Neck and Arm Pain

You can treat most neck pain at home with simple anti-inflammatory medicines. However, it is time to go to your doctor when those home remedies no longer give the relief they once did.

For example, if the neck pain doesn't resolve with simple anti-inflammatory medications or it starts going in your arm, it is time to go to your physician. However once pain, weakness, or numbness is experienced in your arm, it is crucial to consult a Dr. Johans immediately. These symptoms could result from nerve damage, which is potentially irreversible. Seeking treatment earlier on will give patients a high chance of recovery. Weakness or numbness is a big red flag that the nerves are dying, and help is needed immediately.

Until then, be assured that 80% of neck pain resolves on its own just by diminishing your physical activity. Ice, heat, and anti-inflammatory medicines usually can reduce pain, but when that is no longer effective, it is time to go to Dr. Johans.

The time to seek a neurosurgical consultation is when the neck pain has become unbearable and your primary care physician has identified something of concern. While some insurance companies may require a referral from a primary care physician, it is not always required to schedule a consultation with Dr. Johans. For example, cancer, tumor, or instability can cause the pain in your neck to rotate and radiate down your arm to such a degree that it is causing significant distress.

Another reason to seek the help of Dr. Johans is when your arm or hand begins experiencing weakness or numbness. These effects can be permanent, so you need to get into the neurosurgeon's office quickly when they start. Whatever sensation you lose might be gone forever. It can also be helpful to bring a description of your job and its physical requirements to the first consultation with Dr. Johans so he can have a clear picture of what your post-op goals and needs might be.

It is essential to understand that when you are sent to a neurosurgeon for a consultation, it doesn't automatically mean that you will have an operation. Thanks to the effectiveness of at-home remedies, you usually won't have an operation. However, the red flags of weakness, numbness, cancer, tumor, trauma, and pain control issues call for more immediate surgery.

It is difficult sometimes to know whether or not your neck pain is critical enough to require a trip to the emergency room. It is time to go to the emergency room for neck pain if it is unbearable, if you lose bowel or bladder control, have high fever, and feel progressive numbness or weakness.

Significant reasons to go to the emergency room for neck pain include numbness and tingling in your arm or body. If you've recently experienced trauma, like a car wreck, you should go to the emergency room immediately to ensure no further injury or harmful complications. Neck pain can also indicate infection, which is common in immunocompromised individuals.

If any of those symptoms are starting to occur, head to your nearest emergency room sooner rather than later, probably right now.

The big goal of putting off surgery is to give your body time to heal. Once that fails, surgery will become necessary.

The biggest reason to move towards surgery is when your arm begins to lose strength and become weaker or if there is increased numbness and pain moving from the neck to the arm.

We will proceed with surgery after an evaluation with an MRI and if there is progressive weakness, advanced numbness in your arms or anything below your neck, loss of bowel or bladder control, or if the pain is unbearable.

There are quite a few reasons one might need neck surgery. We'll discuss whether surgery is in your best interest during your consultation. Bone spurs and disc herniation are two significant conditions that may require neck surgery in the following segments.

When a disc herniation or a bone spur is large enough, or if it is causing neurological loss (weakness or numbness), or if the pain radiating down from your neck down your arm is unbearable, it is time to consider surgery.

The largest goals of neck surgery are to provide stability, increase range of motion, and prevent further pain, numbness, tingling, and weakness. Neck surgery can help ease neck pain, but it is never a 100% guarantee because you may or may not get your strength or sensation back.

When you are sent to a neurosurgeon like Dr. Johans for neck pain, we will consider a few different things. There are some excellent reasons to have a neck operation for neck pain. Patients with cancer, tumor, neck instability from trauma, or arthritic problems that cause neck pain, can benefit from neck surgery.

It is a complex judgment for a neurosurgeon to determine whether or not neck surgery will help your neck pain since it doesn't always relieve neck pain. The primary goal for the surgery is to ease problems in your arm or neck instability. Harmful instability is when the bones move too much when moving your head back and forth.

Dr. Johans has been through this process himself. After six years of treating his own neck pain with anti-inflammatory medicines and other nonsurgical remedies, surgery was necessary. The pain had become severe and unbearable, and his daily routine was no longer normal. Once the pain, numbness, tingling, and weakness had begun affecting his arm, he underwent an operation.

