Neck Pain - Ty Thaiyananthan, MD

Dr. Sechrest: Hello, I’m Dr. Randale Sechrest, your host for eOrthopod.TV. Today I have as my guest, Dr. Ty Thaiyananthan. Dr. Thaiyananthan finished his medical school training at the University of California San Francisco. From there he complete a neurosurgical residency at Yale. He completed a complex, minimally invasive spine fellowship at Cedar Sinai in Los Angeles. Today, Dr. Thaiyananthan is the Director of the Neurosurgical Spine Center at University of California Irvine. Good morning, Dr. Thaiyananthan.

Dr. Ty Thaiyananthan: Good morning, Randy. Thanks for having me.

Dr. Sechrest: Thanks for joining us. Today what I’d like to do is discuss a common problem in neurosurgery, which is neck pain. I’m sure as a neurosurgeon you see a significant number of patients who present to your office with neck pain. What do you start with when you see that patient? What’s the first thing you do with those patients?

Dr. Ty Thaiyananthan: Well, neck pain is actually one of the most common presenting complaints that we see patients coming into our clinic with. The initial assessment for patients with neck pain really involves taking a detailed history, going back and asking the patient what brings on the pain, what aggravates the pain, what makes the pain better. Does the pain shoot down their arms? Is it just isolated to their neck, a condition we call axial neck pain. So the initial evaluation of that condition begins with taking a very detailed history. That history then leads you into performing a very focused physical.

Dr. Sechrest: Now when you’re talking about a difference between pain that is axial in nature, pain right in the middle of the neck, versus pain that goes down the arm. What’s the significance of that?

Dr. Ty Thaiyananthan: It gives me, as a physician that’s evaluating a patient, an idea of where the pathology lies in the neck. When a patient comes in and complains of neck pain, the questions that are going through my head are: Is it coming from the vertebral body? Is there some sort of compression on the nerve roots that are exiting from the cervical spine, from the neck? Is there compression of the spinal cord? Is there pain radiating down someone’s arm or is just isolated to the neck? Are there other signs and symptoms that lead to forming a diagnosis and then selecting appropriate treatment?

Dr. Sechrest: Once you’re finished with the history and, I think you’ve already mentioned a couple things: 1) the things you’re looking at with the patient are ‘Where’s the pain? How long has it been there? What’s causing it, what’s bringing it on, what’s making it better?’ Any other things you’re looking for as a neurosurgeon that would tip you off to whether this is something to be concerned with from the patient’s standpoint, or whether this is pretty typical neck pain that most of us are going to get at some point in our lives?

Dr. Ty Thaiyananthan: One of the key things that I look for in evaluating these patients are there any motor or sensory changes? Is there any muscle weakness in the arms? That can be a sign of compression of nerve roots. Is there any, what we call, hyper-reflexia? It’s a symptom that leads us to suspect that there may be compression of the spinal cord. Is the patient having any difficulty walking? Even though the condition may deal with the patient’s neck it can actually affect an individual’s legs. Are there any bowel-bladder problems? For a very common and sometimes simple complaint, it can actually have a whole host of manifestations of symptoms and, I think especially with neck pain, it’s very critical for a patient to sit down with his physician and go through a very detailed history.

Dr. Sechrest: It’s interesting that you mention reflexes because a lot of patients come into the office and they’re confused, I think, about what we’re looking for when we’re testing reflexes and that sort of thing. I’ve seen a lot of patients who come in and say, “My reflexes are very good”, thinking the more powerful the reflex the better off they are, and I think what I’ve just heard you say is in some cases that’s not the case. Describe for patients, what you as a neurosurgeon, how you use reflexes to really decide what’s going on and what information that tells you.

Dr. Ty Thaiyananthan: The reflexes, in conjunction with a lot of other symptoms, are very similar to when you start your car. There’s a ‘check engine’ light, there are a lot of different lights that light up and tell you if there’s something wrong or something that’s not quite right. The car may still be running, but there may be something out of tune. The reflexes are an indication of how well tuned the spinal cord may be in relation to is it being compressed. Reflexes that are brisk, a lot of people may say I have good reflexes but that may actually be an indication of some sort of pathology in which the spinal cord is being compressed. So we look for hyper-reflexia, in addition we look for hyporeflexia, which is abnormal or decreased reflexes, which may also be an indication of compression of nerve roots or chronic compression of the spinal cord.

