Featured Spinal Article

Musculoskeletal Consumer Review took an opportunity to sit with Dr. Razmi Rahmat, a Consultant Spine and Orthopaedic Surgeon from Centre For Spine and Orthopaedic Surgery to discuss about the common neck problems seen in his clinic and the management for those problems.

MCR: What are some of the common neck problems seen in your clinic?

Dr. Razmi: The most common cause of neck pain is actually simply overuse! Most young, economically viable and techno savvy people, spend too much time in front of the computers. The muscles and ligaments that hold the cervical spine become fatigued and strained and these cause pain. The next cause is degenerative, due to wear and tear from over use or from injury. It can also be part of ageing process. Traumas like whiplash injury from car accidents make up the rest.

MCR: What can a patient expect when he/she goes to you with complaints of neck pain? (i.e. Procedures you do as an Orthopaedic Doctor to find out the cause?)

Dr. Razmi: The first step would be a good history taking to find out more about the pattern of pain or disability. Often it gives you a clue as to the origin of pain. Next would be a thorough clinical examination, to find the location of pain, assessment of range of motion and most importantly if there is any nerve involvement. Then comes the radiological investigation, which would be in the form of plain x-rays and MRI. Both are important and must be done, as different modality will allow the doctor to assess different tissues. In some cases, nerve conduction studies and electromyographic tests are necessary in some more complex cases.

MCR: What are some of the symptoms of herniated cervical disc protrusions?

Dr. Razmi: The most common symptom would be neck ache. This can be severe and of acute onset or it can be chronic. Some herniated discs are one sided and these give rise to pain going down either the left or right arm. There can be tingling or sensation of numbness. In more serious cases, the herniated disc can press on the spinal cord. This has more serious consequence as it can cause a person to lose fine motor skills in the upper limbs in the early stages and paralysis of all 4 limbs in the late stage.

Dr. Razmi Rahmat

Qualifications M.B.B.S, Masters of Medicine Fellow of the Academy of Medicine, Singapore Fellow of the Royal College of Surgeons Professional Highlights Dr. Razmi is a practicing orthopaedic consultant at Gleneagles Hospital, Mount Elizabeth Hospital and East Shore Hospital. His current research interests are in repair and regeneration of diseased spinal discs using autologous chondrocytes transplantation. First surgeon in Singapore to perform stand alone anterior approached spine fusion using the Synfix implant. In 2003, he was selected to represent Singapore in the Junior ASEAN Orthopaedic Travelling Fellowship. He spent a month travelling around the ASEAN region to share as well as learn with the leading surgeons in the region. Awarded a clinical fellowship at the Spinal Unit, Department of Orthopaedic and Trauma, Royal Adelaide Hospital in Adelaide.

MCR: If a patient has pain radiating from the neck to the hands, what can be done to determine nerve-related problems?

Dr. Razmi: The most useful investigation would be an MRI scan. MRI scan is 100% safe as it uses magnetic field rather than radiation. It is very accurate and can give excellent details on soft tissue problems, like ligament, muscles and more importantly the nerves. In some complex case where by we may need to differentiate whether the numbness is caused by compression of nerve in the neck or carpal tunnel syndrome where the compression occurs in the wrist, then a nerve conduction and EMG is useful.

MCR: What is the course of treatment for radiculopathy problems?

Dr. Razmi: Most spinal problems are approached conservatively first. These would include, a period of rest and modification of lifestyle and activities. All activities that aggravate the symptoms should be avoided or lessened. Medications like anti-inflammatory painkillers will help during the acute period. However it is not advisable to take it long term. New neuropathic pain medications that alter the sensitivity of the affected nerve like Gabapentin and Pregabalin can also be used. Nerve supplements in the form of Vitamin B complex are good to “strengthen” nerve function.

One of the most useful modes of treatment is physiotherapy. In the early phase, heat therapy, gentle stretching and gentle spinal mobilisation will help greatly in overcoming muscle spasm. Later, gentle intermittent cervical traction can be applied. Next come exercises to stretch and also to strengthen muscles around the neck.

Acupuncture can also be tried. However, harsh or rough manipulation by sinseh can be harmful rather than beneficial. Targeted epidural steroid injection around the affected nerve can also be done but it has to be guided by CT scan and must be done by a highly trained spine or radiology specialist. Finally, if all these measures fail, then surgery needs to be considered to decompress the affected nerve.

MCR: If a specific nerve is found to be inflamed, what treatment can be given to reduce the inflammation?

Dr. Razmi: The most effective way to reduce inflammation of nerve or neuritis is rest and the use of anti-inflammatory medications. Rest comes in the form of avoidance or reduction of activities causing the inflammation. A cervical collar is useful to immobilise the neck so that it reduces movement of the neck and helps settle the inflamed nerve. Anti inflammatory medications will help reduce the inflammation fast and at the same time acts as a painkiller. Only in very severe cases are strong opiates like Morphine is needed to control the pain. This will require admission for monitoring. -CG