Marc Darrow MD,JD

Chronic neck pain is one of the more frequent problems we see in our new patients because of its complexity and difficulty in finding the true cause of pain.

Patients may also present themselves with numbness or pain radiating from the neck into the arm due to nerve compression. Cervical radiculopathy is a common cause of pain in the arm. It is caused by nerve root compression in the neck as a consequence of a herniated disc, or spondyliotic foraminal stenosis. It causes severe pain especially during the first few weeks, and paraesthesias in the forearm and hand. Patients also suffer from neck pain and loss of strength in the relevant arm. The arm pain can be exacerbated by certain movements of the head. Diagnosis can be made on the basis of history and physical examination. The pain generally disappears without active patient treatment.

In cases where it does not, the patient will live day to day on pain medications, frequent chiropractor and physical therapist, and then onto a surgical recommendation.

Disc degeneration is a diagnosis typically given when reading an MRI or x-ray. The problem is that the image on the film of a suspect disc or discs may not be showing the true cause of pain. Often our patients will be visiting us as the 6th, 7th, or more clinics they have visited seeking relief of their neck problems.

While many patients will come in with a diagnosis of herniated cervical discs and a recommendation for cervical spinal fusion, it is ligament instability, once identified after a physical examination, which is the causing of the patient their neck pain.

Chronic neck pain usually centers around the nerves.

Chronic neck pain usually centers around the nerves. A disc in the neck can become herniated or “bulge” because of the wear and tear of the tendons, ligaments, and muscles. One possible diagnosis out of many may be spondylolisthesis – where one vertebra slides forward over the bone below it. Another reason neck pain is so prevalent is that the weight of the head is not proportionate to the strength and size of the neck. Often times, laxity in the ligaments create pain down the arms, when most doctors think there is a radiculopathy, needing surgery.

Sometimes in an attempt to stabilize the weakened area of the neck, bone spurs will form (osteoarthritis) to “hold things in place.” It is at this point “conservative treatments” for alleviating the pain of the neck area are used. This can begin with a steady diet of anti-inflammatory medications to ease the nerve pain. Cortisone may be injected to reduce inflammation and swelling.

Chiropractics is often tried to push the vertebrae back into place and usually it does, but the vertebrae will slip back because of loose ligaments that chiropractors can cause, and the pain cycle starts again. As pain increases, the surgical consultation is considered. To prevent pain, either bone is chipped away from the nerves (laminectomy) or fusion to prevent the vertebrae from slipping out of place is recommended. Fusion Surgery Fusion surgery is of course a complicated surgery, metal and/or bone is attached to the vertebrae and “fused” together to prevent the vertebrae from moving and cause distress on the nerves. Fusion surgery has its draw backs. First, even if successful, the fusion will limit the patient’s mobility in the neck region.

Second, the fusion can cause a “different pain,” because new stress is placed on the non-fused area above and below the fusion. Third, new pain can be caused by the damage of the surgery to connective and supportive tissue, ie ligaments and tendons already in a weakened state. As a former surgeon in training, I believe that surgery should always be the last option (unless an emergency situation), especially when there are treatments such as Prolotherapy available that can ease the patient’s pain, permanently. Prolotherapy Prolotherapy causes inflammation by irritation. How can this possibly be beneficial? Because the inflammation is controlled to those select areas of ligaments and tendons damaged by wear and tear and whose weakness causes bones to slip out of place. Is this effective for disc degeneration?

However in our office, we see a patient who will come in with chronic and long-standing neck pain with clear indicators that their problems are brought on by cervical ligament and tendon weakness.

Series of cervical spine MRIs

Neck MRI findings.

Everyday we get many emails.  In many of these emails the person asking a question sends me their cervical neck MRI findings. That is all they send: A cut and paste of their MRI report. They never say what their pain is like, how this neck pain is affecting their day to day quality of life, or any other glimpses into how this chronic neck pain is hurting them. The email that they send me is all about their neck MRI. Our own clinical findings and that of researchers is that maybe your neck pain should not be all about your MRI.It should be about you.

