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Severe pain in the neck that increases with flexion and can last for more than one week after onset could be from disc origin. An MRI that “didn’t show anything” could have demonstrated degenerative disc disease and not have been recognized. Facet disease and inflammation will typically not show up on MRI but facet pain typically occurs from bending the head backwards (extension)- not your complaint.

The previous fusion could also have failed and taken this long to declare but that is unlikely. You need to have your films reviewed by a spine surgeon and get an opinion from him or her.

Dr. Corenman

Cervical cord compression can cause myelopathy which in turn can cause paresthesias in the upper and lower extremities. There should be more symptoms than these paresthesias however. Imbalance, some loss of fine motor control, possible electric shocks down the spine and other symptoms could occur. If the paresthesias increase with neck extension, this could be myelopathy as the spinal canal narrows with extension and cord compression increases.

Dr. Corenman

Unfortunately, most “muscular back aches” are really from degeneration of spinal disc, nerve or facet. A disc herniation compressing the nerve root will cause mainly buttocks and leg pain but there are variants that can cause only lower back pain.

My recommendations for non-surgical care of disc herniations are that there is no motor weakness (except the extensor hallicus longus- big toe lifter) present and the pain can be controlled and improves on a timely basis. There is some data that indicates surgery performed after six months has poorer results than if done before the six month period.

That being said, what I tell my patients is that if they go through a good rehab program, epidurals and proper medications and still after 6-8 weeks are dissatisfied with their pain or progress, I would consider surgery. It is really a patient decision regarding whether to do surgery or continue down the course they are on.

Of course, if there is motor weakness, I recommend surgery sooner than later.

Dr. Corenman

If you have a fusion from T11-S1, there are two areas that need to be watched- the sacroiliac joints and the T10-11 level. You can mitigate the wear by doing just what you stated- low impact activities. The spine fusion should not affect your hips, knees and ankles.

Swimming, cycling including mountain biking, hiking (without a heavy pack), rowing, reasonable gym workouts, cross-country skiing and snowshoeing are all activities that in general, would not harm your back.

Intermediate activities that could cause increased wear are skiing groomed slopes, hiking with a heavy pack, heavy weight lifting and water skiing.

Acivities to avoid are all impact activities such as running, tennis, volleyball, basketball, soccer as well as others that increase the load on the back.

Normally, both a CT scan on a 64 slice scanner and an MRI on at least a 1.5 tesla machine are necessary for the workup. In-office standing x-rays with flexion and extension view are necessary.

Dr. Corenman