01
Freeing a nerve root
Arm pain, pins and needles and weakness caused by a compressed nerve respond well, and often quickly. This is the most dependable reason to operate on a neck.
Do I need neck surgery?
For most people the answer is no. Neck surgery has one reliable job, which is taking pressure off a nerve root or the spinal cord. This page sets out what has to be true before an operation is worth considering, what can safely be watched, and the small number of signs that change the timing.
The short version
Surgery treats compression of a nerve root or the spinal cord. It is not a treatment for neck pain on its own.
More than eight in ten people with acute nerve pain from the neck improve without an operation, most within eight to twelve weeks.
A finding on a scan is not a reason to operate. It has to explain the symptoms you actually have.
Cervical myelopathy is the exception. It tends to progress, and function lost to it does not reliably return.
Non-surgical treatment should have had a fair go first, unless the cord is at risk or weakness is worsening.
Being told you do not need an operation is a common and useful outcome of a specialist consultation.
8 in 10+
Acute cervical nerve pain improves without surgery, most of it within eight to twelve weeks.
Not neck pain
Surgery is unreliable for neck pain that has no nerve or cord compression behind it.
The exception
Cord compression is the one pattern where waiting carries a cost of its own.
4 patterns
Four presentations, and four different answers about whether an operation helps.
WHAT IT IS FOR
Neck surgery does one thing reliably
It takes pressure off something. Everything else an operation might be hoped to fix is a good deal less predictable, and knowing the difference is most of the decision.
02
Decompressing the spinal cord
Where the cord is compressed, the operation is about stopping further loss as much as recovering what has already gone. Timing counts for more here than anywhere else in the neck.
03
Stabilising a level
Sometimes a level has to be held still once the compression is removed, or because it is unstable. That is a consequence of the decompression rather than the point of it.
04
What it does not do
It does not reliably treat neck pain with no compression behind it, and it does not stop the rest of the neck ageing. Both are worth hearing before you agree to anything.
Wear and tear on a report is not an indication for surgery. Disc bulges and degenerative change turn up on the scans of large numbers of people who have no symptoms at all, which is why the scan is read against your examination rather than on its own.
WHERE YOU SIT
Four patterns, four different answers
Most people arrive in one of these four situations. The honest answer to whether you need an operation depends a great deal on which one you are in.
Neck pain only
Very common
What it usually is
Pain from the muscles, joints or discs of the neck, with no nerve involvement. Any wear seen on a scan is often incidental.
Does it need surgery
Almost never. Surgery is unreliable for neck pain without compression, and is not a treatment for it.
Pain into the arm
Common
What it usually is
A compressed or irritated nerve root, most often C6 or C7. Cervical radiculopathy.
Does it need surgery
Usually not. Most settle over weeks to a few months. An operation is considered for weakness that is worsening, or pain that will not settle.
Clumsy hands, unsteady walking
Less common
What it usually is
Pressure on the spinal cord itself rather than a single nerve. Cervical myelopathy.
Does it need surgery
Often yes, and the timing matters. This is the one pattern on this page to act on rather than watch.
A finding on a scan
Very common
What it usually is
Disc bulging, wear or narrowing reported on imaging done for another reason, or for symptoms it may not explain.
Does it need surgery
Not on its own. The finding has to match your symptoms and your examination before it means anything.
Not sure which of these describes you? The conditions pages start from how each one feels rather than from its name.
WHEN THE ANSWER CHANGES
The signs that move this up the queue
Most neck symptoms can be watched safely for a while. These cannot, because they suggest the spinal cord or a nerve is under real pressure.
Weakness that is getting worse
Not pain, but power. An arm, a grip or a shoulder that is measurably weaker week to week rather than simply sore.
Hands becoming clumsy
Dropping things, fumbling buttons, keys or coins, or handwriting deteriorating, particularly if both hands are affected.
Unsteadiness on your feet
Feeling less balanced walking, or as though your legs are not quite doing what you ask, without another obvious cause.
Changes below the neck
New numbness spreading in the legs, or any change in bladder or bowel control. This one is not a website question.
Seek urgent care
Sudden or rapidly worsening weakness, a sharp decline in walking or hand function, or any new loss of bladder or bowel control needs emergency assessment rather than an appointment. Call 000 or go to your nearest emergency department. GPs with an urgent concern can phone the rooms directly on (07) 3870 3708.
PUBLISHED RESEARCH
What the evidence says about waiting
Two findings do most of the work in this decision. They point in opposite directions, which is exactly why the pattern of your symptoms matters more than the pictures.
More than 85%
Acute cervical radiculopathy, natural history
More than 85 per cent of people with acute cervical radiculopathy improve without any specific treatment, most of them within eight to twelve weeks, and 83 per cent have regained satisfactory function by three years. Patience is doing real work in that group, not just delaying an operation.
StatPearls, Cervical Radiculopathy
56% by 10 years
Untreated cervical myelopathy
In studies of untreated cervical myelopathy roughly 21 per cent had deteriorated by two years, close to 28 per cent by three years, and around 56 per cent by ten years. The decline is gradual rather than sudden, which is what makes it easy to miss.
