Neck Pain and physicians

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I have had a few colleagues, surgeons and anesthesiologists, who have required surgery for cervical herniated disks. It appears that we are at risk for these conditions in our profession (think there was a recent occupational health study to this regard). I had been experiencing some mild radiculopathy and neck pain with running but it became something more this summer. I tried a medrol dose pack but then stupidly was throwing my kids in the pool this summer and the next day I thought my shoulder had exploded. Some PT quickly revealed that this was not my shoulder but my neck. Obtained an MRI and had severe foraminal stenosis at C5-6 and C6-7. Every day I wake-up and I have nearly debilitating pain into my shoulder/triceps/scapula. I have weakness in my triceps. I have a great surgeon (one who all the docs go to) who thinks he can do a microdiskectomy from the back and spare my disks. Epidural steroid injection calmed things down mildly for a few days but still with significant pain that is limiting my activities and making work difficult.

Any of my colleagues out there had similar issues?

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I know we are not supposed to give medical advice on here but I feel for you

If the weakness is mild and not worsening:
Try home traction
Gabapentin if you tolerate it
One or even two more epidurals before you commit to surgery

If the weakness is significant or is worsening, get the surgery sooner rather than later, or you may be left with a permanent deficit
 
I used to get a really stiff neck. Daily. I thought I'd be having an MRI---> potential surgery at some point. No radicular symptoms, just neck arthritis. Never had it evaluated in any professional sense.

After addressing an anxiety/depression problem it improved 80-90% and I now realize that it was extreme neck strain from "stress". My neck muscles were just unbelievably tight. I still have some stiffness not attributable to muscle tightness (thus likely some legit arthritis) but it's markedly improved.

I only bring this up because, of course, our profession subjects us to some degree of stress, and if others have similar symptoms (not like the OPs) it may be attributable to stress induced muscle rigidity as it was for me..... My "condition" prevented me from having the best insight into the matter at the time. Never could I have imagined this could have been muscular in nature..... It was rather severe.
 
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Not me personally but I have a few colleagues who are at high risk for needing cervical surgery as well as bilateral knee procedures in the near future
 
I have a mentor who became a good friend who was debilitated by cervical disease.

He SWEARS that there is something traumatic about how we do intubations that sets us up for neck issues. Saw him intubate a few times - he wasn't one of those "eyes in the patient's mouth guys", nor was he obviously awkward in his technique.
 
There are some papers looking at it for surgeon's related to their ergonomics and for anyone who spends a ton of time at a computer desk doing paperwork.

Work-related Musculoskeletal Symptoms in Surgeons
SAGE Journals: Your gateway to world-class journal research

Not to offer specific medical advice, but generally I counsel against surgery for pain, but for motor weakness due to nerve compression, there are better data. With that said, steroids do not fix severe foraminal compression, so if something must be done, find someone you trust to do something definitive rather than microdiscing you every few years, unless it's really just a disc issue. In the cervical spine, it's more often a combination disc/facet joint/bony issue, as those discs get dry/stiff pretty early, and so a foraminotomy/laminectomy/fusion are often better. If it were me, I would much rather have an anterior procedure than a posterior one most days of the week, as I see less chronic pain problems after those cases, but I don't have data to back that up.

I try to avoid AEDs in most people that are high functioning, but I am more aggressive with trials of TCA/SNRIs.

I would definitely hit it hard with PT/traction/etc to delay a surgical event unless you're having frank defined motor deficits that are not secondary to pain, in which case operate sooner.
 
I have a mentor who became a good friend who was debilitated by cervical disease.

He SWEARS that there is something traumatic about how we do intubations that sets us up for neck issues. Saw him intubate a few times - he wasn't one of those "eyes in the patient's mouth guys", nor was he obviously awkward in his technique.

Interesting. Any thoughts on what kind of positioning/movements cause it then?
 
I used to get a really stiff neck. Daily. I thought I'd be having an MRI---> potential surgery at some point. No radicular symptoms, just neck arthritis. Never had it evaluated in any professional sense.

After addressing an anxiety/depression problem it improved 80-90% and I now realize that it was extreme neck strain from "stress". My neck muscles were just unbelievably tight. I still have some stiffness not attributable to muscle tightness (thus likely some legit arthritis) but it's markedly improved.

I only bring this up because, of course, our profession subjects us to some degree of stress, and if others have similar symptoms (not like the OPs) it may be attributable to stress induced muscle rigidity as it was for me..... My "condition" prevented me from having the best insight into the matter at the time. Never could I have imagined this could have been muscular in nature..... It was rather severe.

my neck muscle is crazy tight too and it also gives me neck pain and headache. i feel a knot in the back of my neck! happens more often when im working or reading and it gets really annoying.

i wonder how stress causes all these things.
 
Not to be cliche, but I think part of the blame goes to cellphones (and millennials). Think about what most people do all day...hunched forward staring at cellphone, hunched forward driving a car, hunched forward at a desk or computer. We are flexed forward all day long, so no wonder people have neck and back problems. I’ve made a conscious effort to do neck and back extension stretches and exercises and it has helped quite a bit.
 
