Transcription:
Neck and Arm Pain and Surgical Options

Disclaimer: The medical health information provided during this program is for general information and educational purposes only, and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment. Neither does this program serve as approval for any health product or brand.

This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice ensure you consult your physician.

Melanie Cole (Host): to Say Yes to Good Health with Memorial Hospital. I'm Melanie Cole, and I invite you to join us today, as we discuss neck and arm pain and surgical and nonsurgical options for that pain. Joining me is Dr. Rahul Basho. He's a Spine Specialist and Orthopedic Surgeon at Midwest Orthopedic Specialists in Hannibal, Missouri.

And he now also sees patients at Memorial Medical Clinic in Carthagw, Illinois. Dr. Basho, it's a pleasure to have you back on with us again. You're such a great guest. As we get into this really important topic for all those people suffering from neck pain and arm pain, why did you choose to come to Carthage to provide service to the region?

Rahul Basho, MD (Guest): Well, really two reasons. Number one, I had a huge population of patients that were coming down to see me, and it just made sense to expand the practice into that region. And secondly, the Carthage Memorial Hospital is really what I would call you know, a diamond in the rough. It's an amazing hospital that has all kinds of facilities that you would expect to see in larger hospital settings. But they provide that advanced care locally. And so, the administration was very kind and very welcoming to having me expand my expertise in spine specialty over in that region.

Host: So, how often are you there Dr. Basho? How do people get to see you?

Dr. Basho: Currently, I'm there once a month. And patients just call my office and request an appointment over at Carthage, but with the demand that we're seeing growing, I expect, I expect that to continue to grow hopefully at least two times a month.

Host: I'm guessing that it will because you're obviously an awesome doctor, such a good educator. No, I mean it, you're great. You're also a great guest. Okay. So, let's talk about neck pain and the prevalence and the most common causes of it. Why do people get this neck pain?

Dr. Basho: Well, you know, when I was training, one of my professors told me that there are three kinds of people in the world. There's people that have neck pain, people that have had neck pain and people that are going to have neck pain. And so what that means to me is that neck pain is ever present throughout the population.

And it's a normal part of the aging process. It's a normal part of the daily wear and tear that we go through. Just because someone has neck pain doesn't necessarily mean that something bad is going on. So, I want to just establish that from the outset. It's when that neck pain remains persistent. When it becomes radicular in nature. And that's a fancy way of saying that it's radiating. So, when that pain starts to radiate from our neck into our shoulder blades or into our shoulders, down our arms, into our fingers, when certain positions of the neck make it difficult to sleep through the night or when we can't check our blind spots, as we drive; that's when patients end up coming to see me and we start exploring that neck pain further and seeing is this something different than the normal everyday wear and tear that we come to expect?

Host: So, how do we know if it's like a chronic issue, like an arthritic issue or a degenerative issue or something acute, like a bulging disc there or something we did wrong? Because people get neck pain just from sleeping on a pillow weird or sleeping weird, you know, there's a lot of reasons we wake up and go, oh, but how do we know if it's something really serious?

Dr. Basho: That's a great question. And you know, the severity of the symptoms is really what dictates how much we look into it. Now, if you fall asleep wrong on an airplane or in the car or on a new pillow and you have some neck pain that resolves in a day or two, obviously nothing to be worried about, but it's when this pain is waking us up at night, when it's making it difficult for us to fall asleep.

That's when we start to really put it in a category that, that deserves, you know, scrutiny under a microscope, really. Another really good point, when you talk about the fact that you know, you said you used the word bulging discs, lot of patients will get imaging studies of their neck. And they'll say, doctor, I have these bulging discs. And they think that's something, you know, horrible is going on. When the truth of the matter is that, you know, depending on what decade of life. you're in, it's absolutely normal to have bulging discs. And those don't always cause pain.

Host: I'm so glad that you pointed that out because that's a really good point for people that really don't understand that a lot of this is age related and we all have it. And for some people it's painful and for some people they don't even know they've had it. I've seen people with scoliosis that were walking upright and didn't have any pain. So, you never quite know. Now what is the first line of defense? Because the neck is a scarier place, Dr. Basho. And I know even myself when I've seen a chiropractor before, and they do your neck for the first time. That loud pop is really scary. And so I stopped letting them do that, but it's just seems to be a more scary area because people assume that neck pain. And like you said, it's not always dangerous, but I mean, we think of the worst things.

