Neck pain is a frequent complaint after motor vehicle accidents, especially after rear-end collisions. The pain may not be experienced immediately, but sometime later when neck motion precipitates muscle spasm. The majority of neck pain after traffic accidents subsides however, and in one study of over 200 individuals where medico-legal implications are not relevant, the prevalence of chronic symptoms are not higher than in the general population. Expectation of disability, a family history and attribution of pre-existing symptoms to the trauma are important determinants for the chronicity of the neck pain. The outcome of acute neck pain after traffic accidents is better for patients who are encouraged to continue to engage in their normal activities as usual than for patients who are given sick leave and immobilized in a soft collar during the first 14 days after the accident.
Instability is corrected by reduction and fusion of the involved vertebrae.
Decompression of the nerve root may be accomplished via a posterior laminotomy and foraminotomy, or an anterior discectomy with or without fusion of the vertebral bodies. Oftentimes, a fusion is necessary to re-establish the spinal stability or to prevent a future deformity due to the weakening of the supportive structure after the decompression. Controversy still surrounds the indications for operating on degenerated discs without demonstrated neural compression. A recent study showed that surgical fusion of cervical discs may bring relief of neck pain to a certain number of selected cases. Only in cases in which radiographic changes correlate with the results of diagnostic nerve blocks should surgical fusion be considered as a last therapeutic means to resolve the painful condition.