Neurosurgical Conditions - Neck Problems

Neurosurgeons treat a great many diseases of the cervical spine (neck). These include prolapsed intervertebral discs (slipped discs), canal stenosis (narrowing), and spinal tumours.

Prolapsed Intervertebral Disc (Slipped Disc)
As we get older the intervertebral discs wear out and can then bulge backwards. In the neck these can press on the nerve roots going down the arm, causing severe arm pain (brachalgia), as well as weakness and sensory changes. A disc bulge can also press on the spinal cord itself, a potentially serious problem, which may cause weakness, sensory changes, alteration of bladder and bowel function, up to complete paralysis from the neck downwards. The disc is demonstrated using a magnetic resonance image (MRI). If necessary it can be surgically removed by an anterior cervical discectomy.

The disc prolapse can best be demonstrated by MRI (magnetic resonance imaging) and can then be surgically removed if necessary. This is usually done through the front of the neck (an Anterior Cervical Discectomy) and traditionally the two vertebrae are then fused together as one bone using a variety of different materials interposed between them. Whilst this is very effective in decompressing the nerve roots and spinal cord it does lead to the loss of a small amount of neck movement and, in the longer term, can lead to increased wear and tear of the adjacent discs sometimes necessitating further surgery. This so called ‘adjacent segment disease’ probably occurs at the rate of about 3% per annum so in younger patients it represents a significant risk.

Furthermore, in those paitients who need 2 levels (and occasionally more) operating on the loss of movement if the disc spaces are fused is certainly noticeable. For these reasons we are increasingly replacing the removed discs with mobile artificial discs (called ‘arthroplasties’) in order to preserve the movement and hopefully decrease the amount of adjacent segment disease seen in the longer term.

There is more information on this in the ‘special interests’ section of this website.

Sometimes, if the nerve is mainly being compressed by bony narrowing of its canal, this can be tackled form the back of the neck by opening up the bony canal in which it sits; a cervical foramenotomy.

Cervical Canal Stenosis
As we get older the bones and ligaments of the cervical spine (neck) gradually wear out. This causes the neck to lose some of its normal shape and the bony canal in which the spinal cord sits can become narrowed, sometimes quite severely. This pressure on the spinal cord can be quite serious, causing weakness, sensory loss and bladder and bowel changes, or even complete paralysis below the neck. The stenosis can be demonstrated by magnetic resonance imaging (MRI) and, if necessary, can be surgically treated by a cervical laminectomy.

Cervical Spinal Tumours
A wide variety of growths and tumours can occur in the cervical spine (neck). These can cause pressure on the nerve roots supplying the arms, causing pain, weakness or sensory changes, as well as pressure on the spinal cord itself, causing weakness, sensory change, bladder and bowel disruption, or even complete paralysis. Tumours are visualised using magnetic resonance imaging (MRI) and some may need to be surgically removed, often via a cervical laminectomy

Associated Terms
Neck pain, arm pain, weakness, pins and needles, trapped nerve, paralysis.