Assuming patients and healthcare providers follow clinical guidelines for managing neck pain, most neck pain sufferers can experience resolution of their pain and disability with the aid of a conservative, multimodal treatment approach, such as those provided by chiropractors. However, for a variety of reasons, some patients may still undergo surgical intervention, and it is estimated that up to 40% may continue to experience persistent or disabling neck pain. Why is this the case, and is there anything chiropractic care can do to help these patients?

The first potential cause of persistent post-surgical neck pain is an incomplete or incorrect diagnosis. This can occur when imaging reveals positive findings—such as a disk herniation—that are attributed to the patient’s symptoms but may not, in fact, be the underlying cause. In some cases, a disk herniation may play a role; however, other contributing factors that are not visible on imaging or are missed during a physical examination may also be involved.

There are also cases in which the pain generator is correctly identified and treated, but complications from surgery result in ongoing neck pain. For example, scar tissue formation around nerves and soft tissues can tether nerves or create a chronic inflammatory environment that triggers pain. In addition, a decompressed nerve may continue to experience impaired function as though it were still compressed.

Finally, a new source of neck pain may develop following an otherwise successful surgical procedure. This can occur when spinal alignment is restored but the joints and soft tissues are not accustomed to supporting the altered loads and forces and subsequently become injured. Additionally, in cases of surgical fusion that restrict movement at a cervical spinal level, the vertebrae above and below the fusion may become hypermobile to compensate, pushing them beyond their normal range of motion and increasing the risk of injury.

With all of this in mind, how can a doctor of chiropractic help manage post-surgical neck pain? The first step is a thorough review of the patient’s history, which guides the physical examination. The examination not only seeks to identify potential pain generators but also helps detect red flags that contraindicate chiropractic treatment. In addition to traditional red flags (such as fracture, infection, tumor, severe osteoporosis, and vascular abnormalities), the chiropractor will also assess for signs of cervical instability or incomplete healing. To help restore normal movement and function of the cervical spine, a doctor of chiropractic will often employ a multimodal approach that combines low-force manual therapies, gentle traction, therapeutic exercises, and physiotherapy modalities.