The Epidemiology of Neck Pain

, Medical College of Wisconsin, Milwaukee, Wis.

Disclosures
In This Article

Outcome

In 1982, Rothman[22] stated, "It does not appear that cervical disc degeneration is a brief self-limited disorder but rather a chronic disease productive of significant pain and incapacity over an extended period of time."

As discussed in the previous sections, degenerative disease of the cervical spine and neck pain are not synonymous. Degenerative changes are often present in asymptomatic people, and in some people with neck pain no structural abnormality can be demonstrated. However, in our experience, Rothman's statement holds true for patients with neck pain with or without degenerative changes.

In 1987, we reported on a review of 205 patients initially seen for neck pain in an office setting.[23] Patients with previous neck surgery, objective neurologic deficits, malignancies, or rheumatoid arthritis were excluded. The patients were re-examined and interviewed an average of 15 years (10 to 25 years) after the onset of their neck problems. In all patients, lateral roentgenograms were available for comparison between the initial visit and the final evaluation.

At follow-up, 79% had a decrease in pain, and of these, 43% were pain-free; however 32% had moderate or severe residual pain. Patients who had been injured and initially had severe pain were most likely to have an unsatisfactory outcome; however, no other clinical features were of value in predicting the final result. Initially, 121 patients had injuries, of which 76 were due to motor vehicle accidents. Sixty-eight were involved in litigation, 58 in personal injury claims, and 10 in workman's compensation claims. At final evaluation, all but 4 claims had been settled, and all of these patients stated their initial pain had decreased in severity. Interestingly, 23 patients were dissatisfied with the outcome of their litigation. However, there was no statistical relationship between their level of satisfaction and the amount of pain or pain relief reported at final interview.

The roentgenographic features measured were degenerative changes at each intervertebral disc space, sagittal diameters of the spinal canal at each disc space, and cervical lordosis. None of the roentgenographic findings present initially or developed in the follow-up period correlated with pain or had any predictive value for pain relief.

Most important, this study emphasizes that neck pain is frequently not a self-limited problem, and that many patients will have long-term symptoms that may be moderately disabling.

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