Neck Pain
Anatomy
 The normal anatomy of the spine is usually described by dividing up the spine into 3 major sections: the cervical, the thoracic, and the lumbar spine. (Below the lumbar spine is a bone called the sacrum, which is part of the pelvis).
The cervical spine is in the neck region. Though the cervical spine is very flexible, it is also very much at risk for injury from strong, sudden movements, such as whiplash-type injuries. This high risk of harm is due to: the limited muscle support that exists in the cervical area, and because this part of the spine has to support the weight of the head. This is a lot of weight for a small, thin set of bones and soft tissues to bear. Therefore, sudden, strong head movement can cause damage. Each section of the spine is made up of individual bones called vertebrae.
There are 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae. An individual vertebra is made up of several parts. The body of the vertebra is the primary area of weight bearing and provides a resting place for the fibrous discs which separate each of the vertebrae.
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Conditions
Facet Joint Syndrome
 The vertebral bodies are stacked one on top of another to form the entire structure we call the spine. In between vertebral bodies are tiny joints called facet joints. As arthritic change and inflammation of the joints occur, the nerves to the facet joints can convey severe and diffuse pain. The pain does not follow a nerve root pattern. It is actually called 'referred pain', as the brain has trouble localizing these internal structures. Patients often complain of pain in a generalized poorly defined region of the neck or back. There may be some tenderness overlying the involved joints as well.
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Muscular Spasm
 The muscles around the neck can tighten up as the result of trauma or underlying disease and result in a painful spasm. This is usually the component of pain which responds to massage and heat the best. Often there are several things going on at the same time which necessitate treatment. When the underlying condition causing the spasm is improved and treated, the spasm often resolves.
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Cervical Radiculopathy ('Pinched Nerve')
 Degeneration of the cervical spine can result in several different conditions that cause problems. These are usually divided between problems that come from mechanical problems in the neck and problems which come from nerves being irritated or pinched. A cervical radiculopathy is a a problem that results when a nerve in the neck is irritated as it leaves the spinal canal. This condition usually occurs when a nerve root is being pinched by a herniated disc or a bone spur.
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Spinal Stenosis
 Most neck pain is due to degenerative changes that occur in the intervertebral discs of the cervical spine and the joints between each vertebra. Perhaps the most serious of the problems caused by degeneration of the spinal segment in the cervical spine is the condition of spinal stenosis. In the late stages of spinal degeneration, bone spurs from the degenerative process can cause a condition known as spinal stenosis. As the bone spurs form, the size of the spinal canal becomes smaller. The bone spurs begin to press on the spinal cord or the nerve roots. Pressure on the nerves in the spinal cord can cause numbness, tingling, or pain in the arms, hands, and legs. This condition is sometimes called cervical myelopathy. It is from the simpler problem where only one nerve root is being pinched by a herniated disc or a bone spur.
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Whiplash
Whiplash is most commonly associated with rear-end car collisions in which the heads of those in the front car are suddenly snapped back and forth by the impact. It is more accurately called cervical acceleration/ deceleration (CAD) trauma or syndrome, which describes the rapid movements that can injure the vertebrae of the neck and the muscles and ligaments that support them.
Anyone can be subjected to whiplash, even in a low-force car crash at speeds as low as 5 mph. But injuries associated with whiplash can also result from other mishaps in which the head is pushed or jerked beyond its normal range of motion. Whiplash most commonly causes serious and lingering neck pain, but there may also be back pain, headaches and dizziness.
Since bruising of the brain can also occur in auto accidents and similar severe causes of whiplash, some victims experience blurred vision, ringing in the ears, nausea and numbness. The sudden accident that caused the whiplash may fade into memory, but the physical and psychological damage can become chronic, eroding a victim's quality of life.
Pain management techniques may be particularly well-suited to relieving the neck pain and debilitating effects of whiplash. In many cases, they can:
- Restore movement lost after the accident
- Overcome muscle weakness and enhance muscle tone
- Speed recovery, and
- Diminish chronic symptoms that can persist or recur over many years.
Treatment can reduce many of the aspects of the distress that results from whiplash, allowing patients to return to their normal activities rather than seeing themselves as invalids -- as is otherwise true of many whiplash patients long after an accident.
Above all, however, we continue to stress the importance of seeking treatment as soon as possible.
Once you contact us, we will perform a complete exam and will develop a treatment approach tailored to your particular injury -- including traditional medicine, acupuncture, massage, physical therapy, or other approporiate alternatives and techniques -- and we will explain our approach in detail. If necessary, we will help you begin to cope with the legal and insurance aspects of your case as well.
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Procedures
 Epidural Anesthetic Block and Steroid Injection
A block that is performed under fluoroscopy to confirm a specific diagnosis and/or decrease pain and inflammation.
 Selective Nerve Root Block (SNRB)
A block that is performed to determine if a specific spinal nerve root is the source of pain and reduce inflammation around the nerve root (usually from a herniated disc at this level) thus decreasing or relieving the pain.
 Facet Block
A block (or local anesthetic injection) that is performed to confirm that a facet joint is the source of pain and decrease pain and inflammation in a facet joint or joints. Actually this is the only true way to diagnose Facet Joint Syndrome, as an abnormal looking joint on X-ray or CT scan, may be painless, and vice versa a normal looking joint may be the pain generator.
EMG/NCS
 An electromyogram/nerve conduction study (EMG/NCS) is a diagnostic test that looks at the function of the nerve roots leaving the spine as well as their terminal branches in the arms and legs. The test is done by inserting tiny electrodes into the muscles of the lower extremity and by surface electrodes to check the speed and magnitude of signal transmission. By looking for abnormal electrical signals in the muscles, the EMG/NCS can show if a nerve is being irritated, or pinched as it leaves the spine. The test is similar to checking the electrical system in a car to find out where the wiring is not functioning properly. Based on the EMG/NCS, a physician can better formulate a treatment plan.
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Nonprocedural Treatments
Physical and Occupational Therapy
This type of therapy may consist of exercises to improve range of motion, strength and conditioning. A good therapist will examine you, assess your deficits and disease and formulate a plan based on optimizing function and minimizing pain. These exercises are specific for the nature of your injury and should be executed under the supervision of a physician who understands your case.
Modalities
Modalities include simple age-old treatments such as heat, cold and massage as well as newer treatment methods such as acupuncture, manipulation, and electrical stimulation. Your physician and therapists should formulate an optimal treatment protocol to maximize your healing potential. These modalities are often used in conjunction with Physical and Occupational therapy.
Medications
Depending on the nature of your problem, Non-steroidal antiinflammatory drugs ['NSAIDS'], corticosteroids, and opioids [narcotic] medications may be used. If there is a muscular spasm, a muscle-relaxant may help alleviate that aspect of your pain. Narcotics should be minimized and used only for short periods if at all possible due to rapid tolerance and all the attendant risks associated with abuse of a controlled substance.
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Surgery
Dr. Sandhu performs minimally invasive surgeries which result in a rapid recovery and minimal risk to the patient. Although we do not perform large-scale open surgeries in our clinics, there are occasions where a problem requires surgical intervention.
We can help screen potential surgical candidates and send them for evaluation by the appropriate specialist. These surgeons are usually orthopedic surgeons or neurosurgeons with specialized training for the particular disease process involved.
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