Neck Pain, Bulging Discs, and Degenerative Changes.

I have spent a lot of time discussing low back pain and how the things found on MRI and x-rays are usually not the cause of a person’s symptoms and are more likely just normal, age-related changes that occur in all of us-even those of us without pain. The question I want to look into today is whether or not the same holds true for the neck region. [...]

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I have spent a lot of time discussing low back pain and how the things found on MRI and x-rays are usually not the cause of a person’s symptoms and are more likely just normal, age-related changes that occur in all of us-even those of us without pain. The question I want to look into today is whether or not the same holds true for the neck region.

​The reason I am bringing this up is because in the past week I have evaluated 2 different patients who have been told that they need to have their neck fused-a major surgery without good long term outcomes.  Understandably, they were very concerned and scared. Thankfully, they came to me to see if there was anything less drastic that could be done to help.

Now, before I go further, I want to say that I am not against all spinal surgery (low back or neck). However, the percentage of people that actually need it based on the evidence is very, very small. Surgery is indicated if a person’s MRI or x-ray shows a problem that specifically accounts for some serious signs and symptoms. These would include a sudden changes in balance or the way a person walks, loss of the ability to control bowel and bladder function, cancer or fracture in the spine, and lastly weakness in muscles that correspond to the area of the spine showing the problem (although this one is not quite as exact because this can get better with time as well). The thing I am seeing more and more frequently is that many people are having spinal surgeries in the absence of these findings.

Neither of the  two people that I met with last week had any of these signs and symptoms that would indicate a surgery is needed. They had neck pain and stiffness. However, their MRIs showed a disc bulge that the surgeon felt was the cause of their pain. Now, if this is the case, then everyone with disc bulges, should have pain. Is this really the case?

In 2015, Nakashima and colleagues published a paper that that looked at the MRIs of over 1,100 people without neck pain.  What they found was that “most subjects presented with disc bulging (87.6%) which significantly increased with age. Even subjects in their 20s had bulging discs with 73% of males and 78% of females showing these.”

Much like the findings with MRI and x-rays done on the low back region, it appears that the presence of bulging discs is actually quite normal and it should not be concluded that this is the cause of a person’s neck pain symptoms. With this being the case, there is no reason why a surgery should be recommended without the presence of the signs and symptoms I listed above.

The other thing that is commonly diagnosed in people with neck pain is degenerative disc disease.

Again, many surgeries and injections are recommended based on finding these things. In 2015, Rudy and colleagues concluded from their study that “clinical symptoms such as pain level, headaches, shoulder referral, and hand radiculopathy or numbness are not reliably correlated with radiographic findings of degenerative joint disease in the cervical spine.”

So what does this mean for you, the patient? First, do not be talked into risky, invasive procedures because of these diagnosis if you do not have any of the serious signs and symptoms that I listed above.

Secondly, seek conservative treatment by a physical therapist with extensive training in treating pain in the neck. The good news is that there is a lot of research supporting the benefit of an individualized physical therapy program for the treatment of neck pain and stiffness. This is shown to be effective even when disc bulges and degenerative changes are present in the spine.

If you have questions specifically about this information or want to discuss what appropriate treatment would include, feel free to contact me and we can discuss your situation further.

Thanks for reading,

Bob