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New Option for Patients with Neck Pain

By Michael Lasalandra
Beth Israel Deaconess Medical Center Correspondent

Patients with neck pain due to cervical disc issues generally respond to conservative therapy, but those who need surgery have a new option available to them in the form of an artificial disc that replaces the one that has worn out or become damaged.

"These types of problems are very common and we can usually treat them conservatively," says Dr. Kevin J. McGuire, chief of orthopedic spine surgery and co-director of the Spine Center at Beth Israel Deaconess Medical Center. "In some cases, surgery is indicated and usually works very well. But the message is that there are options and in most cases the prognosis is very good. And there are some new things on the horizon."

A common cause of neck pain is a ruptured or herniated cervical disc or one that is simply worn out. "It's a big problem," says McGuire. "It's one of the most costly health problems in the United States, second only to lower back pain. There's a large burden of disease, a huge cost to society."

Fortunately, most cases of neck pain due to cervical disc issues can be treated conservatively, according to McGuire. Treatments include anti-inflammatory medications, physical therapy, traction, massage, the wearing of a soft collar and "the tincture of time," he says. "We rarely operate on such cases because the surgeries don't work well for relieving this kind of pain."

In cases where neck pain also radiates down the arm, which may be caused by disc herniation or arthritis producing pressure on the nerves, conservative management is the first line of therapy, but surgery may be needed, he says. "And the surgery is generally very successful," he says.

The operation may be a discectomy -- removal of the disc causing the problem -- combined with a spinal fusion, which involves the use of a small metal plate and screws to fuse the adjacent vertebrae together. While the operation is usually successful in relieving pain, it can result in a decrease in motion and puts pressure on the discs above and below the one that has been removed, according to McGuire.

A newer alternative to spinal fusion is disc replacement. Titanium discs to replace the damaged or worn-out one were approved by the FDA about a year ago. The replacement disc can relieve the pain while at the same time preserving the range of motion usually lost to fusion surgery, McGuire says. It also helps reduce pressure on the discs above and below the one that has been removed.

"We're trying to get away from fusion and that is where disc replacement comes in," he says. "It is an exciting option that should give patients a better long-term outcome."

A number of versions of the replacement disc are being tested in clinical trials at the moment. "We've got a clinical trial that is going to be started very soon," he says.

A third type of cervical disc problem is one that causes pressure on the spinal cord itself rather than the nerves. Called myleopathy, this type of problem can result in balance issues. It is the rarest of the three types of cervical disc issues. Myelopathy can also be treated surgically by decompressing the spinal canal and opening the nerve roots. The goal is to prevent further decline. The problem is most common in the elderly.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

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Spine Center
Beth Israel Deaconess Medical Center
Shapiro Clinical Center, Second Floor
330 Brookline Avenue
Boston, MA 02215