Dr. Sechrest: So it’s not necessarily the one reflex itself, it’s the quality of the reflex and then the interpretation of the reflex.

Dr. Ty Thaiyananthan: The symmetry of reflexes, is the reflex different on the right side than it is on the left side. That can help to lead to isolating where the pathology may be coming from.

Dr. Sechrest: Now you also mentioned another thing that I think is very important, and that is, we always watch the patient walk. Most orthopaedic surgeons and neurosurgeons are very interested in watching how a patient walks. Explain for patients why that’s important.

Dr. Ty Thaiyananthan: It’s important because it gives us an idea of how well the neural axis is doing. The impulse for a person to walk starts in the brain goes down the spinal cord, down to the nerves in the legs, which then stimulate the muscles to walk. That’s sort of a simplified overview, but any sort of abnormality along that pathway can affect a patient’s ability to walk. Patients that have chronic compression of their spinal cord may have a wide-based gait and it has slowly progressed over time. A lot of patients may not even pick up on that because it’s so slow but when they walk into your office, it’s one of the things we can clearly see as they walk in through the door. A lot of patients depending on, again, where they’re having problems may have an abnormal walking pattern due to numbness in their feet or weakness as well, and those are all clues that help us as physicians figure out where the problem may be.

Dr. Sechrest: It’s interesting. I get a lot of patients who are elderly and, obviously, a lot of elderly patients have these problems that we’re discussing; the problem with the spinal cord pressure, and the wide-based gait, and a lot of them just think that it’s a part of getting older, so they have this problem with their balance and they come in and they don’t think much of it and they just attribute it to age. I think what I hear you saying, and I’m usually telling patients, is that, “yes, some of that’s okay”; some of it, but when I start to see that I start thinking about what’s going on with this person, and is this just age-related or is this coming from something that’s correctible.

Dr. Ty Thaiyananthan: That’s a great point because a lot of people will come into the office saying, “Oh, I’m just getting older that’s I’m walking this way”, and that is true because as you get older your spine also ages; and with an aging spine there are certain things that may happen that make that walking pattern develop as you get older. So, yes, it may be a sign of an aging spine and a lot of people push it away and say, “I’m just getting older”, but it may also be a sign of something a little bit more serious that needs to be checked out.

Dr. Sechrest: And is potentially correctable. I think the real thing is those folks don’t necessarily have to put up with that. It’s not a part of getting older.

Dr. Ty Thaiyananthan: That’s correct.

Dr. Sechrest: Once you’ve gotten what you think is an acceptable history and you have a pretty good idea of what’s going on with the patient, and you’ve completed a physical exam, what’s next? What test do you generally rely on, as a neurosurgeon, to clarify your diagnosis?

Dr. Ty Thaiyananthan: So with each step of the way you’re sort of honing down a decision process, you make a broad initial diagnosis saying, “okay, this person has something going on with either their neck, the middle of their back, or their lower back”. You use the physical exam to narrow that down a little bit saying, “okay, it’s in their neck but it’s affecting possibly these nerve roots or their spinal cord”; and based on that you, as myself as a neurosurgical spine surgeon, decide what test modality, what sort of test to order, and there are a whole host of different tests. The initial imaging studies may involve just plain x-rays that give you an overview of what the general condition of the spine may be at that point. Something a little bit better than x-rays that yield a little bit more useful information about the bony anatomy and the structures of the bones and the state of the bone are CT scans. If we need to look a little bit more specifically at nerve roots, there are MRIs that are available that give you a very clear picture of the nerve roots, the spinal cord. Another study that we commonly use are CT myelograms, which are very similar to the type of information that you yield from a CT scan but we have an added component of being able to look at the nerve roots that are exiting, and it gives you a very nice picture of the way the bones are interacting with the nerve roots. Those are the most commonly employed imaging modalities. There are also electrical tests that we can do. We have the ability now to electrically stimulate nerves and muscle groups and see how those are working along the pathway from the spinal cord down to their end target, the muscles.

Dr. Sechrest: Now, a couple of questions about that. I think patients, and some physicians, are confused about when a CT scan, for example, is very useful, and when an MRI scan is more useful. What are your thoughts? Do you normally order both of these tests in neck pain patients, or do you do one versus the other?

