When Neck Pain Is Serious

Carl Karchner, 48, of Stroudsburg, Pa., received treatment for his herniated disc

Fusion hasn’t slowed him down—Carl Karchner (with son Michael in foreground) is back on the court, thanks to skilled neck surgery and a determined attitude that helped him recover quickly. Freed from years of pain, he says, “I’m doing everything I want to in life.”

The problem first appeared after Carl Karchner spent a whole day raking stone. The 48-year-old Stroudsburg, Pa., man had always been physically vigorous; he owned a construction business and had played sports all his life. But now, it was clear something was wrong with his neck. “If I tipped my head back, it was like flipping a switch and getting shocks in my arm and fingers,” he says.

Arm pain or weakness, along with neck pain, is a classic sign of a “pinched nerve.” It can be due to a herniated disc or bone spur from degenerative disc disease in the cervical (neck) spine, says orthopedic spine surgeon James Weis, M.D., of Lehigh Valley Health Network. Degenerative disc disease is extremely common. “It’s normal for the spine to degenerate with age,” he says, “but some people develop a herniation or bone spur that pinches a nerve or compresses the spinal cord.”

The condition runs in families. It also can result from accidental injury, sports (soccer pros who do a lot of “heading” are at high risk), and job-related factors like heavy lifting—the apparent culprit for Karchner.

After an MRI revealed the herniation, his doctor prescribed a series of treatments including steroid shots for the pain, physical therapy and chiropractic decompression. “We start with conservative measures whenever possible, and often that resolves the problem,” Weis says.

If the diseased disc is actually pressing on the spinal cord, surgery is required, says Weis’ colleague, neurosurgeon Chris Lycette, M.D. “Spinal cord compression is what makes cervical disc problems much more serious than pains in the lower back,” he says. “The consequence of a further accident could be paraplegia.”

Karchner’s various treatments eased his pain—temporarily. Then his car was rearended, and while the physical impact wasn’t serious, “It shook me up mentally,” he says. “I realized my neck was vulnerable, and also that my personality was changing from the constant pain.” He asked for a referral to a surgeon.

Both orthopedic surgeons and neurosurgeons perform cervical spine procedures. “The key is to find someone who is fellowship-trained as a spine surgeon or does a high volume of spine surgery,” Lycette says. When Karchner arrived in his office, the two discussed his options.

The classic surgical cure for badly diseased discs is fusion, a word that strikes fear into many patients. It shouldn’t, Weis says: “Spinal fusion has a long and very successful track record. It’s a great surgery—if the indications are there for the particular patient.”

Working from an incision in the front of the neck, surgeons remove the diseased disc and insert a bone graft to act as scaffolding. Today’s grafts use bone from a bone bank rather than from the patient’s own hip (which was painful), and sophisticated stabilizing hardware. The titanium plate Lycette used in Karchner’s neck is no bigger than a quarter. Many patients—including Karchner—go home the same day. “A fused vertebra won’t move the same as a healthy one,” Lycette says, “but when your pain is so severe you can’t turn your neck, fusion can actually improve range of motion.”

A newer option is the artificial disc. Made of metal backing and a moveable core of high-density plastic, the disc “functions pretty much like a natural disc,” Weis says. “The other advantage is that unlike fusion, disc replacement puts no added stress on adjacent discs.” Researchers are now studying multilevel disc replacement for the many people who have more than one diseased disc.

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