The correct tactic in such a case is to image the cervical spine, preferably by magnetic resonance imaging. The goal is to confirm or rule out problems that may be pressing on the nerves coming out of the spinal cord or even the spinal cord itself.
Neck pathology and the importance of the spinal cord
The essential difference between the pathology of the neck (of our neck) and the pathology of the lower spine (of our waist) is that the neck hosts the spinal cord. The spinal cord is a key organ of man in the sense that it does not simply control the nerves coming out of a particular area as it does in the lumbar spine. It controls the whole body from every point down. “In short, if we have a problem in the middle of our neck, this problem may cause a malfunction throughout our body from this point in the neck and down, that is, in our arms and legs or even in our breathing.
The above element makes the pathology of the neck very important.
All patients should be aware that if they experience any discomfort in the neck that travels to the arms or legs, an investigation should always be performed. “MRI of the cervical spine is a necessary step in case we suspect any pathology of the neck.”
Another important difference between the neck and the lumbar spine is the speed with which the treatment should be done. When we have a foot discomfort from a problem in the middle we can wait, use preservatives and see how it goes.
In the neck, however, if we see that the function of the spinal cord has been affected, ie we have numbness in the arms and legs along with weakness, in this case we should deal with the situation more immediately and more drastically. The consequences if we ignore such a problem can even be paralysis. Therefore, in case of symptoms, it is always necessary to be evaluated by a neurosurgeon and to make the necessary examinations so that we can proceed faster with the appropriate treatment.
Therapeutic options
A neurosurgical lesion (a lesion that needs to be treated by a neurosurgeon) in the neck may correspond to a disc that presses on the spinal cord, or to a hypertrophy (commonly a swelling) of the ligaments or bones that presses on the spinal cord. This pressure can also affect the nerves that come out of it, which mainly control our hands.
The solutions initially include, as in our case, conservative treatment with drugs, painkillers and anti-inflammatory drugs. The difference, however, is that in case there are symptoms that indicate spinal cord damage as mentioned before, we proceed directly to surgical decompression to save the spinal cord.
Epidural injections in the neck play a much smaller role than in the problems in our waist, and one of the main reasons for this is the risk of spinal cord injury during an injection but also the risk of leaving a lesion of the spinal cord to evolve with the corresponding consequences.
The arms in case there is damage to the spinal cord, which as we mentioned is manifested by numbness and weakness in the arms and legs, usually in combination with some discomfort in our neck, are quite limited.
Surgical treatment
“There are basically two surgical solutions in our neck, the decompression from the front and the decompression from the back. In both cases, with special tools we remove the bones, ligaments and discs that cause pressure on the spinal cord either by incision in the back of our neck or by incision in the front of our neck “, adds the doctor.
The essential differences between the two techniques have to do with the effectiveness of each technique depending on how serious the problem is. When the neck has been affected on multiple levels, ie a large percentage of its height, the best solution is usually surgery from behind. On the other hand, when many levels have not been affected but the percentage of stenosis, ie how much the space where the spinal cord travels has narrowed is very large, then the best solution is surgery from the front.
In addition, there are a number of factors that influence this decision, but in each case a small incision is made either in the front of the neck or in the back of the neck and through this incision pass the special tools with which bones, discs and ligaments are removed. which press on the nerve structures.
When the surgery is done from the front, materials are always needed, that is, a specific material must be inserted at the point where we will have intervened to support the vertebrae.
This is not always necessary when performing surgery from the back, but it is necessary when multiple levels of surgery are performed and when there is a case for the patient to show instability after the surgery. By instability we mean that the vertebrae move between them and their normal anatomical relationship changes, which can lead to severe pain and symptoms in the patient.
Is it safe to avoid surgery?
As patients we need to know that neck pain that is accompanied by pain in the arms or legs, or neck symptoms (numbness, weakness) that are accompanied by symptoms in the arms and legs at the same time, should always move us attention and we must always look for them.
The result, if we ignore some serious pathology of our neck, can be extremely unpleasant.
The other key element that every patient should know is that neck pathology is treated much more frequently surgically, requires much more frequent immediate treatment, and responds much less to conservative treatment making the role of conservative treatment more limited to these pathologies.
“So the common question of whether I can avoid surgery when I have a pain or neurosurgical symptom in the neck combined with pain / symptom in the arms or legs is that quite often it is not possible to avoid it, and I should not avoid it. If the symptoms are limited to sheer pain then yes, I can avoid it just the arms to deal with this pain are quite limited.
In conclusion, when we have a problem in the neck that is accompanied by pain or symptoms in the arms, legs and neck, we should always do magnetic to confirm or rule out some pathology of the cervical spine and always be examined by a neurosurgeon.
In case there is a neurosurgical pathology that presses and causes symptoms of numbness or weakness in the arms and legs, it should always be treated surgically. “Conservative treatment has a role when the patient is just in pain, but it is moderately effective and the role of alternative techniques such as epidural injections is extremely limited”, concludes Mr. Blionas.
He writes o:
Mr. Alexandros Blionas, Neurosurgeon, Research Associate Metropolitan General
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