What procedures help treat neck pain?

When conservative treatments such as medications, physical therapy, and alternative treatments such as acupuncture and massage therapy fail, one may consider interventional pain procedures to treat neck pain. 

After a complete history and physical is performed by a trained interventional pain physician, patients may be considered for a procedure to treat their neck pain. These procedures should be performed under fluoroscopy or x ray guidance to confirm accuracy and safety. All procedures have some associated risk which should be discussed with the physician performing the procedure.

Cervical epidural steroid injections are commonly used to treat neck pain associated with arm pain or discomfort. Under x ray guidance, a needle is placed into the epidural space which is a part of the spine where the nerve roots are located. Delivery of a small amount of steroid may reduce the inflammation surrounding the nerve roots and decrease pain and discomfort.

Another procedure that is commonly performed is cervical facet and medial branch blocks. When this provides significant but short term relief, your doctor may discuss radiofrequency ablation as a longer lasting solution for neck pain. Please see the videos I posted on the Sharecare website for more information regarding this procedure. This treatment is used to treat neck pain and may also help with associated symptoms such as headaches and pain referred to the shoulder area. 

When interventional pain procedures fail and the pain is severe and persistent, consultation with a neurosurgeon to discuss surgical options may be necessary. Surgery is considered first when alarming symptoms such as weakness, loss of bowel and bladder control, and loss of balance are present, to name a few. In general, when these symptoms are not present, surgery is considered only after conservative measures have failed.

Surgery is rarely needed for neck pain. It may be an option when:

• A neck injury causes a fracture or abnormal motion (instability). Surgery may be done to stabilize the spine and prevent a bone fracture from causing instability and possible paralysis.
• Pressure on the nerve roots or spinal cord causes numbness or arm, hand or leg weakness; severe pain that lasts for months; or loss of bladder or bowel control. Pressure on the nerve roots or spinal cord may be caused by problems such as a narrowing of the spinal canal (cervical spinal stenosis), arthritis of the neck (cervical spondylosis) or a herniated disc in the neck.

• Discectomy (with or without fusion). The surgeon removes herniated disc material that is pressing on a nerve root or the spinal cord.
• Cervical spinal fusion. Selected bones in the neck are joined (fused) together.
• Spinal decompression. Pressure is reduced on the spinal cord or spinal nerve roots by removing part of a bone or disc.

Some people can consider artificial disc replacement instead of spinal fusion. This surgery is currently just for carefully selected patients, and it is done by specially trained surgeons. Doctors have not yet done long-term studies to know how well this works over time.