7 March: Q&A with Mr Deb Pal

I have been suffering from chronic neck and arm pain for about two years following a car accident. My GP has suggested that he refer me to see a neurosurgeon. Can you tell me what will happen at the appointment and what a neurosurgeon will need to do to diagnose and treat my problem?

Mr Deb Pal, Consultant Neurosurgeon at Spire Leeds Hospital

The three most common causes of chronic neck and arm pain that we see in practice are:

1) Discogenic pain- Bulging disc between the vertebra in the neck
2) Facet syndrome- Wear and tear in the joints between the vertebra from injury or repetitive strain to neck.
3) Spondylosis-  Wear and tear process causing bony growth at edges of vertebra (bony spurs)

Any of the above could be responsible for your symptoms. When you see the Neurosurgeon, they will take a detailed history from you focussing on the onset, intensity of pain, its radiation to the precise distribution in your arm and whether there are problems with grip, walking or balance. They will try to establish if your symptoms are static or progressive. They will then examine you to identify any muscle weakness or signs of neurological deficits.

If appropriate they will then refer you for a MRI scan of your neck, which will help to see if any nerves are trapped. They will then correlate any abnormal scan findings with clinical findings to make a definitive management plan.

The first line of management is generally conservative with physiotherapy and modification of lifestyle. If this fails and you have a big bulging disc or significant compression of the nerves, the option of surgery will be discussed. In the correct patient, the surgical outcome is usually excellent.

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Mr Deb Pal

Mr Deb Pal, Consultant Neurosurgeon, Spire Leeds Hospital

Mr Deb Pal, Consultant Neurosurgeon, Spire Leeds Hospital


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