The patient's history and physical examination may be sufficient to diagnose the cause of neck pain. In neurosurgery, we first want to exclude serious causes of neck pain, such as diseases such as neck hernia, narrow canal in the neck that compress the spinal cord and nerves, as well as more serious conditions such as myelopathy, infection or cancer that can cause spinal cord damage.
When questioning: He will ask about past neck injuries that may have caused accidents, spinal cord injury or herniated disc. We ask questions about work or other activities that may strain your neck. You will be asked when your pain started, where it is, how long it lasts, and how intense it is.
Physical Examination: We check the position of the head and neck and observe the range of motion when the neck is moved. By examining the neck and the muscles that support it, we look for signs of tenderness or stiffness. Imaging tests are not always needed to determine the cause of neck pain. However, if you have a serious injury or severe pain that does not go away, imaging of the inside of the neck tissues is required.
X-Ray: X-rays can reveal bone and spinal alignment problems that can cause neck pain. X-rays can show spinal alignment problems such as neck straightening, fractures, ossified cervical herniation (disc herniations), and detect the level of osteoarthritis-related calcification.
Magnetic Resonance Imaging (MR): MRI of the spinal cord, nerves, bone marrow and soft tissue can reveal tissue problems. This will tell you if your disc is dislocated, signs of infection, or a lump such as a cyst or tumor that can cause neck pain.
Computed tomography (CT) scan: If an MRI is not available, a CT scan may be done. Osteophytes and signs of bone loss may appear. In rare cases, providers may order additional tests such as:
EMG (Electromyelography): These tests check signal transmission and muscle response by electrical stimulation of the nerve. Laboratory tests: Blood tests identify causes of neck pain other than simple musculoskeletal pain such as infections, rheumatic disorders, and cancer as the source of the pain.
Tests include inflammatory (inflammatory) markers such as complete blood count (CBC), urinalysis, rheumatoid factor, CRP, sedimentation.
How to Perform Neck Hernia Surgery ?
Patients who do not benefit from other treatments may require surgery. The aim of the surgery is to remove the part of the disc that is pressing on the nerve. This is done through a procedure called a discectomy. The hernia is entered through a skin incision made in the front or back of the neck. The decision to operate anteriorly (anterior approach) or posteriorly (posterior approach) is affected by many factors, such as the location of the disc herniation, surgeon's experience, and patient preference.
In both approaches, the portion of the disc pressing on the nerve is removed and generally good results is taken. In the anterior approach, most of the disc will need to be removed to reach the herniated disc, which will usually require a fusion. The biggest disadvantage of fusion surgery is the disappearance of movement in the fusion region. Single level discectomy does not pose a significant disadvantage in terms of neck mobility. This is because the lost mobility of this segment is compensated and tolerated by other intact levels. However, the increased movement and workload applied to the upper and lower segments will cause abrasion, neck hernia and pain in these areas. Today, thanks to the developing technology, removable prostheses can be placed in the space created by removing the disc instead of fusion. However, prostheses are not suitable for every patient. Ideal candidates are patients who are relatively younger, whose facet joints have not degenerated, and whose disc heights have been preserved. Your best doctor will decide whether the prosthesis is suitable for you.
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