Because the neck is so flexible and because it supports the head, it is extremely vulnerable to injury. Motor vehicle or diving accidents, and falls may result in neck injury. The regular use of safety belts in motor vehicles can help to prevent or minimize neck injury. A “rear end” automobile collision may result in hyper-extension, a backward motion of the neck beyond normal limits, or hyperflexion, a forward motion of the neck beyond normal limits. The most common neck injuries involve the soft tissues: the muscles and ligaments. Severe neck injuries with a fracture or dislocation of the neck may damage the spinal cord and cause paralysis.
If severe neck pain occurs following an injury (motor vehicle accident, or fall), medical care should be sought immediately. A chiropractor or orthopedist specialize in neck injuries. Their treatment may consist of one or more of the following procedures:
- A physical examination consisting of an evaluation of neck motion, neck tenderness, and the function of the nerves and muscles in your arms and legs.
- MRI (magnetic resonance imaging). This non x-ray study allows an evaluation of the spinal cord and nerve roots.
- CT (computed tomography). This specialized x-ray study allows careful evaluation of the bone and spinal canal.
- Myelography (injection of a dye or contrast material into the spinal canal). This specific x-ray study also allows careful evaluation of the spinal canal and nerve roots.
- EMG (electromyography). This test evaluates nerve and muscle function.
How neck pain is treated depends on what the diagnosis reveals. However, most patients are treated successfully with rest, medication, immobilization, physical therapy, exercise, activity modifications, or a combination of these methods.
For example, if pain is caused by inflammation as a result of stretching muscles and ligaments beyond their limits, your orthopaedist may prescribe rest and a neck collar for a specified period of time, as well as medication to reduce inflammation. If medication is prescribed to reduce pain, it should be used only as directed and should not be taken for extended periods of time. In addition, if your orthopaedist prescribes rest, it is vital that you follow these instructions carefully.
When neck pain persists or is chronic, your orthopaedist may recommend a rehabilitation program that includes an exercise program and various types of physical therapy to help you relieve your pain and prevent it from coming back.
If conservative measures do not help, surgery may be necessary to reduce pressure on the spinal cord or a nerve root when pain is caused by a herniated disk or bony narrowing of the spinal canal. Surgery may also be required following an injury to stabilize the neck and minimize the possibility of paralysis, such as when a fracture results in instability of the neck.
For people suffering from back pain, in addition to the tests for neck pain indicated above, the following tests may be performed:
- Bone scans look for areas of possible infection, tumor, or fracture.
- Electromyography [EMG] and nerve conduction velocity [NCV] testssee how well the nerves in the arms and legs conduct electrical signals.
- Bone density studies may be ordered if osteoporosis is a concern. Osteoporosis by itself should not cause back pain, but fractures due to osteoporosis can.
Treatments for low back pain are multiple and varied.
Counseling and Education
At times, counseling and education about the problem to ease a person’s anxiety is enough to make it tolerable until the episode resolves.
A few days of rest can often calm the pain down as well. Prolonged bed rest (more than 2 days to 3 days) is no longer generally recommended for people with low back pain.
Medications such as nonsteroidal anti inflammatory drugs (NSAIDS) or acetaminophen can be helpful. Occasionally, stronger medications such as muscle relaxants and narcotics are used for a short period.
Although there is minimal scientific evidence of their effectiveness in treating low back pain, back braces are commonly used. Most common is a corset type brace that can be wrapped around the back and abdomen. People who use corset type braces sometimes report feeling better supported and more comfortable.
Passive modalities include the application of heat or cold, massage, ultrasound, electrical stimulation, traction, and acupuncture. How long the benefit will last or what the chances are of receiving benefit from any of these treatments is not completely known.
Another form of passive treatment is spinal manipulation. There are many different practitioners of spinal manipulation, each with their own style of manipulation. This has also at times improved symptoms of low back pain.
