Results of Surgery and Injections for Neck PainWhen conservative care doesn't help with neck pain, then doctors and patients may turn to injections or surgery. But no one wants invasive treatment if it's not going to help. It's best to know what type of surgery to perform and when to do it.
In this review article, the authors answer these questions and summarize findings on both types of treatment. A committee of medical doctors, chiropractors, and physical therapists studied the results of over 1200 studies on the treatment of neck pain by surgery or injections. Only high-quality, scientific studies were included in the review.
All studies included patients with common kinds of neck pain and/or neck and arm pain. Anyone with structural problems such as dislocation, infections, or tumors was not included. Some patients had disc problems or ligament tears, but most had no obvious cause for their neck pain.
Treatments studied included steroid injection, radiofrequency neurotomy, and surgery. Methods of surgery included percutaneous (through the skin) or open (with incision). Decompression, fusion, and disc replacements were the most commonly studied types of surgery. Complications from each type of treatment were described. These ranged from allergic reactions and infections to serious spinal cord or brain injury.
Evidence from the research does not support the use of steroid injections into the facet (spinal) joints for neck pain. Neurotomy may be helpful but there were no studies with high enough quality to report the results from. Neck pain alone (without arm pain) should not be treated with anterior cervical fusion or artificial disc replacement.
There was some indication that steroid injections of the nerve root or into the epidural space are helpful in the short-term. But these injections did not prevent patients from ending up with open surgery. Surgery may help improve pain but doesn't always restore function. And surgery is not recommended for ligamentous damage after a whiplash injury.
Future studies should focus on minimal acceptable outcomes. This means finding out (before surgery) what the patients consider is the minimum improvement in pain, medication-use, and recovery after surgery to make it worthwhile.
This research committee also made some recommendations for future studies. Cases series of common procedures and small trials are not advised. Studies should have high quality design, standardization across studies (measure and report the same way for similar patients), and report early and late results. Patient satisfaction should be assessed rather than the surgeon's subjective report of results.
Eugene J. Carragee, MD, FACS, et al. Treatment of Neck Pain. In Spine. Supplement to February 15, 2008. Vol. 33. No. 4S. Pp. S153-S169.
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