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, such as a whiplash suffered in a car accident, it can be of tumor origin, fortunately rare, infectious or cervical degenerative problems. The degenerative problems affect the joints and discs and may or may not compress nerve structures, depending on the picture we will call it in different ways. For example, a cervical pain that does not go anywhere, that stays 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 this pain radiates towards an arm we will call it cervicobrachalgia because it is affecting an extremity with loss or not of sensitivity and loss or not of strength. If the picture is more complex because there has been a compression for a longer time or there has been a major trauma to the cervical spine, we can find ourselves in front of a picture of cervical myelopathy which means that the spinal cord is affected to a greater or lesser degree and is giving us repercussions 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 picture 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 which is the use of selective infiltrations for both diagnostic test and local anti-inflammatory treatment. These infiltrations are performed under local anesthesia and indicate which neck structure is 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 disc replacement elements in the form of cervical disc prostheses.
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 performed anteriorly or posteriorly depending on the case and normally the objectives are to decompress, free the nerve structures, either the roots or the spinal cord and stabilize the spine in such a way that no traumatic or displacement problems occur later. The techniques we have can range from small micro decompressions to release a nerve or remove a hernia, to decompress in the form of vertebrectomy, removing all the bone that compresses the spinal cord and stabilize it in the form of boxes or screwed plates. In some cases, in young patients with few degenerative changes and who present a herniated disc with acute pain that does not subside in the arm, we can replace the disc and the herniation with a mobile element, the cervical disc prosthesis, which allows us to maintain the mobility of this segment and not overload the upper and lower elements of the one we are treating.