I have a mentor who became a good friend who was debilitated by cervical disease.

He SWEARS that there is something traumatic about how we do intubations that sets us up for neck issues. Saw him intubate a few times - he wasn't one of those "eyes in the patient's mouth guys", nor was he obviously awkward in his technique.

This is interesting and I wonder if using the glidescope more will help. Also, if you look at the machines, many monitors are placed above the eye level.

I also refuse to move heavy patients. I only stabilize their head and let everyone else do the heavy work
 
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Don’t have surgery!

PT and time and more PT



So, I still deal with some neck tightness. I just did that Mackenzie technique and I got immediate therapeutic benefit. Very nice. (yes, I realize this is not supposed to be a quick fix....lol)
 
We need to take care of our bodies to enjoy our hard earned money. No one really focus on how a stronger back (upper and lower) and a less tight hamstring/buttock muscles can help decreased the risk of having neck/back pain. How many of you can touch the tip of your feet when bending down? How many of you have lower back pain from a simple look-under-the-drape maneuver to check on your patient? Youtube has a lot of videos to help strengthening your back and loosening of your hamstring. I personally like Athlean-X, lots of videos for your back,buttock, hamstrings, and exercises for your knees and hips. No orthopods gonna touch my knees/hips/back unless it's an emergency.
 
So, I still deal with some neck tightness. I just did that Mackenzie technique and I got immediate therapeutic benefit. Very nice. (yes, I realize this is not supposed to be a quick fix....lol)


I feel like you have imbalances in your pec muscles vs your upper back muscles. How is your posture? Do you bench press a lot but don't do any back exercises?
 
We need to take care of our bodies to enjoy our hard earned money. No one really focus on how a stronger back (upper and lower) and a less tight hamstring/buttock muscles can help decreased the risk of having neck/back pain. How many of you can touch the tip of your feet when bending down? How many of you have lower back pain from a simple look-under-the-drape maneuver to check on your patient? Youtube has a lot of videos to help strengthening your back and loosening of your hamstring. I personally like Athlean-X, lots of videos for your back,buttock, hamstrings, and exercises for your knees and hips. No orthopods gonna touch my knees/hips/back unless it's an emergency.

i can barely even touch my knees.

took a look at the mckenzie video. realized i actually do a lot of this (pulling chin back) to help with my throat discomfort
 
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I feel like you have imbalances in your pec muscles vs your upper back muscles. How is your posture? Do you bench press a lot but don't do any back exercises?

My posture kinda sucks, I'll admit. I do push ups a bit, not much for back per se, at least not recently.

I agree with you that a strong back is important.
 
Microdiscectomy = eventual fusion a few years down the line when the disks above and below blow. The body is amazingly resilient. I know it hurts, but heat, ROM, PT, traction.

Give it time..I say this as someone who spent two years wearing helicopter night vision goggles 5 nights a week. Recurrent debilitating neck pain, occasional weakness in triceps. Didn't even want an MRI. With time, conservative therapy, problem went away.

Also focus on posture
 
I was an orthopedic PT for 10 years in my prior career.

My workday is so much better now!
 
Microdiscectomy = eventual fusion a few years down the line when the disks above and below blow. The body is amazingly resilient. I know it hurts, but heat, ROM, PT, traction.

Give it time..I say this as someone who spent two years wearing helicopter night vision goggles 5 nights a week. Recurrent debilitating neck pain, occasional weakness in triceps. Didn't even want an MRI. With time, conservative therapy, problem went away.

Also focus on posture
Maybe that is my problem...I too am an ex-flight surgeon. Do you have any data to support that a microdiscetomy leads to fusion or is this just your observation? I had a surgical collegue that was dropping instruments from his foraminal stenosis and was back in the OR doing cases 4 days later after his microdiskectomy. He wished he had his surgery earlier. I just get nervous waiting too long with weakness. I mean, it is mechanical obstruction primarly, not inflammation, with a disk herniation.
 
Maybe that is my problem...I too am an ex-flight surgeon. Do you have any data to support that a microdiscetomy leads to fusion or is this just your observation? I had a surgical collegue that was dropping instruments from his foraminal stenosis and was back in the OR doing cases 4 days later after his microdiskectomy. He wished he had his surgery earlier. I just get nervous waiting too long with weakness. I mean, it is mechanical obstruction primarly, not inflammation, with a disk herniation.

Mostly anecdotal, I did a brief pubmed search but the only papers I found followed out for < 3 years and were industry or spine surgeon driven.

I am an IPM guy and have spoken with several very conservative surgeons about this and observed in my fellowship and daily clinical practice, FWIW.

Remember, herniated discs shrink once outside of their milieu. Not uncommon for repeat MRI at 6-12 months to show partial-complete resolution.
 
