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John Abrahams, MD, FAANS
Q. I have a persistent pain in my neck, but I’m not sure if it’s serious. How can I tell whether it’s a cause for concern?
A. The nerves of the spine and neck run through a column of donut-like bones called vertebrae. Spongy disks lie between each vertebra, cushioning the column and facilitating all the movements we expect of our neck and back: bending, twisting, swiveling, to name a few. After years of service—or because of an accident or injury—these disks can bulge, pressing against that column of nerves, causing pain.When neck pain begins to limit your ability to move normally and engage in everyday activities, it’s time to seek medical attention. If the pain becomes chronic or is accompanied by severe arm pain, numbness, or weakness, surgery can be a solution. Often, that surgery means metal implants that can help fuse bone.
Q. What does getting metal implants involve?
A. For patients who are debilitated by the pain or are suffering severe arm troubles due to the nerve pressure, an effective solution is to remove the disk and use metal implants to help fuse the neighboring vertebrae. Because this can reduce range of motion and introduces a foreign body, some patients don’t like the idea and they’ll put off surgery. However, for patients who are reluctant to try this option, there is an alternative.
Q. What is an alternative to metal implants?
A. I perform a procedure that doesn’t require fusing the vertebrae. If a patient’s disk is still functional and there isn’t significant spinal compression—the result of hairline fractures in the vertebrae—an anterior cervical microforaminotomy might be considered. This outpatient procedure involves shaving off about one-third of the disk, the part pressing against nerves. The remaining two-thirds continue to perform the job of cushioning the vertebrae.
Q. What are the advantages to this alternative procedure? Are there any downsides?
A. A potential downside is that the disk may bulge again and the pain may return. The advantages: This less-invasive procedure would allow you to go home the same day and return to your usual routine within a week. It relieves the pain without introducing a foreign body, and you can retain range of motion. The procedure is a viable long-term solution for patients who have pain, weakness, or numbness, but don’t want fusion.
Northern Westchester Hospital
Chief, Neurosurgery
Co-Director, Orthopedic & Spine Institute, Spine Section
Learn More About Dr. Abrahams
Learn more about Orthopedic Conditions and Treatments
More from Dr. Abrahams:Â Chronic Back Pain and Advanced Surgical Solutions
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