As many of you are already aware, MRI interpretations can be a long, hard to understand, somewhat frustrating thing for a patient to see and read. The MRI may also seemingly describes a lot of problems with a lot of terminology that can be considered frightening. This may, for many, cause unneeded anxiety and fear. I have been doing regenerative medicine for more than 20 years. Over the years we have been blessed to have helped many people with their neck pain. I have seen patients with varying degrees of degenerative cervical spine disease trying to avoid surgery, I have also seen patients after a cervical neck surgery with more challenges than before the surgery who, unfortunately, may have had a surgery that they did not need. The one thing many of these people had in common was a cervical neck MRI that suggested a lot more problems than the patient was actually having.

Is the neck MRI really showing what my problem is?

Interpreting MRIs can be challenging. In a recent study from March 2019, (1) researchers found the most prevalent MRI findings were:

  • Cervical foraminal stenosis (77%)
    • The foramen is the gap or passages between the vertebrae that the nerves pass through. If this passageway is made narrower by bony overgrowth there is obviously less space for the nerves to pass through. Over time this passageway can close up enough that the nerves are “pinched.” Why does the bone overgrow? Bone overgrowth can be caused by spinal instability. When the cervical spine is unstable, loose, or wobbly, neck moves in an unnatural motion. Cervical neck instability is generally caused by stressed, weakened and damaged spinal ligaments.

As bad as it may look on an MRI, cervical foraminal stenosis, may not be causing the patient any problems: We have seen this clinically and researchers have seen it and reported it in their published studies:

In the Clinics in orthopedic surgery,(2) surgeons wrote: “Cervical foraminal stenosis is one of the degenerative changes of the cervical spine; however, correlations between the severity of stenosis and that of symptoms are not consistent in the literature. Studies to date on the prevalence of stenosis are based on images obtained from the departments treating cervical lesions, and thus patient selection bias may have occurred.”

The surgeons suggested that the patient was treated based on what the MRI said, not what they patient said was wrong with them. Perhaps this is why when people send me an email, some never suggest what their symptoms are, only what their MRI said. In this study, the surgeons also suggest that patients may have been sent to surgery that was suggested based on the bias of the MRI interpretation. A surgery the patient may have not needed at all.

Returning to our initial overview of most prominent MRI readings, next came

  • uncovertebral arthrosis (74%)
    • This is wear and tear damage occurring at the uncovertebral joint or Luschka’s joint, located on each side of the four cervical vertebrae at C3 to C7 in the cervical spine. This is where bone spurs most commonly develop.
  • and disc degeneration (67%)
    • This is of course are the problems herniated or pinched nerves.

Do these problems indicate surgery? Research: “It is difficult to rule out the possibility of bias; radiological findings may influence surgeon’s decision making.”

Let’s look again at the study in the Clinics in orthopedic surgery.

  • “Cervical neuromuscular disease is manifested by symptoms in specific neuromuscular regions of the upper limbs, and radiating pain is mostly caused by cervical nerve root compression due to stenosis of the cervical vertebrae. In the presence of progressive neurological deterioration, intractable pain, signs of myelopathy, fracture, instability, or ligamentous injury, and bone anomalies or destruction are associated with surgical indications.
  • “However, (this can all be) asymptomatic. To determine the affected level that requires cervical spine surgery, the patients undergo neurological and physical examinations and then both CT and magnetic resonance imaging (MRI); if the results do not match, additional neurophysiological testing is required to determine the affected level. However, if neurological examinations are performed after radiological examinations, it is difficult to rule out the possibility of bias; radiological findings may influence surgeon’s decision making.”

Sometimes surgery is recommended. But should it be for you?