Since then, surgery eliminated the arm pain, and the neck pain was cut in half. While surgery made the pain more tolerable, anti-inflammatory medicines and careful movements were and still are required even after 24 years.

Dr. Johans will sit with you to discuss your unique situation and suggest a treatment plan that ultimately fits your goals and lifestyle.

There are inherent risks for all operations, including surgery on your neck. Dr. Johans seeks to ensure that every patient understands the risks, which include bleeding, infection, stroke, or death. Additional risks include nerve injury (increased numbness and weakness in the arm) spinal cord injury (quadriplegia), voice change, and a lack of fusion. These are serious and rare, but real complications. It is always advised to speak with a surgeon like Dr. Johans who has extensive experience with this exact procedure and a history of very few complications.

On average, in Dr. Johans’ experience patients can expect to lose about an ounce of blood during surgery. As an expert with decades of performing surgeries, Dr. Johans has never had to give a patient a blood transfusion after surgery. Additionally, the national average of developing an infection from surgery is less than 3%. Dr. Johans has never had a patient who has developed a deep cervical wound infection after a surgery. We do everything possible to prevent infection from surgery while patients are in our care.If an infection does occur, it is a severe situation that can cause significant complications that require immediate medical intervention.

A patients’ risk of stroke or death is mainly from their physiology. For example, patients with heart or lung conditions will face a higher risk from having surgery. Dr. Johans will ensure that the anesthesiologist knows these conditions.

Due to the nature of these surgeries, there is some risk of damage to the neck, nerves, or spinal cord. The most significant risk is a loss of arm function or quadriplegia. Dr. Johans has never injured a spinal cord or caused a quadriplegic catastrophe. He has touched the spinal cord hundreds of thousands of times.

Dr. Johans has an impeccable record and has never had surgery resulting in these complications. If you are being evaluated by a different surgeon, that surgeon should know and share their personal risk rates openly with you. If they don’t, find a new surgeon.

Additional risks include:

• Impaired ability to swallow (common but almost always mild and temporary)
• Instability due to an unsuccessful fusion, (smokers have a higher chance of this possibility) (rare)
• Hoarseness of the voice or permanent voice change (<1% chance of persistent hoarse voice)

There are reasons that would require Dr. Johans to order an MRI to diagnose your neck pain. Since this test can be costly and cannot detect early-stage causes of neck pain, only a few significant factors demand an MRI.

These factors include:

• Neck pain that is unresolved by at-home remedies after 6 weeks of non-surgical care like physical therapy, medications or chiropractic
• Pain moves from the neck down to the arm
• Pain that becomes unbearable
• Loss of neurological function (numbness, weakness, or inability to feel arm like before)

Patients’ needs to get an MRI if they are experiencing the above issues. If left untreated, nerve death or spinal cord compression can occur. MRIs will allow Dr. Johans to catch and diagnose the problem before more severe damage can develop.

Another less common reason to get an MRI includes being immunocompromised for example, you have cancer, or if you're on drugs that diminish your immune system. In that situation, any new type of neck pain you experience is probably significant, and Dr. Johans must evaluate that. Additionally, patients who have had trauma recently and are having any neuro compromises, which means weakness or numbness, are another excellent indication that an MRI is needed.

Patients should seriously consider the risks of not doing surgery over the risks of doing the neck surgery. He will discuss all your options personally with you.

A disc herniation in the neck is a common occurrence. A disc is a pad between the bones in the spine. It allows the bones to move and flex while also cushioning them from the kinetic energy caused by our body's natural movement. These discs can bulge, herniate, or rupture. If one of the three injuries occurs, it can put pressure on the nearby nerve roots, causing pain, numbness, tingling, or weakness down the arm.

Over time, discs naturally can degenerate and dehydrate, causing increased neck pain and possibly leading to bone spurs or other conditions. After a surgeon removes a herniated disc and relieves the pressure off the nerve roots and spinal cord, a choice must be made on how to provide a stable spinal column. Either fusion or disc replacement is acceptable.

If a patient or their doctor suspects a disc has become compromised, it is essential to consult with Dr. Johans immediately to prevent further damage.

