Advice to improve your movement, fitness, and overall health from the world #1 in orthopedics.
A simple pain in the neck can often be resolved with medication or physical therapy. But people who suffer from severe pain and symptoms like numbness or weakness may need surgery to get relief.
If you’re considering neck surgery, “it’s important to have a thorough physical evaluation and detailed imaging to determine the cause of your symptoms, and then be informed about all of the possible treatment options, including surgery,” says HSS spine surgeon Darren Lebl, MD, MBA, who specializes in minimally invasive techniques.
If surgery is your best option, you’ll also want to understand what’s involved in recovery to get back to the activities you enjoy.
Issues in the neck often relate to the cervical spine, in the upper back. Compression of a nerve or the spinal cord itself can cause the discs in the cervical spine to deteriorate. This may cause pain and neurological symptoms such as numbness, weakness, difficulty using your arms and hands, or problems with walking, balance or bowl and bladder function. Surgery is often the best choice for people with these issues.
For those who have tried non-surgical treatments like physical therapy or injections and don’t see improvement, or if these methods help for a time but the pain still gets worse, surgery can also be appropriate.
“The risk of allowing the nerve root or the spinal cord to be compressed for too long without any intervention is that neurological issues like numbness and weakness can become permanent,” cautions Dr. Lebl.
The type of operation that’s best for each person depends on the symptoms and the location of the problem. Dr. Lebl sits with patients to go through all the available treatment options, review their x-rays and other imaging studies in detail, discuss the pros and cons of surgery and answer their questions.
“Spine surgery has advanced tremendously over the last several years and we minimize risk as much as possible by taking appropriate precautions,” he says. “That includes a thorough medical evaluation and high-quality imaging before surgery, as well as using technology in the operating room such as advanced scans, surgical navigation, and robotics. But above all else, it’s having good judgement that allows us to do these procedures very safely and effectively.”
According to Dr. Lebl, the most common procedure done on the upper spine involves going in through the front of the neck to access the problematic disc, which is in front of the spine. Using a microscope and other specialized techniques to visualize the problem, the surgeon can relieve the pressure and compression on a nerve root or the spinal cord.
Often, extra structural support is needed where the damaged disc is removed. That typically involves either a disc replacement or fusion surgery to join two or more of the vertebrae in the neck.
“There are pros and cons to each,” says Dr. Lebl. “If you have this issue, it’s best to discuss your individual case with your surgeon to determine which type of procedure is right for you.”
Minimally invasive surgery like Dr. Lebl performs can help to minimize complications, the hospital stay and the time it takes to recover. Most patients leave the hospital within 24 hours, though in some cases it might take two or three days before being discharged. More complex issues may require a person to stay in the hospital longer. The vast majority of people can recover at home.
Pain management depends on the person. “The advantage of operating through the front of the neck is that most people don’t need a lot of pain medication,” says Dr. Lebl. “However, some people do need them depending on the underlying issue being treated.”
Prior to surgery, Dr. Lebl advises patients to be as active as possible and stay hydrated, which can help make recovery easier. After surgery, he generally encourages patients to stay mobile and walk as much as they like. Early on during the healing period, patients should not lift anything heavy or engage in any impact-type activity. Usually, people can shower within 48 hours after surgery.
Patients should report to their doctor signs of infection such as high spiking fever, redness around the surgical area or drainage from the wound, as well as any neurological changes, difficulty breathing, chest pain or shortness of breath, among other concerns.
Physical therapy is a crucial step in the recovery process. Once the initial healing period is over, Dr. Lebl says that it’s best to get to an outpatient physical therapy center to benefit from its dedicated staff, equipment, and facilities. Depending on the procedure, patients typically start physical therapy about two weeks after surgery, but sometimes wait longer.
According to Dr. Lebl, a full recovery from neck surgery can take a few weeks for someone whose daily activities are less strenuous, such as walking or sitting at a desk while working on a computer. For a competitive athlete or someone with a very active job, it could be longer, perhaps three to six months.
As far as driving, there is a bit more that goes into deciding when it’s safe to start again. “It’s important to use good judgement, so patients should be off pain medications and have had some physical therapy prior to driving,” explains Dr. Lebl. “The physical therapist should also assess the patient to ensure they have good strength and reaction time before getting behind the wheel.”
Research has shown that surgical experience and volume impacts patient outcomes. When considering neck or cervical spine surgery, it’s important to choose an experienced surgeon who is highly skilled in those procedures, and a specialized hospital with expertise in musculoskeletal conditions.
“It’s no surprise that more experience and higher volume lead to improved technique and outcomes,” says Dr. Lebl, who adds that it’s an especially exciting time for the field. He and his colleagues have been working extensively the last several years to incorporate new technology and improve surgical techniques for better results.
“Sometimes I tell patients that this is not your parents’ spine surgery,” he says. “Historically, there was this notion that people didn’t do well after surgery. But I think that has changed tremendously. If you go to people who are very comfortable treating the underlying issue, who do it often and well, and who ultimately get it right, the vast majority of people should have a good outcome.”