Scott Webb (Host): If you suffer from neck pain, it's likely the cause originates in your back, but today we're going to focus on the neck specifically and how my guest can help. I'm joined today by Dr. Anh Le, he's the Chief of Spine Surgery with Dignity Health. This is Hello Healthy from Dignity Health. I'm Scott Webb.

Doctor, thanks so much for your time today. This is a topic that is near and dear to my neck, I guess. I'm somebody in my mid fifties who suffers from neck pain and back pain and all sorts of pains. So it's really great to have your expertise for me, for listeners. We're going to talk about neck pain today specifically, and I know the back and the neck are together and you're a spine guy, but let's focus on the neck and just start out here.

What are the most common causes of neck pain?

Anh Le, MD: Well, about 99 percent of the neck pain is associated with the spine, and about 1 percent is associated with other soft tissue. So it's very likely, if you have neck pain, it's very likely that you have a problem with your cervical spine.

Host: Interesting. Yeah, that was gonna be my follow-up question. Because I assume, you know, I'm not being a doctor, but having an expert like yourself on, I just sort of assume, well, everything's connected and, I was assuming that neck pain really is the result of back pain, right? It just, they kind of go hand in hand.

So maybe you can take us through that, whether it's acute back pain from injury that then spreads to the neck or chronic pain that many of us deal with, like me. When you're seeing folks in the office, what are you seeing and what are the most common causes?

Anh Le, MD: Neck pain is predominantly associated with the cervical spine, and approximately 70 percent of people will have neck pain at some point in their lives. Basically three out of four people will experience this kind of symptoms. We break the neck pain down into three types of neck pain.

 One is called mechanical neck pain, which basically just pain along the neck, is exacerbated with sleeping, change in position. The second category is, we call it neck pain that has nerve pain, also known with a medical terminology as cervical spondylosis with radiculopathy, which means that you have neck pain. In addition, you also have pain radiation into your arm. And the third one is a little more ominous, which is neck pain with difficulty usage of the arms, hands, and leg function, also known as cervical spondylosis, myelopathy, which means that the spinal cord in your neck is compressed, producing these symptoms.

Host: So take me through this when folks come in and they say, Oh, I got this pain in my neck. And then you, what do you say? You say, well, you probably have some pain in your back too. And they're like, well, yeah, actually my neck, my back, maybe down my arm. So when you begin to figure out, we think about diagnosis anyway, and you're trying to diagnose the root cause, right, and get at the real cause of the neck pain.

 How do you do that? How do you diagnose? Is it imaging? Is it patient history? Is it just talking to patients? Is it all the above?

Anh Le, MD: The history, which is the symptoms that the patients relate to me, are the most important piece of information. So I always ask, all right, how long have you been having neck pain? Does the neck pain goes down into your arms? Do you have any difficulty buttoning your shirts or you have difficulty walking?

Anybody telling you you're walking like a drunk? Those pieces of history provided by the patient are essential or germane to making the diagnosis. After learning about how long the patients have been having these symptoms, what kind of symptoms they have, then I will put the symptoms that they have into one of those three categories of neck pain. And then I use radiological images such as x rays or MRI to confirm my diagnosis. All right, so which one of these three bags of neck pain that you're involved in? Because the treatments are completely different.

Host: You know, I was talking about my laptop and my phone, thinking about from the patient's perspective and those folks coming into your office. Do you find that as you begin to sort of pull the patient history from them that they spend a lot of time hunched over their phones, hunched over their laptops? Is that a thing?

Anh Le, MD: The advent of the computer, and worse than that, the advent of social media, right? We are now, young or old, glued to the phone on a daily basis. Every Sunday I will get a reminder from my iPhone of my screen time. And every week it increases.

Host: Right.

Anh Le, MD: Right? And now we are seeing children complaining of neck pain just because they spent so much time looking down onto their phone.

And, basically every time a notification comes on, boom, the neck is flexed forward in a non anatomical position to stare at the information come through on their Instagram.

Host: Right. Yeah. I mean, and it's sort of double edged sword, this technology and everything is amazing. But as you say, it's affecting our posture. Uh, you know, anatomically speaking, we're just not meant to like hunch over and bend our necks like that for such long periods of time, but we all do it of course. Want to talk about treatment for neck pain. And as you said, depending on which type of neck pain you have, the treatment is entirely different. And so maybe we could just sort of broadly go through each of the three types and how you begin to try to help folks.

Anh Le, MD: The first one, what we call mechanical neck pain, which is basically just the neck pain itself without any pain radiation to the arms or the legs. So this pain is typically, is exacerbated with activities. such as downward gazing, looking at your iPhone, looking at your computers, and it is affected during with activities and improved by rest.