Dr. Ty Thaiyananthan: There is a lot of controversy on what type of test to order at a specific point. Initially, there’s a clinical gestalt as to what’s going on. If you think that there’s a bony problem, if it’s mechanical in nature, and after getting the initial x-ray if you think you need a little bit more detail in the bony anatomy, a CT scan would be an appropriate test. It gives you a very nice look at the bone, the calcified bony structures. An MRI is a useful test if you suspect compression of a nerve root, or compression of the spinal cord, or a problem with the ligaments. It gives you a very good detailed picture of the soft tissue. So, based on what your clinical suspicion is about what’s going on, you may favor ordering a CT scan versus an MRI. Some patients get both because they may have a couple of different processes going on that may involve both their bones in their spine and also the nerve roots and the spinal cord and soft tissues.

Dr. Sechrest: One other question that I’m always confused with, and that is, when do you think a test, such as a CT myelogram where you actually have to put dye into the spinal canal in order to show the nerves, a test we used to do lots before the MRI scan and before the CT scan. But now I notice that a lot of neurosurgeons really like to see a CT myelogram with dye in that spinal space so that they can really delineate, find things. When do you resort to that test?

Dr. Ty Thaiyananthan: There has actually been a resurgence in using CT myelograms like you were saying. It has a very high utility in re-do spine surgeries where you want to see what effects some of the soft tissues and bones are having on the exiting nerve roots. It’s also very useful in looking at very detailed anatomy of the neuroforamina, that’s a space where the nerve roots exit. It gives you a very clear idea, too, of any specific points where there might be a compression on the spinal cord. You may be able to see generalized compression of the spinal cord on MRI but if you really want to a very specific detailed look at what points may be specifically involved, a CT myelogram would probably be a good test. In some patients, it’s a little bit more sensitive, believe it or not, than an MRI that, traditionally, we associated as the latest high technology diagnostic test. But, again, usually it’s used in conjunction with an MRI and those bits of information from both tests are put together to really get a very accurate picture of what’s going on.

Dr. Sechrest: Do you think that the more powerful the MRI scan magnets become, and the better the software, that we’ll eventually see an MRI scan that gives you that level of detail?

Dr. Ty Thaiyananthan: Absolutely. There’s actually software available now where you could do an MRI myelogram, which is a calculated image, which is an image that’s very similar to a CT myelogram. The way that the technology exists right now, it’s still not as good as a traditional CT myelogram, but it definitely provides valuable information. I think as MRI magnets get more powerful, our ability to see the detail and better clarity will be improved and I think it’s definitely going to be a very powerful and useful tool.

Dr. Sechrest: And that won’t require any sort of spinal tap or dye into the space?

Dr. Ty Thaiyananthan: That’s correct.

Dr. Sechrest: So no needle sticks?

Dr. Ty Thaiyananthan: That’s correct. Sometimes with certain MRIs, the physician will order an MRI with contrast, and that involves just intravenous injection of dye through an IV, and that involves a very small stick, but it’s not the type of invasive procedures that you would need for a CT myelogram where a needle is actually passed into the your back and dye is injected directly into the fluid spaces around the spinal cord.

Dr. Sechrest: Now, one other test that we haven’t discussed, I’d like your opinion on that, and that’s a bone scan. Do you find bone scans very useful in the cervical spine?

Dr. Ty Thaiyananthan: In the cervical spine not so much. For certain pathologies they do yield very useful information. A bone scan is basically, in a simplified version, is an indication of what sort of hot spots in the body are lighting up, whereas the body is sort of actively remodeling; is there a lot of metabolic activity happening in a particular location? And that gives you a view into areas that may be undergoing active bony remodeling. It’s very useful in tumors, where there is tumor growth that may be speckled through the vertebral bodies. In the right patient, with the right pathology, I think it yields some information. It’s good for assessing patients where there may be a suspicion for what’s called pseudoarthrosis. In patients that have undergone spinal fusion, if there’s a suspicion that it hasn’t quite fused yet, it gives you very useful information about whether there’s an active healing process trying to happen there that can let the physician know that may this hasn’t completely fused, a part of the spine hasn’t completely fused yet. It’s a useful tool in the right patient, but it may not be the right diagnostic choice for just a general patient walking in with neck pain.

Dr. Sechrest: So most neck pain patients that just come in and have had neck pain for maybe six months, and it’s just not going away and their primary care provider has finally said, “I don’t know what’s going on. You continue to have neck pain.” It’s not getting better with conservative treatment, maybe some physical therapy, maybe the patient has been seeing a chiropractor. The most common test you would order as a first test would be x-rays? And then maybe an MRI scan?

