Pain in the cervical spine - what does it mean?

An easy riddle: “It is mobile, highly sensitive and extremely important”: Yes! Our cervical spine! It is usually the most mobile part of the entire spine. The two head joints between the skull base and the two cervical vertebrae (atlas and axis) allow about 70% of the mobility of the head. Overall, the cervical spine is made of seven cervical vertebrae (C1-C7), which are located between the head and thoracic spine. Ideally, your cervical spine remains intact for a lifetime - unfortunately, that's not always the case. More than 50% of adults have neck pain at least once in their lives and it usually radiates into the arm(s), sometimes even into the head. Causes can be among other problems: a herniated disc (cervical disc herniation) and spinal canal stenosis. In our clinic, we have set ourselves the goal of performing all surgical procedures as gently as possible and with small incisions, using the finest instruments in order to avoid unnecessary vascular destruction. Under general anesthesia, the operations can be monitored by so-called Intraoperative neurophysiological monitoring (IONM).

When is a microsurgical operation on the cervical spine necessary?

Microsurgical procedures are used in case of, for example, herniated discs, spinal stenosis, myelopathy, tumors, syringomyelia and cysts. When the herniated disc occurs, it usually tears the fiber ring, so that parts of the nucleus pulposus leak and press on nerves and the spinal cord, leading in turn to severe acute pain and deficits, even in movements. In spinal canal stenosis, the spinal canal narrows due to calcification or bony attachments. As a result, the nerves that pass through the canal become trapped. Usually pain occurs during exercise and often radiates to the arm. Herniated disc and stenosis can be successfully treated, preferably by microsurgical procedures. The skin incision is of maximum 4-5 centimeters. With a fine probe, the use of micro-instruments and with the help of a special microscope, microsurgery guarantees a precise development of the treatment. During the process, microscopic enlargements allow to remove disc material or tumors, to eliminate stenosis by dilating the spinal canal (decompression at the cervical spine) and thus to prevents further neurological deficits.

Operation procedure - microsurgery on the cervical spine takes 20 to 50 minutes

No surgery without diagnosis. The possible presence of a herniated disc, tumor or spinal canal stenosis can be confirmed only through an MRI (magnetic resonance imaging) examination because it allows seeing clearly what is going on. Sometimes X-rays are added. Microsurgery (of course under general anesthesia - ITN) takes different lengths - in a herniated disc on one segment the treatment lasts 20-40 minutes, in case of spinal canal stenosis 30-50 minutes. The surgery takes place from the anterior (ventral) in case of herniated discs and some cases with spinal canal stenosis. The dorsal approach (from behind) is usually used in cases with tumors, syringomyelia, cysts, and some stenosis.

We begin with a 4-5 cm long skin incision. If we come from the front, we shift the trachea and the esophagus to the center - the operating field is kept open with a so-called locking system. So that we always know exactly where we are and what we do, and do not damage any structures. The entire procedure takes place under fluoroscopy (C-arm) control. We use the finest miniature instruments. With special small pliers we can remove the disc material that escaped from the gelatinous core. And with other special instruments (rongeurs) we are able to eliminate the narrowing (stenosis) in the spinal canal. Tumors and cysts are removed also micro-surgically. In syringomyelia, the surface of the cavity is opened so that the contents of the syrinx are directed outwards. Diseased discs are usually replaced with disc prosthesis or with cages. Sometimes they will be secured with additional plates for more stabilization

Right after the operation

Slowly and under supervision, you will come back to the recovery room, where your health conditions will be monitored. After that, a nurse will accompany you to your room, where you will continue to be subjected to check-ups. Once anesthetics leave your body, you will wonder: where is the pain? To later find out that they have disappeared. Of course, you feel pain in the operated point, slight tension and difficulty swallowing, but let your new life begin! 

