Failed Neck Surgery Is An Increasing Cause Of Mechanical Neck Pain.
Fusion is traditionally considered as solid bony union in spinal surgery. Surgical spinal fusion was introduced for providing mechanical support to vertebrae affected by tuberculosis and for treating progression of scoliosis. The creation of adequate fusion is of significant interest to spinal surgeons, because unsuccessful fusions result in significant neck pain and suffering and often require re-operations. Mostly, the overall outcome of neck surgery depends upon a solid fusion between the selected spinal bones.
Poor neck surgery technique and other factors, such as smoking, steroid medication and failure of the patient to comply with instructions after surgery are some of the reasons that lead to a non-union of structures. Most cases of neck surgery form a union and become stable, thus requiring no further surgery to revise the situation. On occasion, enough movement will be present at the area of non-union that mechanical or axial pain will be present.
A non-union after sugery forms what is called a pseudoarthrosis and is most often seen with neck sugery performed through the front of the neck in a procedure called an anterior cervical discectomy and fusion, which is a common surgical procedure. With the use of new instrumentation and plates called ventral cervical plates, the rate of non-union or failure to fuse has decreased.
Where there is non-union or pseudoarthrosis from failure to fuse, there can be a collapse of the structures which places the nerves under pressure as the foramen or opening for the nerve through the bones becomes narrowed. In these cases, the patient may have radiculopathy or pinched nerve along with mechanical neck pain.
According to the New England journal of Medicine, Volume 350:722-726 February 12, 2004 Number 7, Spinal-fusion surgery is expensive, with the average hospital bill more than $34,000, excluding professional fees. A Cochrane systematic review (2004) reported the results of 14 studies that evaluated three comparisons of different fusion techniques for cervical degenerative disc disease and concluded that discectomy alone has a shorter operation time, hospital stay, and post-operative absence from work than discectomy with fusion with no statistical difference for pain relief and rate of fusion.
For failed neck surgery, CT scanning is the most useful radiographic technique to evaluate a pseudoarthrosis, as it gives the best bony detail. X-rays can help determine the extent of instability contributing to mechanical neck pain.
The next part focuses on Rheumatoid Neck Disorders, which can cause mechanical neck pain.
Mechanical Neck Pain | Features Neck Pain | Radiographs Neck Pain | Cervical Strain | Cervical Degenerative Disc Disease | C4 Radiculopathy | Rheumatoid Neck Disorders | Shoulder Problems | Mechanical Neck Pain Summary