Category: Procedures and decisions

DO I NEED SURGERY

Neck surgery is clearly the right answer for progressive neurological weakness. It is also right for cervical myelopathy (a squeezed spinal cord) with functional decline. And it is right for radiculopathy (a pinched nerve root) that has not settled with genuine conservative care and matches a structural lesion. For most neck pain, the structure causing it has to be identified first.

Two questions get lumped into one here. Could an operation help you? Has the structure causing your pain been identified? Those are different questions — and the second one has to be answered first.

When is neck surgery clearly the right answer?

There is no doubt in some presentations, and it does nobody any good to invent some.

• Progressive neurological deficit. Strength that is measurably declining, not pain that is severe. This is a decompression question, and it is time-sensitive.
• Degenerative cervical myelopathy with functional decline. Cord compression causing clumsy hands, imbalance, or a change in gait (the way you walk). The clinical practice guideline supports surgical management for moderate and severe cases. Registry data consistently show one thing. Symptoms that last longer before surgery predict a worse functional recovery afterward. This is the one diagnosis where waiting has a measurable cost.
• Radiculopathy that has not settled with genuine conservative management, where a structural lesion matches the exam and the level. In that group, surgery relieves arm pain faster than conservative care. The systematic reviews are fairly consistent on two points. The advantage is in speed. And the gap narrows over one to two years.

The findings that should not wait are listed separately. They are short on purpose.

Do I need surgery if my MRI shows wear in my neck?

Most neck pain is not in the categories above. Persistent axial neck pain — pain in the neck and shoulder blade, without a matching neurological deficit — is the most common case we see. It is also the one where a scan showing degenerative change (discs and joints breaking down) is least likely to be the explanation.

Fusing a level because it looks worn on imaging, with no test tying that level to the symptom, is how people end up with a solid fusion and unchanged pain. The operation succeeded. The question it answered was never asked.

For that group there is a testable alternative path. Facet-mediated pain (pain from the facet joints) can be identified with diagnostic blocks and treated with ablation. And the two procedures treat different problems rather than competing for the same one.

Does this practice perform neck surgery?

We are not a practice that steers patients away from surgeons on principle. It would be dishonest to present restraint as a virtue when the real position is narrower than that. Dr. Padda is a surgeon. The practice performs stimulator and pump implants, nerve decompressions and microdiscectomy. Cervical fusion itself is not part of the treatment plan here. Where it is truly indicated, we say so and help you get to the right surgeon.

What we do is send you into that conversation with an examined diagnosis. The value we add before a surgical opinion is finding which structure generates the pain. That way, the surgeon is answering a specific question, not an open one. That is the same note we send to referring physicians.

What should I ask a surgeon before neck surgery?

• Which structure is generating my pain, and what established that? A level named on imaging is not the same as a level tested.
• What is this operation expected to fix, specifically? Arm pain, neck pain, weakness and numbness respond differently. An operation aimed at one will be judged on all four.
• What happens to the levels above and below? Adjacent segments carry the load a fused level no longer takes. And the rotation you lose is not usually discussed beforehand.

None of these is a hostile question. A surgeon with a clear indication answers all three quickly. That is exactly why they are worth asking. Whether any of this applies to you depends on which structure is causing it.

Frequently asked questions about neck surgery

How do I know if I need surgery on my neck?

Three findings point clearly toward surgery. Strength that is measurably getting weaker. Spinal cord compression that makes your hands clumsy or changes your balance or walk. Arm pain from a pinched nerve that has not settled with real conservative care and matches what the scan shows. For most other neck pain, the first job is finding which structure is actually causing it.

Is it worth having neck surgery?

It depends on what the operation is meant to fix. For a pinched nerve that has not settled, surgery relieves arm pain faster than conservative care. But the gap narrows over one to two years. For cord compression with worsening function, waiting has a real cost. For neck pain alone, fusing a level only because it looks worn can leave a solid fusion and the same pain.

Is there an alternative to neck surgery?

Often, yes. When the pain comes from the small facet joints at the back of the neck, a diagnostic block can show whether that joint is the source. If it is, radiofrequency ablation treats the nerve carrying that pain. Ablation and fusion treat different problems. So the test decides which one fits you, rather than one simply replacing the other.

When should I get a second opinion on neck surgery?

Before the operation is scheduled, not after. A second opinion is most useful when a level in your neck has been named on a scan but never tested. Finding which structure generates the pain means the surgeon answers a specific question, not an open one. A surgeon with a clear reason to operate can explain it quickly.

WHAT IT FEELS LIKE

Most of these procedures feel like a few seconds of sting from the skin anesthetic, then pressure rather than sharpness. You stay awake so you can tell us what changed. Radiofrequency ablation carries the most sensation, and discography is designed to provoke your pain.

