At What Point Should You Begin to Consider Bulging Disc Surgery?

Bulging disc surgery is a Bulging disc surgeryperfectly legitimate option for alleviating the debilitating symptoms often associated with spinal nerve compression if – and this is a big “if” – the symptoms remain stubbornly unaffected by the potential benefits of a well-planned regimen of conservative, nonsurgical treatment. The fact is, more than 90 percent of patients who experience nerve compression related to a bulging disc need never consider surgery. And of the small minority who do consider it, many find through a second or third medical opinion that another, nonsurgical option had been overlooked or ignored. Who, then, should actually consent to surgical treatment for a bulging disc?
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Stretching and Exercise as Cervical Bone Spur Treatment

Bone spur treatmentCervical bone spur treatment is a means to alleviate or manage symptoms associated with the growth of excess bone along the sides or edges of the vertebrae located within the neck region of the spine. Far more often than not, someone with bone spurs (osteophytes) within the spine never even realizes they are there. That’s because most bone spurs cause nothing more serious than a popping or cracking noise called crepitus, which can be heard occasionally when the head is turned.

Debilitating, chronic symptoms associated with spinal bone spurs can include pain, tingling, numbness, or muscle weakness in the upper extremities. These symptoms are caused by spinal nerve compression.
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Treating Thoracic Outlet Syndrome Through Minimally Invasive Surgery

thoracic outlet syndromeTwo newly published studies have found that minimally invasive surgery for neurogenic thoracic outlet syndrome (NTOS) can significantly improve patients’ symptoms. This relatively uncommon condition causes neck pain, paraesthesia in the arms, neck and hands, numbness and weakness in the upper body and is more frequent in young, active and generally healthy patients.

One of the studies found that a fairly recently developed type of surgery is particularly helpful at relieving thoracic outlet syndrome in adolescents when the pinched nerves are being caused by the pectoralis minor tendon. Read more

Treating Whiplash – Usual Care vs. Active Management

neck pain whiplash treatmentResearchers in the UK have concluded that active management consultations of whiplash in the emergency department are not cost effective and do not improve patients’ prognosis in acute whiplash, which can cause a number of symptoms, including neck pain. The types of things included in active management for acute whiplash were intensive physiotherapy, promotion of positivity for recovery, exercise, early re-engagement in daily routines, an educational booklet on whiplash, and pain management assistance. Patients receiving this type of care, compared to standard care, saw little additional benefit and no long-term benefits leading the authors to conclude that ‘less is more’ when it comes to acute whiplash care.

Usual Care vs. Active Whiplash Management

The study was published in the Lancet’s February 16th edition and was carried out by Sarah E. Lamb, DPhil, and colleagues from the Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom. A two-step process was rolled out for patients visiting one of 12 hospitals or 15 emergency departments (EDs) taking part in the study. Six of the hospitals and seven of the EDs recruited patients for the active management protocol and the remainder proceeded with usual consultation practices. The data was adjusted for initial whiplash grade and other potential confounding factors.

Symptoms of Whiplash Associated Disorder

Whiplash can cause a number of ongoing problems years after the initial injury and many of these are difficult to connect to the neck trauma, leading to problems in applying proper treatment. There is some evidence that cervical spine instability is more common in those suffering whiplash, with conditions such as facet joint arthritis and tinnitus an increased risk for such patients. Whiplash associated disorder may also involve cognitive deficits that can take weeks, months or even years to resolve, if at all. Headaches and neck pain are commonly associated with whiplash associated disorder and patients are often advised to do their best to avoid unnecessary stress and strain on the neck.

Little Difference with Added Care

Some 3851 patients took part in the first stage of the study, 2253 of whom were seen in hospitals in the active management group and 1598 in the hospitals providing usual care. Just over half of the acute whiplash patients were women (55%) and the mean average age was 37 years. Follow-up data was available for 70% of patients at the 12 month mark and the results showed little difference between the groups. The median Neck Disability Index scores varied by 0.5; a difference of 3 points is considered clinically meaningful.

Is Additional Physiotherapy Helpful in Whiplash?

In step two of the study, half of the patients were given a single physiotherapy session, to consolidate the advice given in their earlier ED visit, and the other half had a series of six physiotherapy sessions. Two thirds (67%) of the patients in the active group completed the prescribed course of physio after whiplash and 80% of the usual care group finished the course; those who provided follow-up data at four months (80%) showed modest benefit for neck disability but there was no long-lasting benefit at eight or twelve months. The additional cost of these sessions and the lack of clear benefit led the researchers to conclude that a single session and usual care in the hospital or emergency department is the recommended treatment for acute whiplash.


Lamb, S.E., et al, Lancet. 2013;381:514-515, 546-556.

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Neck Pain and Arm Tingling, Rheumatoid Arthritis and B12 Deficiency

rheumatoid arthritis B12 deficiency and neck pain

Is your neck pain really due to RA or are you vitamin B12 deficient?

Cervical spine degeneration is thought to occur in between 25% and 86% of patients with Rheumatoid arthritis (RA) and this can cause a variety of neurological problems including spinal cord compression and even death. Around 7-34% of patients end up requiring neck surgery to decompress the spine and relieve symptoms and one study even found that some 10% of patients dying from RA did so because of fatal cord compression.

Recognizing the symptoms of spinal cord compression can lead to prompt treatment and a more positive prognosis, but what if symptoms of cord compression in the cervical spine are really being caused by an underlying vitamin B12 deficiency? Read more

Thyroid Disease and Neck Pain

thyroid dysfunction and neck pain causes

It is easy to see how even slight swelling of the thyroid gland could trigger pinched nerve pain.

The link between thyroid dysfunction and neck pain can be quite complex and is more than simply pain caused by the swelling of the thyroid gland in the neck itself. There are myriad bodily processes reliant on proper functioning of the thyroid gland and many patients with muscle cramps and weakness, an increased sensitivity to pain, rheumatic pain and even carpal tunnel syndrome are unaware of the links between their symptoms and their thyroid gland. Read more

Treating Fibromyalgia-Related Neck Pain with SNRIs

cymbalta savella neck pain fibromyalgia treatment

Is Cymbalta overprescribed for neck pain and other fibromyalgia symptoms?

Cymbalta and Savella offer only a small degree of pain relief for those suffering from fibromyalgia, according to a new meta-analysis. The Cochrane review’s authors suggest that advertisements for the drugs that show women becoming free of fibromyalgia symptoms are misleading and that physicians need to discuss realistic expectations with their patients. More than five million Americans are thought to suffer from fibromyalgia, with around 80% of patients women and many receiving one of these selective serotonin and noradrenaline reuptake inhibitors (SNRIs)as treatment. Read more