This neck issue is making me look at my overall health differently. I could use to lose about 15 lbs. Have any of you had any success with exercise/lifestyle improvement classes that you would like to share? I remember doing p90x about 10 years ago and thought those were badass but wouldn’t likely have much success with those now.
 
While "mechanical obstruction" has a ton of face validity if you think of this as a wire being cut, the problem is pain itself causes weakness and the biologic wires have remarkable plasticity to combat being cut.

Surgery is not reversible and structural changes can have consequences. The studies that are out there looking at reoperation rates are generally in the 1 - 5 years and are primarily done by folks invested in doing a surgery. The mechanical obstruction issue in older patients is generally not limited to just a disc as there are often also other bony changes that will need addressing.

The microdiscectomy approach is generally an easier recovery, but once a patient starts down the road of having injections/spine surgery, it tends to be a thing they'll need in the future. It may get a person back up to speed faster, and if they are having frank/definable motor fiber issues, then it may prevent further damage.

As with 61N, I primarily see the trainwrecks in pain medicine, so there is some observer bias at play.

Posture, PT to help target the area, OT to help you understand your work environment, CBT/DBT, and anything other than a needle/blade is preferrable.

Reasonable people can argue about discectomies vs laminectomies vs plates vs rods, but that's better to talk with spine surgeons about.
 
We need to take care of our bodies to enjoy our hard earned money. No one really focus on how a stronger back (upper and lower) and a less tight hamstring/buttock muscles can help decreased the risk of having neck/back pain. How many of you can touch the tip of your feet when bending down? How many of you have lower back pain from a simple look-under-the-drape maneuver to check on your patient? Youtube has a lot of videos to help strengthening your back and loosening of your hamstring. I personally like Athlean-X, lots of videos for your back,buttock, hamstrings, and exercises for your knees and hips. No orthopods gonna touch my knees/hips/back unless it's an emergency.

Exactly this. I think even @FFP has hit on this point but we need to take care of our bodies as
Physicians and not just be fat slobs. Get in that gym, get on that bike, and get on that track and set a good example.
 
This neck issue is making me look at my overall health differently. I could use to lose about 15 lbs. Have any of you had any success with exercise/lifestyle improvement classes that you would like to share? I remember doing p90x about 10 years ago and thought those were badass but wouldn’t likely have much success with those now.

Weight loss is 90% in the kitchen and 10% exercise
 
This neck issue is making me look at my overall health differently. I could use to lose about 15 lbs. Have any of you had any success with exercise/lifestyle improvement classes that you would like to share? I remember doing p90x about 10 years ago and thought those were badass but wouldn’t likely have much success with those now.

Metformin 1-2 gm/day and low carb diet.
 
While "mechanical obstruction" has a ton of face validity if you think of this as a wire being cut, the problem is pain itself causes weakness and the biologic wires have remarkable plasticity to combat being cut.

Surgery is not reversible and structural changes can have consequences. The studies that are out there looking at reoperation rates are generally in the 1 - 5 years and are primarily done by folks invested in doing a surgery. The mechanical obstruction issue in older patients is generally not limited to just a disc as there are often also other bony changes that will need addressing.

The microdiscectomy approach is generally an easier recovery, but once a patient starts down the road of having injections/spine surgery, it tends to be a thing they'll need in the future. It may get a person back up to speed faster, and if they are having frank/definable motor fiber issues, then it may prevent further damage.

As with 61N, I primarily see the trainwrecks in pain medicine, so there is some observer bias at play.

Posture, PT to help target the area, OT to help you understand your work environment, CBT/DBT, and anything other than a needle/blade is preferrable.

Reasonable people can argue about discectomies vs laminectomies vs plates vs rods, but that's better to talk with spine surgeons about.

I share an office with a spine surgeon and we talk about cases constantly as we share many patients.

He told me a story once that when he was doing his fellowship, the fellowship director's wife developed acute lumbar radicular pain, with legit drop foot.

The fellowship director wanted conservative care for her first, prior to jumping into surgery, even with this frank motor deficit!

Spine surgery is no joke. Even though the cash grabbing scuz buckets of the world seem to have somehow taken over the field.

E.g. my dad and brother both had cervical radicular pain with no weakness at all that had only been going on for a month or two, no PT/meds/injections yet, etc and both were offered spine surgery

Both resolved in a few months on their own with no intervention (which is the natural history of radicular pain)

Be careful out there...

On the other hand, my younger brother at the end of high school had severe lumbar radicular pain (had to drop out of school for a semester and quit his job too, just laid on the floor in our living room mostly, was brutal to watch) for a year and a half and failed everything conservative and eventually had surgery. When you wait that long, even if you decompress the nerve, at times the damage is already done to the nerve, which was the case with him. He has had chronic radicular pain for the last ten years.

So its not a one size fits all deal. An art as much as a science.

But I think your case is very straight forward. I would advise you as I posted above.

Best wishes.
 
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Try aquatherapy first, CESIs, gabapentin...

if refractory, surgical option.
 
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