Dr. Ty Thaiyananthan: X-rays. Yes, an x-ray is actually a very good first step. A lot of people think that with an x-ray you get a static image of the neck but, in actuality, you can have a patient flex, bend their neck, extend their neck, rotate, and get x-rays of the neck in various positions, and that gives you some useful information of how the bones are interacting with each other, how the joints are interacting with each other. That’s a very good starting point.

Dr. Sechrest: Do you ever just see patients and don’t do any imaging and essentially begin treatment without any imaging?

Dr. Ty Thaiyananthan: Absolutely. Especially if patients come in, in my opinion, that haven’t had adequate conservative therapy. The way I view surgery, it’s really an option of last resort for a lot of patients, or it’s an option where you have a very clear pathology that you know you can go in and fix and have a very high rate of success. For most patients that walk in off the street saying that they have neck pain, the common questions that I would ask are: “Have you gone through physical therapy? Have we tried some neck exercises that may help with some of the musculoskeletal components of neck pain?” Have we tried some medications that help with neck pain to see if that gets them back to a level where they say, “Hey, I can go on and live my life”, I really don’t need to do much more of this. It really depends on the condition of the patient when they walk in. It depends on the age. I think that’s a very significant factor in deciding what you want to do with the patient, and how severely their condition is affecting the quality of their life.

Dr. Sechrest: Now, let’s move on a little bit and look at some of the causes of neck pain. When you’re at this point where you’ve evaluated and let’s say this patient has axial neck pain; the pain where it’s hurting in your neck, you’re not having any sort of neurological symptoms either pain down the arms or anything that you would think represents any sort of spinal cord compression. What’s causing the pain in that patient’s instance? What are the structures that are what we would consider pain generators?

Dr. Ty Thaiyananthan: Axial neck pain is actually a very complicated problem and treating it is a very controversial issue in spine surgery. For the most part, when patients complain of axial neck pain, it really involves some sort of mechanical motion of the spinal column – the bones, the joints that are perceived as pain. They can be from the joint in the back, which are called facets. It could be from an aging spine where you have bone that’s rubbing against bone. It could be from disc degeneration, what we call degenerative disc disease, and all of these could be perceived by a patient as pain in my neck. So it’s a very complicated issue, and it’s one of those conditions in spine surgery where I think a lot of tests are warranted, like getting an MRI, doing a nerve block, or facet blocks to see if those joints are really causing pain, and in that case the workup actually becomes very critical, because you want to pinpoint the source or sources of the patient’s neck pain, because it gives you the ability to hone down a treatment plan that becomes very effective.

Dr. Sechrest: It’s common to see patients who come in with a conception, or maybe even a misperception, that they’ve had some sort of a cervical strain, which is a common diagnosis that people say. So they come in assuming that, “I’ve strained something”, and normally they think that they’ve strained a muscle. So it’s muscles causing pain in the neck. What are your thoughts on that? It sounds like we’re moving into an era of where people are trying to be a little more exact and not just give people this blanket diagnosis of cervical strain. We didn’t really know what that meant.

Dr. Ty Thaiyananthan: Cervical strain can actually be a symptom of some other process that’s going on. It may be nothing more than just simply a muscle strain. But, it could also be a symptom of some other process that’s going on in the neck in which the muscles in the neck are trying to compensate for a weak joint or some sort of instability in the neck. A lot of patients will come in saying, “It feels really sore. It feels like I have a knot. I get headaches from this pain that starts in my neck”; and it really may be an indication of some deeper lying problem. When you do walk into a physician’s office, it guides them into finding a diagnosis with what may be going on. It’s really an indication to look a little bit deeper, and you want to rule out a lot of other pathologies that may be causing it.

Dr. Sechrest: So let me get this straight, I think what I hear you saying and I probably agree with this – a lot of patients come in and they think they have muscle strain, muscle cramps, muscle spasms, whatever they perceive is going on; and I think what you’re saying is that, “Yeah, you do have muscle spasm, but that’s not the problem.” The problem is that you’ve got arthritis of your facet joints or you’ve got a degenerative disc and that spinal segment is not working right, so those muscles are working overtime to try to compensate or try to stabilize that. As they work overtime they actually begin to hurt. But if you correct the underlying problem, the muscle spasm goes away.

Dr. Ty Thaiyananthan: That’s correct. That’s correct. So I think it’s really important, when a patient does come in complaining of that, to look a little bit deeper and rule out some of the other processes that may be causing that.

