What are the most common problems of cervical origin?
The main problem of cervical origin is always pain and that pain can be due to different causes. It can be of traumatic origin, like a whiplash suffered in a car accident, it can be of tumoral origin, fortunately rare, infectious or due to cervical degenerative problems. Degenerative problems affect joints and discs and can compress or not nerve structures, as the picture will be called in different ways. For example, a cervical pain that does not go anywhere, which remains at the occipital level, in the posterior area of the spine we will call it cervicalgia and it is usually due to degenerative problems of the joints of the cervical spine. If that pain radiates to an arm we will call it cervicobracalgia because it is affecting a limb with loss or not of sensitivity and loss or not of strength. If the picture is more complex because there has been compression for a longer time or it has been an important trauma in the cervical spine, we may find ourselves in front of a picture of cervical myelopathy which means that the marrow is more or less affected and It is giving us repercussion not only at the cervical level, not only at the level of the arms but even at the level of the legs. The treatment therefore, depending on which frame we have, will be more or less aggressive and using different systems.
What treatments can we perform?
To treat pain of cervical origin we have a whole battery of treatments, starting from pharmacological or physiotherapeutic treatments to surgical treatments. In the center we have a possibility that is the use of selective infiltrations both for diagnostic tests and for local anti-inflammatory treatment. These infiltrations are performed under local anesthesia and indicate which structure of the neck is the most affected. In cases of nerve compression, if pharmacological treatment is not effective, surgical treatment is sometimes necessary, either with nerve decompression and fixation of the structures or with the use of replacement elements in the form of a cervical disc prosthesis. .
What is the role of surgery in cervical pain?
In those cases in which the conservative treatments are not effective, for example physiotherapy, infiltrations, pharmacological treatment or the problems that we have diagnosed of cervical origin are serious, that is to say, there is an excessive compression of the nerves or an instability of the structures, we have to resort to surgery. Cervical surgery can be done by anterior or posterior route depending on the cases and normally the objectives are to decompress, leave the nerve structures free, either the roots or the marrow and stabilize this column in such a way that it does not produce traumatic or displacement problems a posteriori. The techniques that we have can be from small micro-discompressions to release a nerve or remove a hernia, to decompress in the form of vertebrectomy, eliminating all the bone that compresses the cord and stabilize it in the form of boxes or screwed plates. In some cases, in young patients with few degenerative changes and who have a herniated disc with an acute pain that does not give in the arm we can replace the disc and the hernia with a mobile element, the cervical disc prosthesis, which allows us to maintain the mobility of this segment and not overloading the upper and lower elements that we are dealing with.