The most commonly used injections are local anesthetic and/or steroids. They are usually given either in the area that is believed to be the source of the pain, such as into a muscle or facet joint, or around the nerves of the spine (an epidural or nerve root injection). Injections are occasionally placed into the disk, but this is done far less frequently.
Exercise and Stretching
Exercising to restore motion and strength to a painful lumbar spine can be very helpful in relieving pain. Although there is controversy as to which are the most effective spine exercises, it is generally agreed that exercise should be both aerobic (aimed at improving heart and lung function) and specific to the spine. Aerobic exercises include walking, jogging, swimming, and bicycling.
Proper Lifting Technique
Instruction in lifting techniques can be helpful as well. Improperly bending over to lift can cause a large increase in strain on the low back. Proper lifting keeps the back straight while you bend with the knees.
Surgery for low back pain may be necessary when a number of conditions have been met.
- The first condition is that nonsurgical treatment options have been tried and have failed. For example, surgery should not be done if an exercise program is effective but the person does not want to do it.
- The second condition is the surgeon believes the patient has a good chance of having a successful result with surgery.
- Another consideration that can influence a successful surgical outcome is stress. Low back pain, like many other pain problems, can be worse during times of stress. It may not be a good idea to commit to an operation like this when there are other major stressful events going on in one’s life. Occasionally, the back problem can become more tolerable once the stress is reduced.
- The third condition is that the patient must decide whether he or she is having enough of a problem to undergo an invasive procedure that is not guaranteed to work.
Spinal Fusion. Historically, the most commonly performed surgical procedure for low back pain has been spinal fusion. There are a variety of ways this is done, but the basic idea is to take the painful segment of the spine and get it to become a solid piece of bone. This will eliminate motion and, in theory at least, if it does not move, it should not hurt.
This can be done through the back (posterior approach) or through the front (anterior approach), or sometimes both ways. Spinal fixation of some sort is often combined with some form of bone graft or bone substitute. Bone graft can either be obtained from another part of the skeleton such as the pelvis (autograft) or be donated bone (allograft) that is processed and used in a spinal fusion.
The results of spinal fusion for low back pain vary. A good result is a decrease in pain. It is very rare for a patient to be completely pain-free after spinal fusion. Full recovery can take more than a year.
Disk Replacement. A newer technique that has recently been introduced in the United States is disk replacement. The procedure involves removing the disk and replacing it with artificial components, similar to what is done in the hip or the knee.
The goal of disk replacement is to allow the segment of the spine keep some flexibility and thereby maintain more normal motion. The recovery time may be shorter than with spinal fusion because the bone does not have to solidify.
Although disk replacement has been used in Europe for years, it has only recently been used in the United States. Early results are promising. Currently, disk replacements are done through an anterior approach and are primarily done on the lower two disks of the lumbar spine.
If you have suffered this type of injury, due to the negligence of another person or entity, you may be entitled to monetary compensation. These types of accidents require expert analysis and the resources of an experienced, board certified civil trial attorney. The Law Office of Steven S. Farbman, P.A., specializes in cases involving this type of injury and will make sure the negligent parties are held accountable for their actions. The Law Office of Steven S. Farbman, P.A. is committed to helping people who have been involved in an accident. We understand that being injured in an accident is a difficult time for you. Our office will be there for you in your time of despair. You are more than a file number at the Law Office of Steven S. Farbman, P.A.. You are family. We will protect your rights and aggressively pursue all legal remedies available to you under the law.
Call now for a FREE initial consultation 1(866) FLA-ATTY or fill the form below for a FREE on-line evaluation. These types of cases are subject to a Statute of Limitations. Therefore, it is extremely important you act immediately to ensure your claim is preserved and you do not waive your rights to the compensation you deserve. Our firm works on a contingency fee basis. This means we get paid for our services only if, and when, there is a money recovery for you. You deserve the best possible legal representation, so call us now 1(866) FLA-ATTY.