The cervical spine consists of seven vertebral bodies which are interconnected by the help
of a cushion like here and this cushion is called a disc. It consists of two components.
The outer component is made up of cartilage which is strong and the inner component is
jelly which is soft. The disc has three important functions. First,
it maintains our spinal mobility. That’s why we flex, extend, and move side to side.
Second, it acts as a shock absorber. And third, it acts as a weight transferring from vertebra
above to vertebra below. With time, as we grow older, it forms cracks
or tears in the outer coat through which the jelly piece pops out and it can compress on
the narrows and can cause pain in the arm. This is called a degenerative disc disease.
Degenerative disc disease is more common in the cervical spine or in the lumbar spine
because they are the most mobile part of the spine in our body. So if there’s a cervical
disc disease, people usually complain of neck pain, neck spasm, pain in and in between the shoulder
blade and radiating toward the shoulder and then subsequently, when there’s a compression
on the nerve, people do feel pain, aches in the arms. They feel numbness in the arms,
sometimes paresthesia, and upon careful questioning, they start losing dexterity in the hands to
start with and when it goes to the more advanced stage from they drop things from the hands
and if there’s a compression on the spinal cord, people do feel that they’re losing
their balance and in the advanced stage, they become more stiff and wobbly.
If the problem is in the lumbar spine, people usually complain of lower back pain and then
when there’s a compression on the nerve, the pains starts radiating from the lower
back down to the legs and if we don’t act at that stage, then people will start developing
numbness and then subsequently weakness in the legs. If it’s a significant compression
on the nerve especially in the lower spine, it can affect the bladder, bowel, and sexual
functions.
So for initial consultation, if the patient
has a short duration of symptoms, we offer a non-surgical treatment which consists of physical
therapy and management. The majority of patients usually get better. But if the problem persists
or gets further or they’re developing a progressive numbness or weakness in the
arms, then we offer a surgical treatment. The surgical treatment for young people is
a cervical disc replacement. It has the advantage over a fusion operation because it avoids
the adjasent segment disease and future long-term problems. In the lumbar spine, I do a keyhole
endoscopic spine sub -3 which is better than an all open operation because it’s usually
done as a day case and people can go home quickly and their rehabilitation and recovery
is much quicker and they go back to work sooner.
I operated a patient, young, 35 years
of age two weeks ago who presented with a long history of neck ache and left sided brachalgia since he was
involved in a car crash and he was having this persistent pain for the last five years. He’s
tried all sort of conservative management and nothing was helping him. He reached to
the point that it’s impacting his quality of life - he cannot sleep properly, he cannot
have a family life properly. He can't sit at a desk and work in front of a computer in his office.
He came to me and he opted for surgery. He had a surgery two weeks ago and I assessed
him today and he’s completely pain free in both neck and arms. His numbness is
improved and he’s got full strength now. Excellent. Can you squeeze my finger as hard
as you can and don’t let it go? Fantastic. Same on the other side. Very good. I think
it looks very good. Great news. I will see you once more in three months' time. We’ll do
a check x-ray at that point and after that hopefully, I will let you go completely.