Q I have had neck pain for a few years. It recently became worse with back and shoulder blade pain as well. The pain goes all the way to my hands and even my legs. I saw a neurologist and was told it is cervical stenosis myelopathy.
A spine specialist told me it is a mild case based on a magnetic resonance imaging (MRI) scan and, therefore,
I do not need surgery.
I sought a second opinion with a private specialist and was advised to go for surgery as my condition had worsened since the last MRI.
I am well aware that it is a degenerative condition which
will only get worse over time.
I am disturbed by the pain every night even after taking painkillers. Should I go for surgery?
A Having neck pain is a very common condition.
A large proportion of the population would experience neck or low back pain in their lifetime.
Thus it is good to know when you should see a doctor and when it would be all right to continue observing the condition yourself.
The spine in the neck has seven bones and there are over 30 small joints that articulate with one another.
The joints allow the neck to bend forwards, backwards, tilt and rotate in many directions. They are important and delicate structures.
The neck also contains the spinal cord and nerves that help control both arms and legs.
Unfortunately, the joints may wear out over time. The discs in the neck can age and compress on the nerves. When this occurs, you may experience neck discomfort or pain.
If the neck discomfort and pain is tolerable and predominantly isolated in the neck region, it is usually temporal and may improve with time. This is commonly referred to as cervical spondylosis.
Most often, the doctor would advise some medications, physiotherapy and neck care.
When the pain starts to run down the arms to the fingers, it may indicate the nerves in the neck are compressed. This may be associated with hand weakness or numbness.
If that occurs, we need to monitor it more closely as we are concerned that the nerves may become progressively injured and damaged.
This condition is known as cervical radiculopathy. This condition can be treated with an initial trial of conservative treatment.
Sometimes, the symptoms improve and surgery can be avoided.
However, if the symptoms worsen or there is progressive neurological deterioration, surgery may be indicated to free the nerves and relieve the compression.
Other than the peripheral nerves in the neck, the spinal cord could also be compressed. This is usually a more insidious condition.
Pain is usually not a predominant symptom. Unsteadiness in gait and frequent falls may be a more common symptom.
There can be poor coordination in the hands when writing and holding coins and chopsticks, and sewing may become more difficult.
When it is more severe, hand and leg weakness and numbness may become more prominent. This clinical condition is known as cervical myelopathy.
If there is a severe compression of the cervical cord and there is progressive neurological deterioration, surgery should be considered as medications and physiotherapy cannot free the compressed spinal cord.
It is sometimes more prudent to decompress the spinal cord early as chronic compression may cause permanent nerve injury and damage.
This cord injury is likely to be permanent as we have limited capacity to self-repair or heal the spinal cord and nerves.
This is unlike skin and bone tissues where we have better re-generative capability.
It is a concern to hear that you have persistent neck pains and require medications, and that you have difficulty sleeping and resting.
I would suggest a further consultation with a spine specialist and close monitoring of your condition by the specialist.
Dr Guo Chang Ming
Senior consultant in the department of orthopaedics at Singapore General Hospital.