Dr. Basho: Yes. As you said, the neck is a dangerous area. And the term that I use in clinic is it's really high priced real estate. I mean, this is an important part of your body, where the end of your brain, which becomes your spinal cord, passes through that neck. And so, you know, any arthritis, bone spurs, large disc herniations, anything that affects the spinal cord or the nerves that branch off of it can have tremendous consequence in our quality of life.

And the first line of defense, you know, in terms of what do we do when people have neck pain that's been chronic and getting worse, is we get a set of x-rays in the office and, and I think a good thing to talk about is, you know, the different types of imaging studies that people have, where some people are getting x-rays, some people, if they go to the emergency room, maybe they get a CT scan.

Some people, if they come and see me, I order an MRI. So, you know, the first step, is hearing the patient's history and getting some basic imaging studies and the basic imaging studies that I start with are x-rays. X-rays allow me to see the alignment of your neck, of the bones. It allows me to see indirectly how healthy the cartilage is and the nice thing about x-rays is they're dynamic.

So when you get an MRI or you get a CT scan and you're sitting down, I'm sorry, you're laying down and you're going through a tube, but when you get your x-rays, you're standing upright. So, we get to see what happens when gravity pushes your head down, pushes those bones down and CT scans and MRIs are done with you in one position. With the x-rays, we can have you bend forward, bend back. We can kind of dynamically see what's changing in the neck as we move in different positions. And then based on those x-rays we say, you know what, you need just basic treatment in the, the form of some maybe some anti-inflammatories, maybe some physical therapy to strengthen your neck, or if we see some malalignment and you know, we've got some red flags on the physical exam, then maybe at that time it's necessary to get a CT scan or an MRI.

Host: After you have determined what's going on with their neck, do we look at meds first? Do we look? I'm a remember back in the day Dr. Basho, my mother wore a neck brace and she had arthritis and she had rheumatoid, but I remember her in that neck brace since I was a little kid. And what do we do first? Tell us a little bit about ice, brace, nonsteroidal anti-inflammatories any of those things you would try first?

Dr. Basho: Yes. And I think that you've hit the gamut in terms of what conservative treatments we've had, we have available to us. We have rest. And how do you rest your neck? Well, a cervical collar is a quick and easy way to allow that neck to rest. Sometimes when people are having severe neck and arm pain at night, I try to have them sleep in the collar to keep their neck in a neutral position. That allows some healing to take place. And allows you not to exacerbate the pain throughout the night and have, and suffer in the morning. Anti-inflammatories are a great first line of medical treatment for arthritis pain, whether it's in your back, your neck, your joints. And so we want people to, you know, obviously try things that are non-narcotic and anti-inflammatories are our go-to. The downside of anti-inflammatories is that with long-term use, they can be damaging to your kidneys. That can cause stomach ulcers, especially if you've had a heart attack, you want to take those with caution. And so somebody, either a primary care doctor, ourselves, needs to monitor kidney function and really look at the patient's cardiac history before we aggressively start taking anti-inflammatories.

And I'm a big believer in physical therapy. I think physical therapy plays a huge role, strengthening the muscles. All the muscles that hold up your head are in the back of your neck, and there's some thought that if we can strengthen those muscles, we offload the discs. We offload the joints and we can translate that into pain relief. Chiropractic care, as you mentioned is a great conservative first line of defense in terms of neck pain.

I have a lot of patients who go see chiropractors and have great results. And so I, encourage people to do all the easy things before they come and see me.

Host: Well, I mean, there's also yoga and acupuncture, right? There's all these things. Even meditation, people have used and relaxation techniques because the neck is such a spot of stress for us. I mean, we get really tense in the neck when we're getting tense and we're all tense right now, most of the time. Wrap it up for us, Dr. Basho, for this first segment of this informative episode, with what you want people to know about the non-surgical conservative measures to help us with our neck pain and you seeing them at Memorial Medical Clinic in Carthage.

Dr. Basho: Yes. And you know, in terms of yoga and acupuncture, all of these things, that have been around for thousands of years through human history. There's a reason that they withstood the test of time. Now we may not have formal journal articles, you know, with double-blinded studies that say, if you have acupuncture, you're going to do this much better than someone who doesn't.

But you know, these things have withstood the test of time. And I, I always encourage my patients to try these alternative medical modalities. Because you never know how much better they're going to get you. And maybe all of your pain doesn't go away. Maybe you're 30% better or 40% better, but maybe that 30 or 40% is something that you can now live with and function with and have a much better quality of life with without having aggressive treatment. For me, that's a no brainer.