Nobody asks this in the room, and almost everybody wants to know. So here it is, procedure by procedure. We leave out the kind of reassurance that makes people trust the answer less.

Are you awake for a neck injection?

Everything we do is done with you awake and able to talk, under local anesthetic, with no sedation. That is not a cost-saving decision, and it is not stoicism. A block is a question put to a specific structure. The answer is you telling us what changed. Sedate that away, and you have performed the procedure but lost the information it existed to produce.

There is trial evidence on exactly this in the transforaminal epidural setting. Adding sedation changes reported pain scores in a way that muddies the diagnostic read. For a diagnostic injection, it defeats the purpose. We use no sedation for any of them, and most patients drive themselves home.

The other half of the reason is safety. A needle near a nerve root is safer when the person attached to the nerve can say “that went down my arm.”

Does a neck injection hurt?

• Medial branch block. Local anesthetic in the skin first, which stings for a few seconds. After that, pressure rather than sharpness. Two or three small nerves per level, a few minutes in total. Most people are surprised it is over. The block is a test, not a treatment, which is why it is short.
• Cervical epidural. The same skin anesthetic, then a deeper pressure feeling. Occasionally your usual arm symptom is briefly brought on as the space is entered. That is useful rather than alarming. It is delivered to a level, not to a neck.
• Occipital nerve block. Among the quicker ones. A small volume goes in at the base of the skull. Afterward, the scalp is numb for a few hours. People rarely expect that, and occasionally find it stranger than the injection. It answers a diagnostic question the same day.
• Radiofrequency ablation. The longest of them, and the one with the most sensation. Test stimulation comes first. That is a buzzing or tapping you will be asked to describe. Then comes the lesion itself, under local anesthetic. Aching for a few days afterward is normal. The nerves regrow, which is the deal nobody explains up front.
• Discography. The one we are most honest about, because it is designed to provoke. The question is whether pressurizing a given disc brings on your pain. So a positive result hurts. It is the only test that asks a disc directly, and it is not ordered casually.

Does an EMG or nerve conduction study hurt?

Nerve conduction studies and EMG have a worse reputation than they deserve. The published work on tolerability (how well people handle them) is reassuring. The studies are safe. People consistently rate the discomfort lower afterward than they expected beforehand.

Two halves. The conduction half delivers brief electrical pulses. They are startling rather than painful, like a static shock you can see coming. The needle half uses a fine wire electrode in several muscles. It is held still while you contract gently. It aches. It does not require anesthetic, and it takes a few seconds per muscle.

Anticipation is doing most of the work here, and that is not a dismissal. Trial data on procedural anxiety shows that simply describing what is about to happen lowers both anxiety and reported pain. That is the entire reason this page exists.

What are the side effects of a steroid injection in the neck?

Corticosteroid injections are well characterized (well studied). In trained hands, the serious complication rates are low. The common effects are a sore site for a day or two, a few days of flushing or disturbed sleep, and a short-lived rise in blood glucose. That rise matters if you are diabetic, and it is discussed beforehand if you are.

We are not going to inflate that into a warning block. And we are not going to pretend it is nothing. It is a short list, it is known, and you should hear it before rather than after.

What we ask of you

Tell us during, not afterward. If something brings on your symptom, say so at that moment. That is the data. If something is unpleasant in a way you did not expect, say that too, because almost everything can be adjusted. Nothing is done on the first visit, so you will have met us and seen the room before any of this applies to you.

Frequently asked questions

How long does it take to recover from a neck injection?

After a steroid injection, the most common effect is a sore injection site for a day or two. Some people also have a few days of flushing or disturbed sleep, or a short rise in blood sugar, which matters if you are diabetic. Radiofrequency ablation leaves an ache for a few days, which is normal. After an occipital nerve block, the scalp can feel numb for a few hours.

Is it normal to feel my arm pain during a cervical epidural?

It can happen, and it is useful rather than alarming. As the needle enters the epidural space, some people feel a brief return of their usual arm symptom. Say so at that moment. Being awake and able to report that sensation is part of what makes a needle near a nerve root safer.

Does radiofrequency ablation hurt?

It is the longest of the neck procedures and the one with the most sensation. First comes test stimulation, a buzzing or tapping feeling you will be asked to describe. The treatment itself is done under local anesthetic. Aching for a few days afterward is normal. The treated nerves regrow over time, which is worth knowing before you start.

Why is discography painful?

Because it is designed to be. Discography asks whether putting pressure on one particular disc brings on your own pain. So a positive result hurts by definition. It is the only test that asks a disc that question directly, and it is not ordered casually.