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Treatment of Neck Pain

Injections and Surgical Interventions: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders

  • Best Evidence
  • Published:
European Spine Journal Aims and scope Submit manuscript

Study Design

Best evidence synthesis.

Objective

To identify, critically appraise, and synthesize literature from 1980 through 2006 on surgical interventions for neck pain alone or with radicular pain in the absence of serious pathologic disease.

Summary of Background Data

There have been no comprehensive systematic literature or evidence-based reviews published on this topic.

Methods

We systematically searched Medline for literature published from 1980 to 2006 on percutaneous and open surgical interventions for neck pain. Publications on the topic were also solicited from experts in the field. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our Best Evidence Synthesis.

Results

Of the 31,878 articles screened, 1203 studies were relevant to the Neck Pain Task Force mandate and of these, 31 regarding treatment by surgery or injections were accepted as scientifically admissible. Radiofrequency neurotomy, cervical facet injections, cervical fusion and cervical arthroplasty for neck pain without radiculopathy are not supported by current evidence. We found there is support for short-term symptomatic improvement of radicular symptoms with epidural corticosteroids. It is not clear from the evidence that long-term out comes are improved with the surgical treatment of cervical radiculopathy compared to non operative measures. However, relatively rapid and substantial symptomatic relief after surgical treatment seems to be reliably achieved. It is not evident that one open surgical technique is clearly superior to others for radiculopathy. Cervical foramenal or epidural injections are associated with relatively frequent minor adverse events (5%–20%); however, serious adverse events are very uncommon (<1%). After open surgical procedures on the cervical spine, potentially serious acute complications are seen in approximately 4% of patients.

Conclusion

Surgical treatment and limited injection procedures for cervical radicular symptoms may be reasonably considered in patients with severe impairments. Percutaneous and open surgical treatment for neck pain alone, without radicular symptoms or clear serious pathology, seems to lack scientific support.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Stanford University School of Medicine; Orthopaedic Spine Center and Spinal Surgery Service, Stanford University Hospital and Clinics, Stanford, CA, USA

    Eugene J. Carragee MD, FACS

  2. Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawaii at Mānoa, Honolulu, HI, USA

    Eric L. Hurwitz DC, PhD

  3. Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Ivan Cheng MD

  4. Department of Public Health Sciences, and the Alberta Centre for Injury Control and Research, School of Public Health, University of Alberta, Edmonton, Canada

    Linda J. Carroll PhD

  5. Departments of Orthopaedics and Environmental Medicine and Program of Ergonomics and Biomechanics, School of Medicine and Graduate School of Arts and Science, New York University, New York, USA

    Margareta Nordin PT, DrMedSc

  6. Occupational and Industrial Orthopaedic Center (OIOC), New York University Medical Center, NY, New York, USA

    Margareta Nordin PT, DrMedSc

  7. Department of Medicine, University of British Columbia, Vancouver, Canada

    Jaime Guzman MD, MSc, FRCP(C)

  8. Occupational Health and Safety Agency for Healthcare in British Columbia, Vancouver, Canada

    Jaime Guzman MD, MSc, FRCP(C)

  9. Endocrinology, Analgesia and Inflammation, Merck & Co., NJ, Rahway, USA

    Paul Peloso MD, MSc, FRCP(C)

  10. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

    Lena W. Holm DrMedSc

  11. Departments of Public Health Sciences and Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

    Pierre Côthé DC, PhD

  12. Centre of Research Expertise in Improved Disability Outcomes (CREIDO), University Health Network Rehabilitation Solutions, Toronto Western Hospital, Toronto, Canada

    Pierre Côthé DC, PhD

  13. Institute for Work and Health, Toronto, Canada

    Pierre Côthé DC, PhD, Sheilah Hogg-Johnson PhD & Gabrielle van der Velde DC

  14. Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Canada

    Pierre Côthé DC, PhD

  15. Department of Public Health Sciences, University of Toronto, Toronto, Canada

    Sheilah Hogg-Johnson PhD & J. David Cassidy DC, PhD, DrMedSc

  16. Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

    Gabrielle van der Velde DC

  17. Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, Canada

    J. David Cassidy DC, PhD, DrMedSc

  18. Department of Neurology, University of California, Irvine, CA, USA

    Scott Haldeman DC, MD, PhD

  19. Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA, USA

    Scott Haldeman DC, MD, PhD

Authors
  1. Eugene J. Carragee MD, FACS
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  2. Eric L. Hurwitz DC, PhD
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  3. Ivan Cheng MD
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  4. Linda J. Carroll PhD
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  5. Margareta Nordin PT, DrMedSc
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  6. Jaime Guzman MD, MSc, FRCP(C)
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  7. Paul Peloso MD, MSc, FRCP(C)
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  8. Lena W. Holm DrMedSc
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  9. Pierre Côthé DC, PhD
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  10. Sheilah Hogg-Johnson PhD
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  11. Gabrielle van der Velde DC
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  12. J. David Cassidy DC, PhD, DrMedSc
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  13. Scott Haldeman DC, MD, PhD
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Corresponding author

Correspondence to Eugene J. Carragee MD, FACS.

Additional information

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

Corporate/Industry, Foundation, and Professional Organizational funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Reprinted with permission from Lippincott Williams & Wilkins, Carragee EJ, Hurwitz EL, Cheng I, et al., Treatment of Neck Pain, Injections and Surgical Interventions: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders, SPINE, Volume 33, Number 4S, pp S153–S169

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Carragee, E.J., Hurwitz, E.L., Cheng, I. et al. Treatment of Neck Pain. Eur Spine J 17 (Suppl 1), 153–169 (2008). https://doi.org/10.1007/s00586-008-0632-y

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