So that's basically due to the strain exerted on the neck affecting the structures known as the disc, points in the back of the neck and the treatment for that is mostly conservative, right? Number one, reduction of the activities that is the cause of your pain. Number two is physical therapy to strengthen the neck in order to combat the load strain that you put on the disc and the other structures by building up the muscle in the back of the neck and the front of the neck to basically bypass the compressive load, especially when we look down onto the computers, to increase the wear and tear of the neck. So conservative treatment.

Host: Just basically stop doing what you're doing and let's try to strengthen your neck a little bit. And as you say, really conservative.

Anh Le, MD: So for neck pain that has pain radiation to the arms. It tells you something is wrong, something is compressing the nerve, right? So if the MRI tells you that the compression is not that severe and the pain is due to inflammation, you can treat it with strengthening exercises.

If it doesn't work, then you can consider injection therapy, which is basically injecting steroid into the neck, also known as cervical epidural steroid injection. Basically, it relieves the inflammation and therefore abates the pain. If that treatment doesn't work after six months to a year, then surgical solution is the final form of treatment.

You can remove the compression of the nerve, and then either you can fuse the neck, which makes it stop moving, or, at this point, you can do something called a disc replacement, where you put in a prosthetic disc. That still allows your neck to bend back and forth. The third one is more ominous. The medical terminology is cervical spondylotic with myelopathy, which means that the wear and tear in the neck now affects the spinal cord, mostly compressing the spinal cord.

All right. So if you think of the spinal cord, it controls the functions of your leg and your hands and your arm and your whole body. So what happened is that when you compress the spinal cord, they have difficulty walking. If they compress it for so long, they can end up in the wheelchair. And therefore, for the third problem with the neck pain, the treatment, the most conservative treatment, is surgery.

Host: Right.

Anh Le, MD: Right? You actually have to reduce the compression of the spinal cord. If you leave it there for too long, you're going to end up in the wheelchair. So therefore it is completely reverse of the first diagnosis, which is mechanical neck pain, where you're trying to stay away from surgery. If you have neck pain with compression of the spinal cord, the most conservative treatment is surgery.

It's basically either, again, you remove the disc or the compression of the spinal cord and fuse the neck. Or, if you could, you can remove the compression of the spinal cord and put in a prosthetic disc so that it continues to move and not lose in your motion.

Host: That is ironic, I guess, is probably the best word. The conservative treatment for the third type is surgery, which doesn't sound conservative at all and something that all of us would probably like to avoid and seems like just a good reason among the many reasons because our quality of life has probably been suffering, just good reason to speak with a provider, to share our history with someone like yourself, to get that MRI so that we maybe don't end up having surgery and we don't end up in a wheelchair, right?

Anh Le, MD: Correct.

Host: Yeah.

Anh Le, MD: So neck pain can be simple or it can be ominous. If you have some of that problem and it's persistent, I think you should see a specialist in spinal surgery so you don't end up in the, like I say, in the wheelchair or being mistreated for something that is not correct.

Host: As you say, ominous is bad. We don't want that. And it makes you just, as we wrap up here, wonder what can we do to prevent neck pain? What can we do to ever avoid being in your office?

Anh Le, MD: To prevent neck problems, number one, reducing the affected activities or the trigger causes of neck pain, such as use your phone a little bit less. Wait for the 20th notification before you look down. Use the computer a little bit less. Right? Or maybe if you use the computer a lot, then make sure that you have an ergonomically set up workstation where you can bring the screen of the computer to your eye level with the neck in neutral position rather than bending forward.

And number three is one thing that you should always do. Exercise, strengthen your musculature, keep a healthy muscle envelope around your body to reduce the amount of weight that the skeleton has to afford and therefore increase the wear and tear of the spine.

Host: Well, this has been fun today, Doctor. You know, you sound like somebody who understands, you know, the folks who come in. You understand they're using their phones, they're on their computers. They may have been suffering for a long time and you're just there to help. So, as always, we encourage folks to speak with their own providers, be referred to specialists. Possibly even you, of course. But thank you so much for your time today. You stay well.

Anh Le, MD: Thank you so much for the opportunity.

Host: That's Chief of Spine Surgery, Dr. Anh Le, and for more information, go to dignityhealth.org/ central-California/locations/St.Joseph-Stockton/services/spine-care. I'm Scott Webb, and if you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics of interest.

This is Hello Healthy, a Dignity Health podcast. Thanks for listening.