This is a good question and one that certainly needs to be answered inside an examination room. However, returning to our initial overview of the most prominent MRI readings, let’s look at the least prevalent finding:

  • nerve root compromise or compression (2%)

Now if you are in that 2% there is a strong chance that you are suffering from cervical radiculopathy or pain from the nerves. In theses cases surgical options may have to be considered, but, a second opinion looking for non-surgical options may also be warranted.

In my article on this website: Can stem cell therapy help you avoid neck surgery? I write that I regularly see patients who have been told by another doctor that they need a neck surgery to prevent the further degeneration of their cervical spine. Some of these patients are very frightened by what their doctor told them. Some were told that if their symptoms progress they could risk permanent damage to their ability to function maybe to the point of paralysis. I show that research has strongly suggested that many patients decide on cervical fusion surgery because they fear a progression of their problem that will lead to permanent disability. However, follow-up data on patients with degenerative disease of the upper (cervical) spinal vertebrae show little or no evidence of worsening degeneration over time.

Listen to Dr. Darrow explain

This is an audio clip from Dr. Darrow’s radio show Living Pain Free. In this clip – a transcript of the clip is below – Dr. Darrow answers an email from a woman whose husband has had a cervical spine discectomy that has left him in more pain. She is trying to find him help. Dr. Darrow reads her email and discusses the problem of the failed neck surgery.

Dr. Darrow: This woman writes about her husband: “He is now in so much pain. The the worst is waking up. The pain is horrible but he gets up and goes to work. He gets no help with his pain. Please is there anything that can be done to assist him, he has been living with this for years and is getting worse since the surgery. Can you please help?

So this is a cry for help because of a failed surgery.”

I think the key points here are that number one:

  • This gentleman had cervical degenerative disc disease and this poor guy had a neck surgery for it and had a disc removed from his neck. I’m not sure what good that did because he’s in worse pain now. I see this all the time where people come in and have discectomy is and they’re worse. Sometimes the surgeon will put in what’s called a spacer or some type of plastic or metal device between the vertebrae to take the place of the disc they removed. Now some of these surgeries must work very well or they couldn’t keep doing them but I get cases where the surgery didn’t work. Should there ever be a surgery done for degenerative disc disease. In my position, here in the patients I see and the work that I do of regenerating the body, regrowing tissue by doing injections of platelets or stem cells or mixed together that we seem to get people better who have degenerative disc disease.

Not relying on MRI

  • I see many people with degenerative disc disease that don’t have any pain. So I’m not going to trust an x-ray or MRI to decide for me if the person has pain. I know this is a mind-bender for a lot of people because we grew up thinking that if we see something on an MRI or an x-ray that must be the truth of who we are and it just is not the case. It is difficult sometimes to  explain to new patients who come in that what they see on MRI and what they really have can be two different things. Studies show that people that have no pain at all can have terrible things in their MRIs and X-rays and vice versa, they can have terrible pain and their MRI or x-ray shows nothing. We have to be very careful, as doctors to remember to use our hands so as doctors we need to touch the area, move the person around, find out where the pain is being generated from.

The failed surgery

  • It is possible in this case that we discectomy in this man’s neck which was a surgery that in my book should never have been done.
  • Discectomy is a drastic surgery. It removes a disc to get rid of neck pain or back pain and in this case it didn’t work. I get patients like this all the time. They come in after these failed surgeries, failed meaning surgery was done and it didn’t work, now with a diagnosis of failed shoulder surgery, failed hip surgery, failed neck or back surgery. What do these recognized diagnosis tags tell you? That way too many of these surgeries are being done and they are failing people. These failed surgeries should have never been done in the first place.

How can this person be helped?

  • Regenerative medicine using platelets and stem cells are typically the answer for how to heal these areas. These treatments do not work all the time, but I am saying is that the landscape of medicine in musculoskeletal and orthopedics is totally changing from doing surgery to regenerating the body. The easy part about doing regenerative medicine is it’s a very simple injection process we don’t have to open up the body with a scalpel of the side effects are very minimal if any very rare to have side effects if possible that’s very rare wear a surgery there are many side effects.