Dr. Sechrest: Not just assume that it’s the muscles causing the problem and here’s some muscle relaxants and go home and you’ll be fine.

Dr. Ty Thaiyananthan: That’s correct.

Dr. Sechrest: Let’s move on in terms of treatment. If you’ve got that patient who you feel like is suffering from axial neck pain, does not have any dangerous pathology that requires immediate attention, such as surgery, injections, or anything like that. Where do you normally start and what is your treatment protocol for axial neck pain? Do you send that person to a physical therapist? Do you treat them with medications? Do you give them some exercises to do? What should that patient look forward to?

Dr. Ty Thaiyananthan: My philosophy on that tends to be a little bit more on the conservative side. I think what you want to do with those patients is treat them with exercises, refer them to a physical therapist that some special expertise in treating neck pain; maybe start them on a course of anti-inflammatory medications, non-steroidal anti-inflammatory medications, to see if that has some improvement. My experience has been about 30% will improve with that conservative treatment. If that fails, then there are some other treatment modalities that we would consider, but you really want to try treating the patient with the least invasive procedures that you have available to address these problems to see if there’s any improvement to a point where they say, “Hey, I’m okay now” or “I’m okay now to the point that I can continue with doing what I do with my life”, without it impacting it too much.

Dr. Sechrest: How long do you think you should give axial neck pain? So if I go to a physical therapist as a patient and I work with a physical therapist for a month, six weeks, is that enough? Is that normally when you would say, “This is not working”, or when should a patient say, “This is not working”.

Dr. Ty Thaiyananthan: I think it’s really variable on the patient. Traditionally, what a lot of surgeons, including myself, will do is send a patient for about a 6 week treatment course. You see them back in clinic and you ask them, “Are you getting better?” If they are, it may warrant continued therapy for a little longer. If they’re not, then you may want to consider other options at that point. So at some point, during the course of the treatment you sort of want to say, “Hey, let’s do a check and see how you’re doing. Does this help?” If it is, then you would consider continuing that course of treatment.

Dr. Sechrest: You mentioned anti-inflammatory medications for pain relief and that sort of thing. Any other medications that you find are useful in axial neck pain patients that benefit them in the short term and possibly in the long term?

Dr. Ty Thaiyananthan: In addition to the non-steroidal anti-inflammatory medications, you can treat the muscle spasms that we were talking about before with medications that quite those spasms down. In our facility at UC Irvine, we work in conjunction with the pain management physician, we may consider doing injections, blocks of the joints themselves, nerve blocks if there is any sort of pain associated with the nerve. Those are all a combination of different treatments that we could use. In addition, not so much in the neck, but it may have a utility, there are stimulators that may help massage the muscles a little bit that some patients have found some benefit.

Dr. Sechrest: Another popular thing these days is acupuncture. Do you think acupuncture is a useful modality for axial neck pain?

Dr. Ty Thaiyananthan: My philosophy on that is if patients are getting a benefit from that I really don’t have a problem with that. There are some patients that seem to get some relief from it. I think the key thing for a patient to realize is that if you are going through acupuncture and nothing’s getting better, it may be time to see a specialist.

Dr. Sechrest: Okay; and no risk to acupuncture for patients?

Dr. Ty Thaiyananthan: Generally not. It’s generally a safe procedure.

Dr. Sechrest: Let’s move on and talk a little bit about when you make the decision that conservative care is not working. What are the things that tip you off that, “What we’re doing is not working. You’re not getting any better and we need to proceed on to invasive options.” You mentioned injections. When do you stop conservative care and begin to recommend that maybe the patient needs to see a pain physician and consider some of the more invasive options?

Dr. Ty Thaiyananthan: Generally, the conservative therapy and pain management with my patients happen simultaneously. There’s the initial referral to a physical therapist, and I’ll also ask the patient on what their preference may be – “Do you want to see a pain specialist at that the same time?” Some will say, “yes”, some will say, “I just want to try out the physical therapy”. So both those modalities tend to happen simultaneously. There are some patients where they’ll come in after physical therapy and that fails and I’ll still think that they’re not good candidates for a surgical procedure and refer them to a pain specialist to see if they can get some benefit from injections, and a certain subgroup of those patients will get some benefit from that. The question about when do you operate on a patient? It’s a very complicated one. The issues that guide my practice in deciding when a patient should go to the operating room are: Are there any motor or sensory deficits that I can fix? In the case of pain, is the pain affecting the quality of life to a point that we need to do something about this? And that undergoing a procedure has a high likelihood of at least alleviating a lot of their pain? Those are all factors that I would consider in deciding when a patient should go; and it’s not just a decision that I make. I think it really involves a very deep understanding of what your patient wants; who your patient is; and also a very long heartfelt discussion with the patient asking them, “How should we proceed?” It’s really a collaborative decision making process.