Post-operative days

Already on the first post-operative day you can get up, sit and run. You will wear a neck brace. Your inpatient stay will be of about 8-10 days. During this time, you will receive pain therapy and physiotherapy. First, you should avoid bending and twisting in the cervical spine area. In bed you must lie on your back. Dysphagia and tension in the cervical-thoracic shoulder area are normal. Rarely, hoarseness occurs for a few days. If there were arm pain before the operation, they disappear immediately after surgery. Other symptoms, such as tingling, numbness, decreased strength, gait disturbances, or bladder dysfunction (if present before surgery) may take longer to disappear or be alleviated. The neural structures recover very differently after an operation. That depends on how long have you been struggling with pain, what specific structures were affected, if the problem was in one place or if multiple segments were affected, if there was diabetes or other illnesses and other factors.

Driving is possible in 6 weeks and at the beginning short distances. About sport: You are allowed to do backstroke swimming style immediately after leaving the hospital, cycling is allowed after 4 weeks, jogging after three months, golf and tennis have four months break. For 2 weeks it is necessary to wear a neck brace day and night after the operation and further 2 weeks only at night. It is recommended to start certain physical therapy procedures immediately after the treatment. Heavy physical activity and heavy weight bearing are taboos for at least 6 weeks - after that you can start with it and gradually increase your activities.

Advantages/Complications - microsurgery on the cervical spine has many advantages

Microsurgery with all its constant improvements is one of the great advances in medicine. Why is this surgery - which has been used successfully since the 1990s - so valued by doctors and patients? Quite simply, the main purpose of any surgical procedure is to minimize the impact on the body, and instead allow it to be manipulated with small incisions and causing minimal trauma to the skin and soft tissues. It is precisely this combination that makes microsurgery a wonderful treatment. The progress made possible to enjoy extremely magnifying visual aids such as loupes or the light microscope. What is also perfect is the suture, made in small sections, finer than in the so-called major surgery.

Microsurgery on the cervical spine offers a lot of benefits:

  • The original main pain disappears almost directly after the surgical procedure.
  • Usually patients are able to walk and stand up on the first post-operative day.
  • Being the surgical access smaller than in the conventional surgery, it naturally heals faster. Therefore, the so-called 'inner scar' is minimal.
  • Bleedings or infections rate are extremely low. Other complications are even more rare, such as nerve injury, organ injury, problems with the implants or paralysis.
  • Blood loss is minimal.
  • The success rate is at least 90% according to statistical effects.
  • Physiotherapy can be started relatively quickly after the procedure.
  • You can start with sports and professional activities much earlier than with other types of treatments that involve bigger scars.
Dr. med. Munther Sabarini

Author
Dr. med. Munther Sabarini
Specialist in Neurosurgery

Hans-Heinrich Reichelt

Co-author
Hans-Heinrich Reichelt
Chief Editor of Medizin für Menschen

The Avicenna Clinic in Berlin is always willing to help you

Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

If you have severe back pain, a herniated disc or a suspected herniation, please contact us using the following information:

Avicenna Clinic
Paulsborner Str. 2
10709 Berlin

Telephone: +49 30 236 08 30
Fax: +49 30 236 08 33 11
E-Mail: info@avicenna-klinik.de

You can call anytime, write an e-mail or fill out a callback form. Each patient then gets an appointment with a doctor of our clinic, who is a spine specialist (neurosurgeon). Based on MRI images (brought or made in our clinic) and on an in-depth examination, the doctor will discuss with you all the different therapy options or possibly surgery. You can also use our specialists only to obtain a (second) opinion.

If you decide to undertake your therapy and/or surgery in Berlin, we would want to make your stay as pleasant as possible. In our clinic, you are at the center of our attention! You can expect state-of-the-art equipment in all areas - from the operating room to the patient bedroom.

The latest, gentle, minimally invasive treatment procedures are the focus of our clinic. Together we try to find a suitable treatment for your complaints. The actual therapy takes place only after a detailed discussion with the patient, examinations and the diagnostics.

For us, as important as medical care, it is the commitment we take to guarantee our patients a high level of personal care that can, in turn, ensure them a comfortable stay.

During the period of inpatient stay our team of nurses will take care of you 24 hours a day. They also offer services in several foreign languages, including English, Russian, Polish, Turkish, Spanish, Italian, Arabic, Bulgarian and French. We care not only about your safety but also your needs, respecting traditions and religions.

Our team is made up of a group of highly qualified specialists who work together to guarantee you a quick recovery.