Pain in the neck

CASTLE ROCK, Colo. — As people age, the discs in their neck and back naturally deteriorate, causing pain and, sometimes, instability. These disc issues can lead to pain, numbness, or tingling in the neck, arms, or hands. Neck pain affects people of all ages; however, research shows women and older people are more susceptible.

While most people will find relief with conservative treatment such as physical therapy and injections, some conditions will require surgery. A good barometer of when to seek the help of a spine surgeon is if conservative therapies haven’t made a difference after a few months. The two most common neck surgeries to consider are anterior cervical discectomy and fusion (ACDF) and cervical artificial disc replacement (ADR).

“ACDF is still considered the gold standard, as it has a long history of use,” says William Choi, MD, a board-certified, double fellowship-trained spine and neurosurgeon at AdventHealth Castle Rock. “If it was myself or my family members, I would do artificial disc, as the research is continuing to show it’s just as effective and it preserves motion.”

During fusion surgery, the deteriorated or herniated disc is completely removed. Bone or other material is placed where the disc was removed and, over time, the bones mend together, providing stability and reducing or eliminating pain and other symptoms.

Long-term studies show pain and disability improvement in nearly 90% of ACDF patients. But there is a downside.

“During fusion, the surgeon is removing stress out of that level of the spine, but that also eliminates movement and puts stress on other areas of the neck or back, creating a domino effect,” Dr. Choi says.

That stress can result in disc degeneration above or below the fused areas, a condition called adjacent segment disease (ASD). In contrast, replacing the damaged disc with an artificial disc that retains motion reduces the risk of additional disc deterioration.

To keep your options open, Dr. Choi recommends seeing a spine specialist sooner than later. “The longer we wait, fusion may be the only choice, as ADR isn’t an option once the disc collapses,” Dr. Choi says.

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