What is the best course of management for a patient with a history of anterior cervical fusion, neck pain, and numbness in the right hand after cracking his neck?

From the Guidelines

The patient with a history of anterior cervical fusion who experiences neck pain and right hand numbness after cracking their neck should be referred to the emergency department for urgent assessment, as these symptoms could indicate potential damage to the surgical fusion site, cervical spine instability, or nerve compression. The patient's history of anterior cervical fusion, as described in the context of the 2016 IDSA clinical practice guideline 1, suggests that a mature bony fusion provides a durable and physiologically dynamic support system that both protects the neural structures and decreases mechanical pain. However, the patient's recent neck cracking and subsequent symptoms of neck pain and numbness in the right hand necessitate immediate medical evaluation to rule out any complications. Initially, the patient should be immobilized with a cervical collar to prevent further movement and potential injury. Diagnostic imaging, including cervical spine X-rays, which the patient's doctor has already planned, CT scan, and possibly MRI, should be performed to evaluate the integrity of the fusion hardware and to check for any new compression of neural structures. While awaiting medical care, the patient can take acetaminophen 650mg every 6 hours for pain relief, avoiding NSAIDs which may mask inflammation. After acute assessment, the management may include a short course of oral steroids such as methylprednisolone dose pack, physical therapy focusing on gentle cervical stabilization exercises, and possibly gabapentin starting at 300mg at bedtime and gradually increasing to 300mg three times daily for neuropathic symptoms. Key considerations in the management of this patient include:

• The potential for adjacent segment disease, hardware complications, or nerve impingement, all of which require prompt evaluation to prevent permanent neurological damage.
• The importance of immobilization and diagnostic imaging to assess the integrity of the fusion site and neural structures.
• The role of pharmacological interventions, such as acetaminophen, oral steroids, and gabapentin, in managing the patient's symptoms.
• The need for gentle cervical stabilization exercises as part of physical therapy to promote healing and prevent further injury.

From the Research

Patient History and Presentation

• The patient is a 56-year-old male with a history of anterior cervical fusion on 02/03/23, presenting with complaints of neck pain after cracking his neck on 5/8/2025.
• The patient reports numbness in his right hand when moving his neck, despite being aware that he should avoid cracking his neck.
• A comprehensive patient history is essential in this case, as outlined in studies 2 and 3, to inform diagnosis and treatment.

Relevant Studies

• A study on anterior cervical decompression and fusion found that patients can expect improved range of motion, decreased pain, and improved neck function 6 months postoperatively 4.
• Another study reported cases of facial numbness and paresthesias resolved with anterior cervical decompression and fusion, highlighting the importance of addressing compressive cervical radiculopathy 5.
• A case report on the improvement of chronic neck pain after posterior atlantoaxial surgical fusion via multimodal chiropractic care suggests that manual therapies, including spinal manipulative therapy, may be effective in patients with previous cervical spine surgery, but with caution and on an individual patient basis 6.

Management and Next Steps

• The patient's symptoms and history suggest the need for further evaluation, including an x-ray of the cervical spine, to determine the cause of his neck pain and numbness.
• The results of the x-ray will inform the next steps in management, which may include physical therapy, pain management, or further surgical intervention.
• Studies 2 and 3 emphasize the importance of taking a comprehensive patient history and using evidence-based practices to guide diagnosis and treatment.