When every millimetre counts
Why procedures on the cervical spine require the highest level of expertise and how interdisciplinary collaboration maximises patient safety
Have article read aloud
The cervical spine is a masterpiece of anatomy – and at the same time a high-risk area. Vital blood vessels, nerve pathways and connections to the brain run through this area in a very confined space. Procedures in this area therefore require the utmost precision, experience and state-of-the-art technology. At the Sportklinik Hellersen, this expertise is complemented by close collaboration between neurosurgery, specialist spinal surgery and conservative orthopaedics, thereby offering patients unique care. Dieter Henigin, Consultant in Spinal Surgery, and Dr Oliver Meier, Consultant in Specialised Spinal Surgery, provide an insight into the diagnostics, treatment and specialised expertise of the German Spinal and Scoliosis Centre.
Mr Henigin and Dr Meier, you are experts in the field of the spine. Why is the cervical spine a particularly sensitive and complex segment?
Dr. Oliver Meier: The spine has three sections: the cervical spine, the thoracic spine and the lumbar spine. The cervical spine is the most mobile section. However, this high degree of mobility also makes it functionally more susceptible to injury and wear and tear..
Dieter Henigin: Furthermore, many important vessels pass through the relatively thin neck. The most important of these is the carotid artery. But nerves, such as those controlling the voice, as well as other vessels and connections to the brain also run through this area. Depending on what happens, the consequences can be serious: spinal cord injuries, paraplegia, hemiplegia or cerebral haemorrhages. That is why, for example, before a procedure, we ask whether someone is right- or left-handed, and choose the surgical approach accordingly. In this way, in the rarest of cases of a circulatory disturbance, only the less affected side of the brain may be involved. The very idea of having to undergo surgery on this delicate organ causes concern for many patients – some would rather endure the pain than undergo a procedure.
What are the most common complaints or symptoms that patients with conditions affecting the cervical spine present with?
Dieter Henigin: Common symptoms include neck and shoulder pain. Another typical symptom is radicular pain: if a nerve root is compressed, the pain often radiates into the hands or fingers. In some cases, there may also be restrictions in hand motor function – those affected find it difficult to write or to button up a blouse or shirt. If prolonged compression exerts pressure on the spinal cord, this can lead to damage. Those affected often exhibit a shuffling gait.
What causes this narrowing?
Dieter Henigin: The causes vary greatly. Herniated discs are a common cause, but so are injuries such as breaks or fractures, as well as spinal instability. However, a herniated disc is the most common cause.
Depending on its progression, the herniated disc may press centrally on the spinal cord or laterally on the nerve root supplying the arm. If it affects precisely this nerve root, symptoms such as tingling or a sensation of the arm going numb at night usually occur.
And when is spinal surgery the appropriate course of action, and in which cases does specialist spinal surgery undertake surgical treatment of the cervical spine?
Dieter Henigin: In the case of recent, minor injuries, acute herniated discs or narrowing without spinal misalignment, the neurosurgeons in the Spinal Surgery Department take charge of treatment.
However, if there is a misalignment, displacement or instability of a vertebral segment, the biomechanics of the spine become a problem. In such cases, the Department of Specialised Spinal Surgery takes charge of the surgical management.
How do patients benefit from the departments working closely together?
Dieter Henigin: Patients benefit from this close collaboration, particularly through short waiting times and a broad yet highly specialised range of treatments. There is hardly any other clinic that offers this kind of service in this way.
Dr. Oliver Meier: At most clinics, there is usually only a spinal surgeon or only a neurosurgeon, but not both. Our approach, on the other hand, is virtually unique in the country: we cover the entire spectrum of spinal treatment – from conservative treatment and neurosurgical procedures to specialised spinal surgery for instability and deformities, all under one roof.
What diagnostic steps are necessary to reliably assess a condition affecting the cervical spine?
Dr. Oliver Meier: In order to accurately diagnose a condition of the cervical spine, a thorough physical examination is essential. This involves checking mobility, reflexes, sensation and muscle strength. In addition, magnetic resonance imaging (MRI) is the leading diagnostic method, as it provides particularly clear images of nerves, intervertebral discs and the spinal cord. In the case of specific issues, for example to assess bone changes, a computed tomography (CT) scan may also be performed.
Which surgical procedures are most commonly used on the cervical spine?
Dieter Henigin: In spinal surgery, we neurosurgeons mainly use microsurgical techniques. This means that the smallest possible incisions are made. In the cervical spine, disc prostheses or so-called PEEK cages are frequently used. A PEEK cage is a special spacer that fills the damaged disc space so that the affected nerve roots are no longer compressed.
Which procedure is used depends on the location of the herniated disc, its size and type, as well as the individual anatomical circumstances. The cage ensures that the affected segment is immobilised and stabilised. In younger patients, however, a disc prosthesis is more commonly used to relieve pressure on the nerve root and protect the neighbouring segments from potential overload.
Dr. Oliver Meier: With increasing age, instability of the spine can occur. In the cervical spine, for example, the physiological forward curvature (‘sway’) is lost and the spine bends forwards. In such cases, we restore the natural curvature in specialist spinal surgery whilst simultaneously ensuring stability. To achieve this, we sometimes use cages, fix them in place with screws, or supplement the stabilisation with a plate to permanently secure the segment.
What factors play a decisive role in choosing the best treatment?
Dr. Oliver Meier: The key factor in choosing the best course of treatment is, first and foremost, the nature of the symptoms. In addition, the patient’s age and their individual circumstances play an important role. It is particularly important to consider whether the mobility of the affected segment absolutely must be preserved.
What fears or concerns do patients most commonly express before undergoing cervical spine treatment?
Dieter Henigin: Many patients are anxious about cervical spine treatment due to the complications mentioned earlier. However, following a successful procedure, they are often greatly relieved, and a weight is literally lifted from their shoulders. This relief from pain is often accompanied by a noticeable change in their demeanour.
How do you allay the patient’s concerns, and how important is the surgeon’s experience?
Dr. Oliver Meier: The surgeon’s experience plays a crucial role in procedures on the cervical spine, as this area is extremely sensitive and only accessible to a very limited extent. Only specialists with extensive experience and a meticulous approach can ensure that complications are avoided and potential risks are kept as low as possible.
Dieter Henigin: To put patients’ minds at ease in advance, we emphasise the experience of the surgical team. The fact that many procedures have already been carried out successfully significantly reduces the risk. Personally, I have great respect for any operation on the neck. You mustn’t be afraid, but respect is absolutely essential in order to work responsibly and carefully.
Mehr Informationen zum Deutschen Wirbelsäulen- und Skoliosezentrum sowie den Behandlungsschwerpunkten finden Sie auf unserer Website!
You can find more information about the German Spine and Scoliosis Centre and its areas of specialisation on our website!
