) is an option. Many patients obtain pain relief from this approach. But we do know that with a fusion, there is increased load, stress, and tension placed on the segments above and below the fused level(s). The long-term effect can be increased disc degeneration at the next spinal level. This condition is referred to as adjacent segment disease (ASD). ASD can occur at whatever spinal level the fusion is done (neck or low back). At least one study comparing patients with degenerative disc disease who had cervical spine surgery (neck fusion or cervical disc replacement) showed similar results. Between 14 and 16 per cent of the patients developed adjacent-level disease no matter which type of surgery they had. Two other factors were identified in that study as possibly contributing to an increased risk of adjacent-segment disease (ASD). The first was a condition known as osteopenia. Osteopenia is a decrease in bone mineral density and develops before osteoporosis (brittle bones). The second risk factor contributing to disc degeneration in the cervical spine after disc replacement or fusion was the presence of similar disc disease in the lumbar spine (low back area). Before any surgery is done, experts recommend patients try conservative (nonoperative) care for at least six months. This could include the use of medications to control inflammation and pain, physical therapy, steroid injections, or other pain relieving techniques (e.g., massage, acupuncture). Even with surgery at one or two levels, persistent pain may be aided with this type of adjunct treatment. Talk with your physician and see what would be recommended for you based on your age, activity level, severity of symptoms, and goals and expectations. Pierce D. Nunley, MD, et al. Factors Affecting the Incidence of Symptomatic Adjacent-Level Disease in Cervical Spine After Total Disc Arthroplasty. In Spine. March 15, 2012. Vol. 37. No. 6. Pp. 445-451.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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