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Frequently Asked Questions
Dr. Robert Pashman has answered the most frequently asked questions about Neck Pain.
What causes neck pain?
Neck pain has a variety of causes. Poor body mechanics, herniated discs, spinal fracture, muscle spasms, spinal deformity, and osteoarthritis are a few reasons. Your physician will determine if the pain is mechanical, (coming from the joint or the disc); radicular, (coming from a nerve or nerve root); or myelopathic, (coming from the spinal cord) and determine a treatment plan.

What is a herniated disc?
A disc is the fibrous cartilage pads that lie between the spinal vertebrae; each is made up of two parts: a jelly-like center (the nucleus pulposus) that loses moisture with age, and a tough outer ring (the annulus fibrosus) that can split with age or injury A herniated disc occurs when the disc's jelly-like center (the nucleus pulposus) ruptures the tough, fibrous outer ring (the annulus fibrosus) oozing through small openings in the vertebrae where nerves enter the spinal column.

What is the difference between a herniated disc and a bulging disc?
A bulging disc is a slight protrusion of the center of the disc (nucleus pulposus) into the spinal canal. In a bulging disc, the annulus fibrosus (outer ring) has not been ruptured.

A disc herniation is a large protrusion of the nucleus pulposus (center of the disc), which has burst through the annulus fiborsus (outer ring of the disc) into the spinal canal, invading the surrounding nerves and causing pain in the neck, shoulders or arms.

Are bulging or herniated discs normal?
No, they are not "normal" in that we are not born with herniated or bulging discs. They are very common and occur with age and natural dehydration and degeneration of the disc. MRI studies of asymptomatic patients showed that approximately 40% of the population has herniated or bulging discs.

Does whiplash cause herniated discs?
Whiplash refers to a sprain or strain of the muscles in the neck. This occurs when there is a sudden flexion and extension of the neck. A disc that is bulging or predisposed to herniation may become herniated at the time of trauma.

Should I have a MRI if I have pain?
Your physician will determine is an MRI is necessary. Generally, an MRI is ordered for patients that have failed conservative therapy, or have persistent pain in the neck, shoulder, or arms, or exhibit weakness in the arms.

What can I do to avoid surgery?
The best way to avoid surgery is to keep physically fit, maintain a healthy weight, avoid smoking, avoid repetitive motion, and use proper body mechanics. Alternative therapies may relieve the symptoms and allow patients to avoid or delay surgical intervention.

Are there alternative therapies available to help me deal with my pain?
Alternative therapies such as light traction, acupuncture, Pilates, anti-inflammatory medication, a short course of steroids, or trigger point injections are often treatment options for neck pain. While these may relieve some symptoms, there is not a "cure" for herniated discs.

When do I need surgery?
Surgery is only indicated if conservative therapy fails, the patient becomes dysfunctional, or the patient should experience progressive neurological problems.

Will I have irreversible damage if I delay surgery?
Your physician will advise you based on your condition. In general, if there is severe spinal cord compression or a nerve is compressed over a period of time there may be irreversible damage. If a patient experiences an increase in weakness, weakness in the legs, loss of balance, or loss of bladder or bowel control, they should be reevaluated by their spine specialist immediately.

When do I need a fusion?
The treatment plan is individualized for each patient. A fusion becomes necessary when there is instability in the spine. This may occur because of degeneration of the disc, a spinal deformity such as spondylosis, or during as a result of removing a disc during surgery. A fusion is performed to reconstruct the spine's natural balance and lordosis (curvature). Instrumentation such as screws and plates may be used to stabilize the spine while the bony fusion grows.

The BRYAN® Cervical Artificial Disc or Prestige Artificial Cervical Disc may be an alternative to fusion for some patients. To find out if this is an option for you, please call 310-423-9986.

Why is surgery often done through the front of the neck?
The anterior (front) approach is preferred because the muscles in the front of the neck naturally part and offer direct access to the disc while the spinal cord is protected by the vertebra. Because the muscles naturally part rather than being cut, there is less trauma and a faster recovery.

What effect does a fusion have on the rest of the cervical spine?
That is an excellent question. In a one level fusion, there is little impact on the spine.

In a multilevel fusion, the major concern about performing a fusion is adjacent segment degeneration. The discs act as shock absorbers between the vertebras. When the spine is fused, the levels above or below the fusion may absorb the sheer force from every day motion, and thus wear out the discs. When the fusion is performed with the appropriate size bone graft, the balance of the spine is maintained and the adjacent segments are at less risk of degeneration.

Should I have allograft or autograft bone?
This is decided on an individualized basis. In general, I use an allograft (donor bone) and BMP in single level fusions, and autograft (bone graft taken from the patient's hip) for multilevel fusions. Under some circumstances in a single level fusion, and in multilevel fusions, using bone harvested from the patient's hip may have a higher fusion success rate.

Will the surgery lessen my mobility?
A one level fusion does not greatly limit a patient's mobility, possibly 5-7%. Most of the yes/no motion is from C1/C2 area. If a patient is experiencing extreme muscle stiffness, they may experience greater motion following surgery when the muscles relax.

In a multilevel fusion, a patient may have some decreased motion.

Will I have pain after my surgery?
Most patients have minimal pain following an anterior fusion surgery. The first few days following surgery are the most uncomfortable, and patients often experience a sore throat. The pain is well tolerated, and easily managed with pain medication.

What are my chances for success?
The success of the surgery is determined by the reconstruction of the balance of the spine and the reduction/elimination of the patient's symptoms. The outcome is dependent on the condition of the spine and surgeon performing the surgery.

What are my risks?
There are risks associated with any surgical procedure. The risks for a cervical surgery include but are not limited to: inter operative complications, infection, bleeding, hardware failure, hoarseness, paralysis, and death.

Will my surgery be photographed or video taped?
Occasionally Dr. Pashman will take interoperative pictures for educational purposes. The photos or video do not show any identifying features (such as name or your face). This is covered in your surgical consent form. If you have a preference about being photographed, please let Dr. Pashman know when you sign the consent form.

Will I have to wear a collar after surgery?
In the majority of cases, a collar is not necessary.

When will I be back to my normal activities? Driving?
Patients resume normal activities when they have recovered full coordination and experiencing minimal pain.

Can I have an MRI after having an Anterior Cervical Discectomy and Fusion?
MRI or CT scans are performed on patients that have had spinal fusion with titanium instrumentation to rule out re-herniation or to aid the physician in diagnosing a new problem. Always inform the imaging technician performing the MRI or CT scan that you have spinal instrumentation.
Should I donate blood before surgery?
There are pros and cons in donating blood prior to surgery. Generally, Dr. Pashman does not require patient's to donate blood prior to a surgical procedure. More information can be found here.
After spine surgery, do I need antibiotics before getting my teeth cleaned?
Yes. The American Dental Association and American Academy of Orthopedic Surgeons recommend prophylactic antibiotics in joint replacement patients before teeth cleaning. Your dentist will prescribe the antibiotics for you. Here is a copy of the guidelines.

Prestige Total Disc Replacement

Review FAQ's for the Prestige Artificial Disc.

Review Prestige Artificial Disc cases here.


not intended as a substitute for medical advise.  Always consult your physician about your medical condidion.
Last modified: March 14th, 2011