Host: Totally is for me as well. And really that makes so much sense. And it does improve the quality of life. Dr. Basho, just tell us quick about Memorial Medical Clinic in Carthage and the fact that you're seeing patients there now.

Dr. Basho: Yes. So, Memorial Hospital, even though it's a smaller community hospital, it has the full gamut of specialties. I have such a large patient base that would travel to see me from Carthage to Hannibal that it only made sense for me to expand my practice and my reach out there.

Host: That's so cool and very, very excellent for the people in the area that don't have to travel quite so far to see such a great doctor as yourself. Now, before we get into surgical options, we hear about injections, Dr. Basho. So, what does that mean for neck pain? And are we doing the same kind of injections that we might do if it was lumbar spinal pain or shoulder pain? Tell us a little bit about that.

Dr. Basho: Yeah, so what the injections are made of is the same. We're using a combination a numbing medication and a combination of a steroid, which is a powerful anti-inflammatory and the injection is in the neck, conceptually very similar to injections in your lower back, you need to use a x-ray machine, which we call a C-arm. It's a machine that we use in surgery, and we take a needle and we guide a needle into a very specific area of the neck.

And then you have contrast, which is injected to verify that you're at the exact level, that you're not hitting a nerve, you're right around a nerve. And then once the contrast confirms that you're at the appropriate level, the medication goes in. It's a process that should take somewhere between, oh, I'd say 10 to 15 minutes to do. Patients go home the same day. And the beauty of the injections is that they serve both therapeutic and diagnostic purposes. Therapeutic, meaning if you get the medication in the area of your pain, you feel better and diagnostic meaning oftentimes I'll see a patient and they'll have disc bulges at multiple levels or nerve pressure at multiple levels. And to really hone down to where their pain is coming from, which level the injection is what guides us.

So if you get an injection, let's say between bone number four and five in your neck, and a hundred percent of your pain goes away for a few hours, a few days, a few weeks, then we know that a hundred percent of your pain is coming from that level at C4 and C5.

Host: Now, when does it become surgical Dr. Basho? What does that discussion look like? And I'd like you to tell us a little bit about what's being done in cervical spine surgery today. What's exciting. What are you doing?

Dr. Basho: Absolutely happy to do so. You know, the discussions about non-surgical versus surgical management are highly individualized and vary from patient to patient. And so you have to look at what are the demands of the patient, what are their symptoms? There are some red lines that indicate surgery has to be done. If someone comes in and they've got damage to their spinal cord, or if someone comes in and all of a sudden they've lost use or feeling in an arm, you know, in those situations, we tend to be more aggressive earlier on. But if people are coming with persistent pain, that hasn't gotten better with injections, hasn't gotten better with medications, they're having a difficult time with their jobs or difficult time sleeping through the night; then we talk about surgery.

And spine surgery, cervical spine surgery has evolved tremendously over the course of the last oh five years, even. And so just like people get knee replacements or hip replacements, now there's a lot of data supporting cervical disc replacements, where we take out the arthritic disc and we put a prosthetic disc in. Now the indications for that are still very narrow. You can't do multiple levels with those yet. And they're still evolving, but they're really at the cutting edge and that's a service that we do offer. Traditionally, what surgery entails is taking the disc out and putting a spacer into the disc and fusing those two bones together so that we eliminate the pain generator at that level.

And that's a surgery and a technique that's been, you know, used since right around the 1950s and it's evolved tremendously. It's got a great track record. Patients do very well with it. Now, obviously how it was done in the fifties and how we do that surgery now is totally different. We have great technology. We have newer implants, 3D printed hardware, all kinds of things that have really revolutionized cervical spine surgery.

Host: Well, it certainly has, and it's an exciting time to be in your field. And when you mentioned the word fusion, for people that are wondering what that means. Explain a little bit. And I mean, does that mean they can't turn their neck anymore? Does it mean they'll have trouble driving? Tell us a little bit about what that means as far as rehab, motion, any of those sorts of things, what their life is like after something like that.

Dr. Basho: Yeah, so fusion as it sounds, you're taking two arthritic bones and you're making them into one bone. Now patients always ask me if I have a fusion, how much motion am I going to lose? Am I going to be able to drive? And those are all very relevant points and questions. Now about 50% of our motion or rotation comes from where our head actually meets our neck, where our head sits on top of the neck.

