Diagnosing a Pinched Nerve in Your Neck
Having the right surgery for the right indication for the right patient is crucial. Before you and your doctor discuss treatments for pinched nerves in the neck, your doctor will make sure that they have the diagnosis correct. The symptoms for pinched nerves in the neck are pain in the back of the neck going down the back of the shoulder blade and down the arm into the fingers; which fingers have the pain depends on which nerve is pinched.
However, sometimes issues with the shoulder and issues with the neck can be mistaken for each other. Before you have treatment for shoulder or neck pain, your doctor will make sure that you don’t have the other issue. With shoulder problems, symptoms include not liking to do activities with your hand above your head or behind your back, such as reaching for shelves or putting your coat on. However, with a pinched nerve in the neck, putting your arm above your head makes it feel better.
Your doctor will confirm your diagnosis with X-rays and see how much arthritis is in in your neck, and then an MRI will confirm that there is a pinched nerve.
Once the diagnosis of a pinched nerve in your neck is confirmed, there are four options before surgery:
- Wait to give the nerve time to calm down by itself.
- Do physical therapy, which both gives the nerve time to calm down and strengthens the muscles around the nerve.
- Receive injections in your neck.
- Take medications: anti-inflammatories, steroids, and other medications to calm down the irritation of the nerve.
If none of the above treatments work, you’ll start talking with your doctor about surgery.
Your spine is made from vertebrae (bones) with discs in between them. The spinal cord goes through the bones, and nerves come out of the sides and go to the rest of your body.
The spine is divided into three sections: cervical, thoracic, and lumbar. The cervical spine is your neck, the lumbar spine is your lower back, and the thoracic spine is in between. The information here is only about pinched nerves in the cervical spine or neck. Treating your lumbar spine (lower back) is very different.
In most cervical spine surgeries, the surgeon operates from the front of your body because skin is the only thing that has to be cut. At your neck, your spine is much more accessible through the front of your body than through the back of your body.
Fusion in Your Neck
For a fusion, your doctor cuts a small hole in the front of your throat before carefully going in and removing the disc that is pressing on a nerve. From the front, it’s much easier to remove the disc without touching the nerve and therefore irritating it.
With the disc out, the nerve is no longer being irritated and the pain and other symptoms will go away. However, a fusion needs to be done so the bones don’t collapse against each other now that the disc in between them has been removed. This procedure is called an anterior cervical discectomy and fusion (ACDF) and it is the most common procedure that spine surgeons do. It’s minimally invasive and it works for a very high number of patients. Depending on the patient and situation, a surgeon may do an ACDF in an outpatient surgery center or in a hospital.
The ACDF has a 97% success rate, but the bones above and below the fusion have a 25% chance of degenerating and needing future surgery. A couple of decades ago, spine surgeons developed a disc replacement instead of a fusion to try to correct the degeneration of the nearby bones.
Disc Replacement in Your Neck
Disc replacements come in several styles, but they all work equally well. All of them allow the motion between the bones to remain, but they have slightly different styles of motion: some are squishier, while others move more.
However, disc replacements did not fix the issue of the bones near a fusion needing help. Depending on the study, they either made no difference or reduced the risk of degeneration from about 25% to about 10% or 15%. Over the past 13 or 14 years that I’ve been doing disc replacements, we’ve found some cons to go with the pros of preserving motion.
Pros of disc replacement in your neck
- Preserves motion in your neck
- May reduce the risk of degeneration in other parts of your neck
Cons of disc replacement in your neck
- Preserving motion may mean irritating nerves if you have bone spurs or arthritis
- Slightly more complications than fusions
Disc replacements are good for some types of patients. Patients who get a disc replacement in their neck should be younger, not have many bone spurs or arthritis that will cause pain if their neck is allowed to continue moving, and only one or two levels of vertebrae affected with soft disc herniation.
If a patient is in their 70s or 80s, has a large amount of arthritis and/or bone spurs, or has many levels of their vertebrae affected, they are not a good candidate for a disc replacement.
One other consideration is MRIs in the future. Disc replacements can make it difficult to see issues on an MRI if the issue is right next to the disc replacement, so the specific diagnosis of a patient and how likely they are to need an MRI of that problem in the future are taken into account.
Both fusions and disc replacements are equally good in the short term: they are relatively minimally invasive, can be done outpatient, and relieve nerve pain. In the long term, disc replacements have a smaller chance of causing problems above and below the area that was fixed, but they are not right for every condition or every patient.
Frequently Asked Questions
Do some patients get a disc replacement and a fusion in the same surgery?
Absolutely. Disc replacements are only approved to replace one or two discs, but sometimes a patient needs to have multiple discs operated on. In that case, the surgeon can do a fusion on the lower disc or discs to provide a stable base and then do a disc replacement at the top.
Is deciding between a disc replacement and a fusion done in the OR or before surgery?
With shared decision making, you and your surgeon will decide before surgery. Your surgeon will share the data with you and discuss the best option for your neck. Very, very occasionally – I’ve had it happen in one patient out of hundreds – we will be planning to do a disc replacement but need to do a fusion instead. However, in this case the patient knew ahead of time that it might happen, and any plans that change during surgery are discussed with the patient’s family.
If a pinched nerve can heal on its own without surgery, how long do you give it to heal before you know that surgery is needed?
Most pinched nerves get better after 6 to 8 weeks. If the nerve does not get better but the pain is minimal and isn’t interfering with your life, we can leave it alone. If the pain is stronger or there is weakness and you can’t lift your arm, then it’s important to treat the pinched nerve. The longer you wait to treat arm weakness caused by a pinched nerve the more likely it is to become permanent.
What exercises can you do to help relieve neck pain while you’re waiting to have a fusion or disc replacement?
I recommend getting your heart rate up. It may be from running, biking, swimming, a long walk, or any other activity. Getting your heart rate up gets oxygen to your muscles and to the discs and helps to relieve symptoms.