AO Spine RECODE-DCM, natural history
How to read this
These are averages across groups of patients, not predictions about you. What they establish is that the two main reasons to operate on a neck behave differently over time: nerve pain usually settles, and cord compression usually does not. That single difference is what sets the urgency in most consultations.
Cord compression is the one situation where waiting has a cost of its own
Function lost to cervical myelopathy does not reliably come back. Decompression halts progression for most people, and treating it earlier, before significant loss, gives the best chance of getting function back rather than simply holding the line. That is why myelopathy is judged on a different timescale from nerve pain, and why clumsy hands and unsteady walking are taken more seriously than severe pain.
THE ORDER OF THINGS
Surgery is the last rung, not the first
For almost every cervical problem, treatment climbs a ladder. Most people get better long before the top of it, and an operation is considered when the rungs below have not worked or when the cord is at risk.
FIRST
Time and staying active
Many cervical problems, nerve pain included, improve on their own over weeks to a few months. Gentle activity generally beats resting.
NEXT
Physiotherapy and medication
Targeted physiotherapy, anti-inflammatory or nerve-specific pain medication and good pain control carry most people through without anything more.
SOMETIMES
A targeted injection
A carefully placed injection can settle a specific inflamed nerve or joint, and can help confirm exactly where the problem is coming from.
ONLY IF NEEDED
Surgery
Considered when symptoms are severe or not improving, or when the spinal cord is being compressed. What each operation does is explained separately.
Most of this ladder happens without a surgeon. Non-surgical treatment goes through each rung, and cervical spine surgery explains what the operations at the top actually involve.
BEFORE YOU AGREE
Six questions worth asking about your own case
These are reasonable questions and any surgeon should be comfortable answering them. Ask them here too.
What exactly is compressed, and where?
A useful answer names the level and the structure. Not that you have a bad neck, but that this nerve root is compressed at that level by that disc or that spur.
Does that explain my symptoms?
The level involved has to correspond to what you actually feel and what the examination shows. Where the report, the images and the examination disagree, that disagreement is the interesting part.
What happens if I do nothing?
There should be a real answer. For a lot of neck and arm pain it is that it will probably settle. For myelopathy it usually is not.
What are the alternatives, including not operating?
If a fusion is proposed, ask whether a motion-preserving option was considered and what ruled it out. If surgery is proposed at all, ask what non-surgical treatment has been tried and for how long.
What does success look like, and by when?
Arm pain, neck pain, numbness and weakness do not respond in the same way or on the same timeline. Ask which of your symptoms the operation is actually aimed at.
What are the risks specific to a neck?
Swallowing and voice changes after a front-of-neck approach, among others. Ask for the numbers rather than a list of words.
COMMON QUESTIONS
What people ask at this point
My scan looks bad. Does that mean I need an operation?
Not by itself. Disc bulging and degenerative change are extremely common on the scans of people with no symptoms whatsoever. What matters is whether the finding explains what you are feeling, which is a question the images cannot answer on their own.
Will waiting make surgery harder later?
For nerve pain, generally no. Most of it settles, and operating later on the people who do not settle is a normal pathway. For cord compression it is a different answer, because function already lost does not reliably return.
How long should I give non-surgical treatment?
There is no single number, but the natural history of acute nerve pain is measured in weeks to a few months rather than days. Worsening weakness or any cord sign changes that calculation immediately.
Can surgery fix my neck pain?
Where there is no nerve or cord compression, surgery is unreliable for neck pain. Arm pain from a trapped nerve responds well. Neck pain alone often does not, and anyone promising otherwise is overstating the case.
Does having surgery mean my neck is finished?
No. An operation addresses one or two levels. The rest of the neck carries on much as before, though a fused level does place a little more demand on its neighbours over time. That is a known trade-off rather than a complication.
NEXT
Where to go from here
Non-surgical treatment
Time, physiotherapy, medication and injections. What each one does, what the evidence behind it looks like, and how long to give it.
Read about non-surgical care ›Recovery
Hospital stay, driving, swimming and lifting, and the order in which pain, numbness and weakness settle.
Read about recovery ›ACDF or disc replacement
The most common choice in cervical spine surgery, compared on motion, recovery, further surgery and who each one actually suits.
Compare the two ›About this information
This page is general information about how the decision to operate on a cervical spine is approached. It is not a substitute for an individual assessment and it cannot tell you what is happening in your own neck. Where figures are given, they come from the published research listed below and describe groups of people rather than individuals. Please discuss your own circumstances with your GP or a specialist. More about Dr Tollesson.
References
Cervical Radiculopathy, StatPearls, National Library of Medicine, for the natural history of acute cervical radiculopathy.
Degenerative Cervical Myelopathy: Development and Natural History, AO Spine RECODE-DCM, for the progression figures in untreated myelopathy.
A Clinical Practice Guideline for the Management of Degenerative Cervical Myelopathy, AO Spine and the Cervical Spine Research Society, for the treatment recommendations in cervical myelopathy.
Abnormal Findings on Magnetic Resonance Images of the Cervical Spines in 1211 Asymptomatic Subjects. Spine, 2015, for the prevalence of imaging findings in people without symptoms.
The operation is the straightforward part. Working out whether you need one is not.
A consultation will tell you whether what is on your scan explains your symptoms, whether an operation would help, and what the alternatives would offer instead. A GP or specialist referral is needed for a Medicare rebate.