Surgery for neck pain is an interesting topic of discussion, since most spinal operations do not specifically seek to end pain, nor do they frequently succeed in this goal, particularly over multi-year timelines. In fact, when it comes to providing satisfying pain relief, surgery scores among the lowest in terms efficacy, while simultaneously rating the very highest for risks and significant complications of treatment. With shocking statistics like this, any thinking person can not help but wonder why anyone would agree to go under the knife as a form of neck pain treatment. However, there are many reasons why patients follow this path.
Neck surgery is commonplace, bested only by operations on the lower lumbar spine when it comes to invasive forms of dorsalgia treatment. The neck offers a variety of locations and conditions that can be treated surgically, but the objectives of treatment are often not clearly understood by patients, which is a fact made obvious by disappointment when the pain does not resolve postoperatively.
If you are considering neck pain surgery, then this discussion is made just for you. Be sure to read it and understand it thoroughly before proceeding with any type of surgical spinal intervention for neck pain.
Surgery for Neck Pain Defined
Neck pain surgery is not the same as neck surgery. Neck pain operations are performed specifically to reduce or cure pain associated with some form of spinal pathology, at least from the patient’s perspective. Unfortunately, it is well known in medical circles that most of the common spinal surgeries have a bad record for providing pain relief, while some, like spinal fusion, demonstrate absolutely no proof that they reduce pain from any diagnosis. This fact comes as a shock to virtually all patients, who assume that the treatment prescribed for them must be meant to cure their pain. However, this is simply not the reality.
Doctors diagnose pathology in the spine based on imaging evidence. However, most doctors will not commit that the pain that is experienced is a direct result of these structural pathologies. This is because doctors are not stupid. They know that committing to such a claim will subject them to legal consequences if and when a treatment fails to deliver satisfying results. Furthermore, they of course also know that atypical structure in the spine does not accurately predict pain. They know that most neck pain treatments fail to cure pain. They know that surgery is not even meant to target pain-generating mechanisms, but instead simply makes the spinal anatomy more typical in structural presentation. They also know that most chronic pain, regardless of where it occurs, is not structurally-motivated. All this knowledge aside, doctors offer and perform surgery daily, since this is how they make their living and what a fine living it is, placing surgeons at the top end of medical earners worldwide.
So, let’s begin our guidance by informing all readers that just because a doctor recommends surgery does not mean that the idea of pain being cured is inherently being offered. In many cases, pain worsens after surgery, while in few cases is it actually cured. Even when a cure results from surgery, pain often recurs due to symptom substitution in a different and often directly related location, requiring additional procedures. This is statistical fact; not editorial opinion.
Surgical Goals
Why would neck surgery be offered if pain relief is not an inherent goal? Well, this depends on the type of procedure being offered. Some surgeries are symptomatic in nature, which means that they are directed at achieving pain relief. These types of techniques do not address the underlying source of pain, but instead seek to prevent the pain from signaling by interfering with the nerve signals transmitting the messages between brain and body. All forms of nerve ablation fall into this category and since these techniques do work, it is easy to understand their popularity. As long as the spine is sound but the patient is experiencing severe pain, a symptomatic approach to care might actually be ideal, as long as the surgical goal of pain relief succeeds.
Surgical goals for disc and bone abnormalities are more complicated, since these conditions rarely provide evidence that they are the true pain-generating mechanism and have never been established as being universally pathological. This includes degenerative disc disease, herniated discs, osteoarthritic, facet joint changes, atypical spinal curvatures and mild to moderate degrees of spondylolisthesis, among others. Most of these conditions are not only questionable in the pain-potential, but the interventions used to “correct” them are also not proven to reduce pain or even be necessary. This includes the common application of discectomy, spinal fusion and various forms of foraminotomy and laminectomy.
When patients learn these truths they are stunned and begin to understand why they have suffered through often multiple spinal operations, yet still have pain despite every surgery being called a “success” by the operating doctor!
Surgery for Neck Pain Statistics
Alright, so let’s come right down to it and let the facts speak for themselves. We examined the most common non-symptomatic spinal operations on the neck and have found the following outcomes as being typical when it comes to providing pain relief:
Discectomy is the most common of all spinal operations and is used to remove part of a degenerated or herniated intervertebral disc. Some discectomies are followed by artificial disc replacement or spinal fusion, but these examples will be detailed in the sections below. Discectomy as an exclusive form of surgical treatment fails to provide any significant degree of pain relief in the majority of cases over timelines of 7 years. Many patients do not receive any pain relief, while others enjoy several weeks, months or even years of reduced symptomology. Even in these best case scenarios, most patients report still having some neck pain postoperatively. A minority of patients report escalated symptoms immediately following surgery and most will not recover, even with the passage of time and the application of additional surgery. This is the reality of failed back surgery syndrome, which has now become an epidemic condition worldwide.
Foraminotomy and laminectomy are used to increase the size of the neural foramen and central spinal canal. In many instances, this is necessary since the spinal cord or spinal nerves are suffering obvious compression, even when pain is not one of the symptoms expressed. Therefore, some of these operations are needed, even when pain relief is not the primary goal. However, when pain relief is the main objective for the patient, these operations tend to perform moderately well, with about half of all patients reporting marked relief postoperatively. Fewer patients suffer escalated pain compared with discectomy, indicating a higher degree of accuracy in the diagnosis of spinal stenosis and foraminal stenosis. However, even when the operation is a complete success and nerve tissue is freed; about half of the total number of operated patients still have pain, which is then often scapegoated on scar tissue or some other “unpreventable” occurrence.
Disc replacement surgery is very unpredictable in its outcome, but has the potential to completely relieve pain when all goes well and the diagnosis of the disc as the symptomatic mechanism is accurate. However, these assertions are taking much for granted, since complications are commonplace and the misdiagnosis of disc pain is the single greatest blunder in the neck pain industry.
We saved the worst for last. Spinal fusion, also called spondylodesis, is the worst offender when it comes to providing pain relief postoperatively. This is no surprise, since fusion goes against the natural design of the vertebral column and is proven to cause accelerated degeneration and injury to neighboring segments of the backbone. Only a minority of fusion patients enjoy complete pain relief from any substantial amount of time, while a majority suffer escalated pain over future years and require multiple follow-up operations. Of all the spinal operations performed, spinal fusion fails in all goals more than any other and often results in functional disability. Pain relief is no exception to this rule, since the objective is rarely successfully met in postoperative fusion patients.