A fusion is when a surgeon replaces the disc with a titanium cage filled with your own bone between two vertebrae in the neck to encourage them to grow and fuse together. The results are permanent and, in many cases, can relieve pain, numbness, or weakness in the arms. Dr. Johans is highly experienced at performing this procedure but will only recommend it if a patient is not an ideal candidate for disc replacement.

During a cervical fusion, a titanium cage is filled with the bone marrow and placed in the space where the damaged discs once were. Next, a titanium plate and screws are placed to secure the cage and afflicted vertebrae. They work to secure the bones while they fuse and grow together. A fusion can provide instant stability and diminish post-operative pain for a patient.

The downside to a cervical fusion is that once fused, that segment will never move again. Consequently, the disc spaces above and below the fusion will need to work overtime since the range of motion has been altered. Studies show that 25% of people who receive a cervical spinal fusion will need a similar operation above or below the previous one within 10 years. Recovery from a fusion will also take longer than a disc replacement, upwards of three to four months, to allow the bones proper time to grow together.

Dr. Johans aims to help patients keep as much range of motion as possible, so he recommends disc replacement instead of fusion, to good candidates. He has to evaluate you and your MRI to make the proper choice between cervical fusion technique vs. cervical disc replacement (full range of motion).

In contrast to having a fusion done, Dr. Johans has for 15 years been recommending a cervical arthroplasty, or, as it is more commonly known, a disc replacement. The advantage of this technology is that there is no loss of range of motion, and the neck maintains its flexion, stability, and rotation.

In comparison to disc fusion, disc replacement has several advantages. During a consultation with Dr. Johans, patients can expect a comprehensive analysis of which procedure will benefit their goals. He will look closely at any imaging and medical history to determine if they are an ideal candidate for disc replacement or fusion.

An advantage of a disc replacement over fusion is the range of motion that patients will maintain after the surgery, whereas fusion eliminates the range of motion of the affected vertebrae indefinitely. The range of motion outcomes are superior in this particular technology. Patients can return to work much faster (sometimes as little as a week or two) after this operation than after a fusion. Once patients no longer take post-op narcotics, Dr. Johans will clear them to return to work, drive, and other everyday activities commonly in one week.

After the surgery, patients can expect to be discharged the following morning. During the overnight stay at one of the several hospitals Dr. Johans has privileges at, including St. Alphonsus and Treasure Valley Hospital (Boise's highest-rated hospital), patients can expect routine check-ins from specialized neuro-nurses. They will monitor vital signs and neurological checks to ensure recovery is progressing and no function has been lost. Ice packs and appropriate medications will be available to provide the highest level of patient comfort.

On the same day as the surgery, patients will be encouraged to get on their feet, walk around, and begin deep breathing exercises, which will help prevent pneumonia and promote healthy blood flow to the surgical site.

The morning after the surgery, patients will review their immediate post-op instructions with Dr. Johans and the attending neuro-nurses. Specifically for fusion surgery, If a patient wants to go home with a supportive neck collar, Dr. Johans can discuss how to use it, when to wear it, and how long to use it. Before being discharged, a final assessment of the patients’ mobility and an inspection of the surgical dressing will be done. Once the necessary instructions (in-depth details below) and paperwork have been reviewed, patients will schedule a follow-up appointment with Dr. Johans, typically one month after surgery. Wound care, follow-up, activity restrictions and medications will be fully explained.

Post-op instructions will be reviewed with the patient before being discharged from the hospital. During this discussion, Dr. Johans will review medications, wound care, activity and back-to-work restrictions, and any other questions the patient might have. Additional literature will be sent home to ensure patients are aware of all the necessary information.

Medications

To maintain post-op comfort, Dr. Johans will be given a combination of medications: anti-inflammatories, muscle relaxers, and narcotics, if necessary. While still in the hospital, patients will review what medications are appropriate for their recovery and how to use them properly during recovery.

• Anti-inflammatories will typically be used for a few months, and muscle relaxers are helpful in the four to five days after surgery. Dr. Johans might suggest a narcotic for pain relief based on what is best for the patients’ recovery and allergies, with the goal of getting off them as quickly as possible. Be aware of constipation, which is the #1 reason patients have gone to the ER after neck surgery.