And it's rare, if ever, we do surgery at those upper cervical levels. And so we have patients where we've done fusions at four different levels in their neck. They still check their blind spots. They still drive. They still have excellent rotation and little if any limitation in terms of motion. And the thing is, is that most people, when they have arthritis in their neck that's severe enough where they're considering surgery, they've already lost a lot. You know, those joints have already become stiff. Those discs have already worn away. And so their pain limits their rotation even more. So, there are even studies out there that say that people who undergo a fusion actually have better range of motion after surgery because their pain is improved.

So loss of range of motion is something that I think gets a lot more press than it should because on those rare instances where we have to fuse someone's skull to their neck, that's when we lose rotation. And that, again, that's a surgery that's rarely done.

Host: If someone does have to have, and thank you for explaining that because it is a source of confusion for many people. So, I'm glad you did that. If someone does have to have surgery on their neck or a procedure, are these considered minimally invasive? And if so, what is recovery like? I mean, how long are they not able to do certain activities or exercise, that sort of thing?

Dr. Basho: Yes. So the surgeries themselves, the approach to the cervical spine for a one-level fusion is a minimally invasive procedure. People will have, you know, maybe a half to three quarter inch incision that's horizontal on their neck. People, some people go home the same day. Some people stay for 23 hours. Most stay for 23 hours just to make sure that pain is controlled and swallowing is okay.

But for a one-level fusion, yes, you can do that on, in a relatively minimally invasive and sometimes outpatient manner. But you know, if, when you start getting into multiple levels, three levels, four levels, or if some people have what we call a deformity of the neck, where the arthritis is so bad that the curvature of the neck needs to be corrected; those are surgeries that require larger incisions, sometimes multiple incisions and definitely a, an inpatient stay for a number of days at times.

Host: Now I'd like your best advice. I mean, you've been giving it to us for the last 20 minutes here, but you are so informative when people think about keeping a healthy neck; you know, we hear about back, lower back, exercise, keep your hamstring stretched out, live a healthier lifestyle. Right. But your neck, we don't think so much about that, but we do look at pillows, right?

And some people sleep with two or three of those things. Some people think it's better to sleep flat. Can you tell us about a few things that you recommend to people to help with that neck pain or a stiff neck in the morning. Should we be using a pillow? Tell us a little bit about that in our last few minutes here, Dr. Basho.

Dr. Basho: Yeah, so, the advice that I typically give is listen to your body. So, if you're waking up every morning and your neck hurts, or your neck is stiff, then critically look at what you're doing. Is it something that you're doing the night before? Are you on your phone with your chin down on your chest for hours on end right before you go to sleep? Or are you sleeping in awkward positions? And so, you know, there's no studies out there that say one pillow is better than the other. What I preach is that you want to sleep in as a natural and ergonomic position as possible. And so if that means sleeping on your side with your ear, at the level of your shoulders, or just above your shoulders with a thin pillow or an orthopedic pillow, find one that allows you to be in as neutral of a position as possible.

And then again, avoid doing things that require you to be in awkward positions for extended periods of time. That may be as simple as changing how the monitors at work are positioned. So, you're not having to turn or work in an awkward position for hours on end, or it may mean that, you know what we, we get up and we walk around and we avoid our phone time. Or if we're using our phone, we're not keeping it on our lap. We're actually holding our

Host: Text neck, right?

Dr. Basho: Yes. Yes, we don't want that. And so just kind of making sure that we're listening to our bodies, we're paying attention to our symptoms and making small and subtle changes, which can go a long way.

Host: Well, they certainly can. And yeah, we've heard of text neck, and I think our kids are going to suffer from this Dr Basho, cause they're staring down at those phones for hours and hours. And I'm so glad you gave us some ergonomic advice here about sitting at our computer, keeping that stuff at eye level, so our neck isn't pointed downward. What an informative show this was. What an excellent guest you are. Thank you so much for joining us. And for more health tips like this, you can visit our website at mhtlc.org. Or to make an appointment with Dr. Basho at Memorial Medical Clinic in Carthage, Illinois, please call 573-248-1010 and you can get into see him because wow, what a doc, if you're lucky enough to see this guy, you know, you're getting great, great care. And that wraps up this episode of Say Yes to Good Health with Memorial Hospital. We'd like to thank our audience and invite you to download subscribe, rate, and review on Apple podcast, Spotify and Google podcast.

If you found this podcast as informative as I did, share it with your friends and family, on your social channels, because we are learning from the experts at Memorial Hospital together. I'm Melanie Cole. Thanks so much for joining us today.

Disclaimer: The medical health information provided during this program is for general information and educational purposes only, and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment. Neither does this program serve as approval for any health product or brand.

This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice, ensure you consult your physician.