Jeffrey R. Carlson, MD
As we all get busier in life, being injured or sick is a major inconvenience. Every day, I meet with patients with spinal disc herniations in their neck that cause pain in their arm. Some of these patients are in severe pain and cannot perform their daily activities and/or go to work. As a result, they become increasingly more anxious about their prognosis. These patients usually come to my office ready to have surgery to fix their disc herniation. On the other hand, I have patients who find the pain a significant annoyance, but they still aren’t ready to commit to a surgical procedure to eliminate the pain.
Generally, surgery is not the first option for patients that aren’t having severe pain, weakness or nerve injury. In those patients with less pain and dysfunction, we will start with a physical therapy program, as well as an anti-inflammatory medication and muscle relaxer. If these patients do not get better, an injection of steroid around the nerve in the neck can decrease the pain and inflammation, which may improve the pain. When these methods do not work, our next discussion is about surgery.
Cervical spine surgery is one of my most commonly performed procedures. I discuss with my patients several options or approaches to the type of surgery to be done, as well as the surgical risks and recovery period. One of the main questions from patients is “How long can I safely wait to have the surgery?” Scheduling issues, work, and life in general are concerns which lead to this question. The answer is that these are surgeries that are usually completed in less than an hour and the patient can go home the same day. Their arm pain usually goes away in the first 24 hours and patients are very grateful to be rid of the pain.
Recently, the Rothman Institute presented their research at the International Society for the Advancement of Spinal Surgery that helps to answer this question. They looked at the Health Related Quality of Life (HRQOL) scores on patients that were having cervical spine surgery. The HRQOL analysis evaluates patients according to their pain, disability and dysfunction, as well as their mental and physical health. They were able to divide these patients by the duration of their symptoms pre-operatively. Of the 216 patients, all had similar HRQOL scores prior to surgery due to their nerve compression and pain. Post-operatively, those patients with symptoms longer than 6 months had less improvement in their pain and function. In those patients with symptoms that lasted longer than 2 years, there was another step down in the patient’s improvements after surgery.
This makes intuitive sense, in that the longer you have compression on the nerve, the more likely there will be permanent damage to the nerve. This study relates the length of time of the symptoms to the ability to get better. Our nerves can only take so much pressure before they become permanently damaged, and even removing the pressure from the nerve surgically will not be able to completely fix the pain and dysfunction. Unfortunately for some patients, they may not be able to give an exact date for when the symptoms began. There also may be delays in treatment related to insurance issues or other medical conditions. So the overall advice to patients is to get the pressure off of the nerve as soon as you can. This will give the nerve the best chance for improving, as well as getting you back to your normal life and activities more quickly.