Wear-induced (degenerative) deformation of the cervical spine is a very common condition. Intervertebral disc disorders may be a cause of chronic pain (e.g. headaches, pain in the neck, shoulder or arm). Other symptoms, such as numbness and muscular weakness, may also occur. Our clinic offers our clients a full array of comprehensive diagnostic and therapeutic measures, including treatment of pain, physical therapy and surgery.
Complete physical examination is a crucial step in finding the right diagnosis. Complementary imaging techniques include MRI, CT and standard X-ray. Electrophysiological tests may also be useful.
Patients not requiring urgent surgery may receive extensive conservative inpatient treatment including physical therapy and pain management during a short (approx. 5 days) stay in our clinic (Ambulantes Rehabilitationszentrum, attending physician Dr. Westphal). Subsequently, a follow-up treatment may be applied to stabilize the treatment outcome, thus helping to avoid surgery.
Surgical treatment must be considered based on the results of all diagnostic measures in patients with persistent pain or significant neurological deficits. The aim of surgery is to reduce the pressure on the spinal cord or nerve roots. In the case of vertebral column deformities it may also be applied to correct them. The surgical techniques vary depending on the location of spinal disc herniation and severity of coexisting wear-induced deformations. If the entire intervertebral disc needs to be completely removed, the intervertebral space is restored using an artificial element made of biocompatible material or with a prosthetic disc. The decision on the appropriate surgical technique and its application has to be discussed with every patient individually.
The disc can be removed through a small, approx. 3 cm incision in the front of the neck. In some cases of herniated disc or spinal canal stenosis an incision in the back of the neck may be applied. Minimally invasive spinal surgery can then be applied, in which the muscles of the neck are gently and gradually stretched, in contrast to the classical techniques in which the muscles are stripped and separated from the spine and thus are prone injury. Thanks to the minimally invasive surgery technique postoperative mobility limitations and pain can be largely avoided.
Fig 1. Cervical disc herniation at C5/6 level. The patient complained of numbness and pain radiating to his left arm.
Fig 2. Intervertebral disc prosthesis. The patient recovered quickly after the surgery, he was symptom-free, the pain radiating to his left arm was no longer present, his mobility was fully preserved.
Fig 3. Cervical disc herniation at C7/Th1 level. Due to the location at the postero-lateral part of the spinal canal the critical site can be accessed through the incision at the back of the neck (Frykholm operation).
Cross-section: The arrow marks the herniated disc compressing the nerve roots. The arrows also show the access site according to the Frykholm operation technique.
Fig. 4. Minimally invasive spinal surgery: Muscles are only stretched (dilatated), not separated from the spine. The operation is performed through a 14 mm wide canal. The incision in the neck measures only about 2 cm.