Dr. Sechrest: In patients that you see on a day to day basis with neck pain, what do you think are some of the common, I would say, mistakes these patients make in terms of their treatment? Over treatment? Under treatment? Waiting too long? Any advice to those patients about some things that they might want to do or might want to avoid?

Dr. Ty Thaiyananthan: I think the most common thing that I see is that patients fail to see a specialist until their condition has progressed a little bit. If you do have neck pain and you’re some symptoms, the safest thing to do is just go see a specialist. Go to a primary care physician or have them refer you to a spine specialist, have it checked out. It never hurts to gather some information. I think a lot of people wait and then they’ll come in and say, “Hey doc, I noticed some weakness in my hand. I noticed some problems walking. There is some numbness. There is some pain that’s shooting down my arm.” I think most people would benefit from an early diagnosis and at least enrollment in physical therapy or an early evaluation at that point.

Dr. Sechrest: So going back to that earlier statement that we had where the elderly patients, a very common population that has neck pain, tend to attribute their problems to aging and things that they’re just going to have to put up with and they should not necessarily consider this something that they’re just going to have to put up with.

Dr. Ty Thaiyananthan: Yeah. The analogy that I draw on and I think more people are familiar with this – If you’re having chest pain, most people wouldn’t want to get that checked out, no matter how, if it’s just a little bit of chest pain, it’s chest pain when I walk. It’s very similar to the spine, if you’re having pain when you’re doing certain activities, maybe you should have that checked out. It definitely wouldn’t hurt to at least the opinion of a specialist on what may be going on. It may be something that could be treated conservatively. It may be nothing. I think it’s a safer bet to go ahead and have that checked out.

Dr. Sechrest: Well, it’s been a wonderful discussion about neck pain from a neurosurgical standpoint, and I think that I’ve clearly learned a few things, and I hope the patients that are watching have. Do you have any closing comments on neck pain and the current state of our ability to diagnose and treat neck pain that you think patients ought to be aware of?

Dr. Ty Thaiyananthan: Absolutely. Spine surgery is something that’s changing almost on a monthly basis. There are a lot of new technologies that are coming out. There are artificial discs, there is traditional surgery, there is pain management, there are facilities that are now popping up that approach a patient from a holistic standpoint from both the neurosurgical, the orthopaedic, and pain management. So I think the key thing for people to understand is that if they are having neck pain that there are probably things that we could do to help them, and there are a lot of new treatment modalities that they may not be aware of and it definitely probably would be to their benefit to come in and at least talk to a specialist about it and see what options they may have.

Dr. Sechrest: So if I can paraphrase that – Most of us start with our primary care provider where we perceive that that’s a family practitioner, or general internist, or even in some cases with neck problems, a chiropractor. I think what you’re suggesting is that if you’re not getting better and that practitioner, no matter who he is, can’t reassure you with confidence that this is something that you just need to continue to live with. That you should really start questioning that and asking yourself, and asking you’re practitioner, “When is it appropriate for me to see a spine specialist and could you make that referral, and get that process started?”

Dr. Ty Thaiyananthan: Absolutely. I definitely think, and I think most practitioners would be happy to make that referral. It’s just sort of, at some point, making that jump to saying, “Hey, I think you need to be seen by a specialist”, and I think a lot of patients would benefit from that. It’s a very specialized area with a lot of technologies that even general practitioners may not be aware of and I think it actually behooves a person suffering from neck pain to at least see what options may be available to them.

Dr. Sechrest: Okay. Thanks. I think that’s excellent advice. Thanks for joining us.

Dr. Ty Thaiyananthan: Thank you.

Dr. Sechrest: Thanks for watching today. If you have questions about the topic that we discussed today, or any orthopaedic topic, be sure to visit eOrthopod.com. If you’re an orthopaedic surgeon or healthcare provider interested in participating as a guest on eOrthopod TV, you’ll also find instructions on how to apply to become a guest on eOrthopod TV. Thanks for watching.