From the Guidelines
The best course of treatment for this 56-year-old male with prior ACDF who presents with neck pain and right hand numbness after cracking his neck should begin with prompt medical evaluation, including neurological assessment and imaging, with a focus on CT cervical spine to assess spinal fusion and potential adjacent segment degeneration, as recommended by the American College of Radiology 1. The patient's history of anterior cervical fusion increases the risk for adjacent segment degeneration, and the recent neck cracking may have exacerbated an existing issue or created new instability. Initial management would include oral NSAIDs such as ibuprofen 400-600mg every 6 hours or naproxen 500mg twice daily for pain relief, along with a short course of muscle relaxants like cyclobenzaprine 5-10mg at bedtime for 7-10 days.
- Key considerations in management include:
- Discontinuing neck manipulation or cracking to prevent further injury
- Initiating physical therapy focusing on gentle cervical stabilization exercises and proper posture once acute pain subsides
- Monitoring for worsening symptoms, particularly hand numbness, which could indicate potential compromise of the cervical nerve roots or spinal cord at the fusion site or adjacent levels
- Considering advanced imaging (MRI) if symptoms persist or worsen, to evaluate for possible adjacent segment disease, hardware complications, or new disc herniation, as MRI is superior to CT in identifying soft-tissue injuries such as epidural hematoma, cord contusion, and ligament sprains 1. The patient's normal range of motion without neurological deficits on initial assessment is reassuring, but close follow-up is necessary to ensure that symptoms do not progress, and urgent neurosurgical consultation should be sought if severe or progressive neurological symptoms develop.
From the Research
Patient Presentation and History
- The patient is a 56-year-old male with a history of anterior cervical fusion (ACDF) on 02/03/23, presenting with neck pain and numbness in his right hand after cracking his neck on 5/8/2025.
- The patient has a history of regularly cracking his neck, despite knowing it is not recommended.
- The patient's symptoms include neck pain and numbness in his right hand when moving his neck.
Assessment and Initial Treatment
- The patient was assessed and demonstrated a normal range of motion without neurological deficits.
- An x-ray of the cervical spine has been ordered to further evaluate the patient's condition.
- The patient will be followed up after the x-ray results are received.
Relevant Studies and Findings
- A study on anterior cervical discectomy and fusion (ACDF) found that it is a common procedure for treating cervical spine degenerative diseases 2.
- Another study reviewed the anatomy of the spine and treatment options for cervical disc disease, including ACDF 3.
- A retrospective study found that physical therapy and exercise programs after ACDF surgery can improve pain management and do not cause changes in cervical misalignment 4.
- A review article discussed the various types of interbody grafts and anterior cervical plating systems, as well as techniques for optimizing evaluation of cervical spine metallic implants on CT and MR imaging 5.
- A technical report described the anterior approach for cervical discectomy and fusion (ACDF) at the C2-C3 level and evaluated its suitability for treatment of instability and degenerative disease in this region 6.
Potential Complications and Considerations
- The patient's history of cracking his neck may have contributed to his current symptoms, and it is essential to advise him to avoid this behavior in the future.
- The patient's ACDF surgery may have implications for his current condition, and it is crucial to consider this when evaluating his symptoms and developing a treatment plan.
- The patient's numbness in his right hand may be related to his neck pain, and further evaluation is necessary to determine the cause of this symptom.