In a person with failed neck surgery, we would have to examine the neck and as mentioned above, physically find the spots in the neck that is causing this person’s pain. Then we could develop a program to help alleviate the pain and restore function.

Treating cervical ligaments to restore neck stability

In our office, treating chronic neck pain begins with the repair and strengthening of cervical ligaments. Our treatments, discussed below and demonstrated in the video are Platelet Rich Plasma Injections and Stem Cell Therapy injections. Ligaments are the connective tissue that hold your cervical spine vertebrae in place and your neck in its correct anatomical alignment. When your ligaments are weak, they can no longer hold the neck in proper alignment. When the neck is not in alignment the vertebrae can pinch nerves, constrict arteries, put pressure on your esophagus among other problems that may cause the myriad of symptoms people relay to us in their emails.

Injecting the platelets or stem cells right along the ligaments or on the facet joints. This can help restore neck stability and reduce or eliminate pain. I have had this done to my neck to help alleviate my neck pain.

C1-C2 instability and a reverse curve

Of the many emails that I get are ones which discuss C1-C2 cervical spine instability. Many emails will talk about chronic upper cervical subluxation at C1-C2 and a reverse curve. The normal curve of the spine is shaped like a backwards “C.” If you have a problem with your neck, Lordosis is probably a word you are very familiar with. When your curve went from a natural “C” shape to a reverse curve you were probably told you had a reversed lordosis or your neck had become Kyphotic. Your neck is now curving in the opposite direction. This may be causing a lot of pain. Some of the pain maybe from muscle spasms. As the muscles are trying to stabilize the spine, the extra workload causes spasms.

When the spine is moving towards a reversed curve, adjacent segments may show cervical disc degeneration at lower levels such as C2-C3, C3-C4. These are the problems which will lead many people to a cervical spine fusion.

Our treatments to restore cervical neck stability by repairing and regenerating the neck ligaments

Many patients with these problems will talk about dizziness or even Bell’s Palsy. They also talk about 2 – 3 times a week chiropractic adjustments. When the patient says they are having success at the chiropractor with their cervical lordosis and their symptoms of dizziness, we know that we can have a realistic expectation that we can help. The chiropractic is helping because the vertebrae are pushed back towards a natural alignment. The reasons that the patient needs to see the chiropractor 2 – 3 times a week is because the the adjustments are not holding. We do get many referrals from chiropractors to help their patients by strengthening the cervical ligaments with our injection treatments.

Platelet Rich Plasma injections

PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected back into the injured area to stimulate healing and regeneration. Research has shown PRP to be effective in treating degenerative disc disease by addressing the problems of cervical spine ligament instability.

Stem cell injections

Stem cell injections involve the use of Bone Marrow derived stem cells. The stem cell treatments help restore ligaments strength by causing the regeneration of ligament, tendon, cartilage and bone regeneration.

In our articles we discuss these treatment options

PRP and stem cell therapy for TMJ and TMJ with neck pain

Can Stem Cell Therapy help you avoid neck surgery?

Stem cell therapy and PRP for Whiplash associated disorders

Do you have questions? Ask Dr. Darrow

 


A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician.Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

References:

1 Jensen RK, Jensen TS, Grøn S, Frafjord E, Bundgaard U, Damsgaard AL, Mathiasen JM, Kjaer P. Prevalence of MRI findings in the cervical spine in patients with persistent neck pain based on quantification of narrative MRI reports. Chiropractic & manual therapies. 2019 Dec;27(1):13.
2 Ko S, Choi W, Lee J. The Prevalence of Cervical Foraminal Stenosis on Computed Tomography of a Selected Community-Based Korean Population. Clin Orthop Surg. 2018 Dec;10(4):433-438. doi: 10.4055/cios.2018.10.4.433. Epub 2018 Nov 21. —2549

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