Wound Care

The incision site will be covered with gauze and secured with a clear plastic dressing. It is crucial to keep the dressing dry until it is no longer required. No showers for 5 days. Remove the initial dressing on day 5 and then you may shower. Blow dry the wound area. Do not use antibiotic ointments. Don’t let people (or yourself) touch the wound. The topical glue sealant will crack and peel off starting around day 10-12. During the surgery, Dr. Johans will attempt to make the incision in a less conspicuous area, like a wrinkle. With this strategy, many patients note that the incision is minimally visible after six months.

It is important to stay attentive to any possible infections. Signs of an infection include the area around the surgical site becoming red, hot to the touch, or puss coming from the incision. Patients should call Dr. Johans immediately if they suspect an infection.

Activity and Back-to-Work Restrictions

In the time following the surgery, patients will notice that their neck is stiffer than before. This is normal, and movement immediately after surgery is recommended. The main goal of restricting certain activities is to prevent patients from injuring their head or straining their neck while in recovery. You can always ask Dr. Johans about any activity you want to resume.

This means patients cannot:

• Skateboard
• Ride a Bicycle
• Drive a motorcycle or ATV
• Use a ladder
• Get up on the roof

Patients can:

• Shower after removing the dressing on post-op day 5
• Lift items near your body and overhead to your comfort level
• Use the stairs with the aid of a banister
• Take light walks

Additionally, patients may have certain work restrictions, depending on their profession. Patients might need one month to recover from the surgery before returning to work. Dr. Johans will require an in-depth description of the patient's job and will recommend how and when to return to work. If an employer requires any worker's compensation paperwork, patients can bring it to their one-month post-op appointment to review it with Dr. Johans.

If patients are concerned about their recovery at any time between being discharged from the hospital and the one-month follow-up appointment, they can reach out to Dr. Johans. He can always take a call to discuss any questions and provide quick solutions to help recovery go as smoothly as possible.

The follow-up appointments after neck surgery are a favorite of Dr. Johans. As a surgeon, it is meaningful to be present in all appointments with his patients to see the effectiveness of the treatment and the immense relief they might feel even one month post-op.

When patients are discharged home from the hospital from their neck surgery, Dr. Johans will instruct them to come back and see him in about one month. During that follow-up appointment, patients will discuss the wound, the range of motion of their neck, physical therapy orders, return to work issues, including paperwork, and finally, an x-ray will be ordered to be taken in another two months. If at any time between being discharged and the first post-op appointment you feel concerned about your recovery, possible infection, or a sudden loss of sensation please call Dr. Johans immediately. He or his PA-C Meghan can often take a phone call or see you in the clinic on the same day.

While at the appointment, Dr. Johans will check the incision wound to ensure it is healing properly. Next, the range of motion in the neck and arm strength will be assessed. Patients are encouraged to move their necks and arms immediately after surgery within the tolerated pain level. Dr. Johans will measure the patient's progress; if he is not happy with the movement, he may suggest physical therapy.

Many people think physical therapy is needed promptly after surgery, but Dr. Johans advises waiting until the first month of recovery is complete. Delaying physical therapy for one month lets the pain dissipate, making for a more efficient experience.

As previously stated, work restrictions may exist for patients with certain jobs. During the first follow-up appointment, Dr. Johans will revisit the need for further or lift restrictions originally set while in the hospital. Again, if any worker compensation paperwork is needed, please bring it to the appointment. Additionally, Dr. Johans will schedule a time for patients to get a post-op X-Ray. This will be one month after surgery for arthroplasty patients, and three months post-op for fusion patients.

Lastly, Dr. Johans will set a date for the second and last follow-up appointment. This appointment will be two months after your first follow-up and three months after the surgery. He will review the X-Rays to ensure the equipment has stayed in its proper place, the bones are aligned how they should be, and there are no underlying problems with the patient's healing process. There will be a final check to ensure arm strength and range of motion have advanced as they should.

Dr. Johans will answer any final questions or concerns patients might have going forward.He is confident that patients, by following the outlined post-op care instructions and the advice given, will find new comfort and positive outcomes or permanent activity restrictions for many years to come.