Facts about removal of a hernia of the cervical spine: at what size is surgery indicated?

1. Pain in the cervical spine: Symptoms and origin
2. Causes of pain in the cervical spine
3. When is surgery for osteoarthritis of the cervical spine necessary?
4. What operating techniques does the Gelenk Clinic offer?
5. What type of doctor performs the operation?
6. Preparation for surgery on the cervical spine
7. What type of anesthesia does the patient receive during cervical spine surgery?
8. What aids may be needed after surgery?
9. Will there be pain after cervical spine surgery?
10. Conditions of accommodation at the Gelenk Clinic
11. What should you pay attention to after surgery?
12. How much does cervical spine osteoarthritis surgery cost?
13. How can a foreign patient make an appointment and the operation itself?

Pain in the cervical spine: Symptoms and origin

Examination of the cervical spine © joint-surgeon The cervical spine is the uppermost and most mobile part of the spine, which is responsible for the movements of the human head.
The cervical region contains seven cervical vertebrae (C1 to C7). Under the foramen magnum (Foramen magnum), the space located under the skull through which the spinal cord communicates with the spinal canal, the 1st cervical vertebra of the atlas (Atlas) begins. The second (axial) vertebra epistropheus or axis (Axis) is responsible for the mobility of the skull. The difference in the structure of the axis compared to other vertebrae is the presence of a tooth-like bone process (Dens axis), around which the atlas rotates. First of all, the cervical spine is responsible for stability and mobility of the head, as well as for maintaining the functions of the spinal cord. It is for this reason that pain or injury to this part of the spine are quite serious indicators that should be addressed to a specialist. Pain in the back, neck, and arm may indicate cervical spine syndrome, or in other words, cervical syndrome. As a rule, doctors divide this disease into acute and chronic forms. In the first case, the injury is often caused by sudden overexertion. Such incidents include, for example, damage to the cervical spine during an accident, the so-called whiplash injury. In addition, acute syndrome may appear due to physical activity that is unusual for the body or if you are in a draft for a long time. Another source of pain in this part of the spine is acute intervertebral hernia (intervertebral disc prolapse), during which the inner part of the disc comes out, damages its fibrous ring and thereby compresses the spinal nerves.

Chronic syndromes are usually based on degenerative changes in the supporting structures in the cervical spine. This form of the disease is most often observed in the area of ​​the facet (facet) joints. However, lateral deviations of the spine (scoliosis) can cause a chronic form of the disease. Often, this disease can be caused by degeneration of the intervertebral discs and associated protrusions of the intervertebral disc, which arise due to degenerative changes in the fibrous ring (Anulus fibrosus), which surrounds the core of the intervertebral disc.

Characteristic symptoms of cervical spine syndrome are pain in the neck, often radiating to the arm. In addition, tension and tightening of nearby muscle structures are observed. The pain can radiate not only to the arms and hands, but also to the head, which can lead to severe headaches, dizziness, and even blurred vision and tinnitus (tinnitus). Neurological symptoms, such as a feeling of numbness, impaired thermosensitivity and a feeling of cold, or even manifestations of paralysis, are also possible.

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Depending on the distribution of pain, specialists at our clinic divide the disease into “upper”, “middle” and “lower” cervical syndrome:

• Upper cervical spine syndrome (vertebral artery syndrome): Pain that occurs in the occipital and temporal regions. An important role is played by changes in the area of ​​the vertebral joints. Uncovertebral arthrosis is a degenerative change in the region of the articular joints between the vertebral bodies.
• Mid-cervical spine syndrome (radicular syndrome): Radial pain between the shoulder blades and shoulder area. There may be dysfunction of the nerves with corresponding symptoms in the hands. In addition to pain, the patient may experience a feeling of numbness or decreased motor ability of the arm.
• Lower cervical spine syndrome: Similar to upper cervical spine syndrome, hand dysfunctions are observed. The pain radiates to the hand. Depending on its location, damage to the nerve roots is noted.

Anatomy of a normal cervical disc

Between each vertebrae there is a disc, which is a strong, elastic, shock-absorbing cushion. Each disc is composed of an annulus fibrosus, which encloses a gel-like substance called the nucleus pulposus. Nerve roots exit the spinal canal through small passages between the vertebrae and the disc. Pain and other symptoms are caused when a damaged disc presses on a nerve root or spinal cord. A cervical disc herniation occurs when the annulus fibrosus ruptures and the nucleus pulposus extends beyond it.

Causes of pain in the cervical spine

Damaged intervertebral disc with low moisture content. © joint-surgeon

Degenerative changes due to wear:

• Distortion of intervertebral discs (protrusion or hernia)
• Ligamentous disorders (functional disorders of the retaining ligaments)
• Dislocation of intervertebral joints
• Osteophytic (nodular) reactions (bone growths on the cervical spine)

Congenital disorders:

• Scoliosis or Scheuermann's disease
• Hereditary developmental anomalies (wedge-shaped vertebrae and spinal fusion/vertebral fusion)

Inflammatory diseases:

• Rheumatoid arthritis
• Ankylosing spondylitis (acute inflammatory rheumatism, primarily affecting the spine)
• Infectious diseases (spondylitis or spondylodiscitis due to the presence of bacteria)

Metabolic diseases:

• Osteoporosis (low bone density)
• Rickets (musculoskeletal and bone formation disorders)

Tumors:

• Primary neoplasms (plasmocytoma/myeloma)
• Metastases

Injuries:

• Fractures
• Whiplash-like lesions in the neck

When is surgery for osteoarthritis of the cervical spine necessary?

• Paresis (paralysis)
• Sensory disturbances, feeling of numbness
• Rapidly worsening drug-resistant pain

With this disease, from the very beginning it is necessary to exclude the presence of damage to the nerve roots and cervical spine. This means that especially when the disease recurs, the specialist doctors at the Gelenk Clinic use the full range of clinical, radiological and neurological diagnostic methods. In addition to a thorough medical examination of the patient, such techniques also include electromyography (EMG) and MRI.

Surgeries are recommended in cases of significant limitations in quality of life, pain, sensory disturbances and paralysis. Clinical aspects, which are the main indicators of the operation, are neurological deficits (numbness, paresis, pins and needles), etc. In some cases, operations should be performed as early as possible in order to be able to implant an intervertebral disc endoprosthesis, which will help reduce pressure on the spinal cord of the cervical region spine.

In the chronic form of the disease, which occurs as a result of degenerative changes, a relapse may occur. Sometimes it is not possible to completely get rid of complaints. In this case, it is necessary to think carefully about when it is better to decide on a stabilizing operation with possible blocking of the vertebral body (spondylodesis), and when it is better to undergo an operation to implant an endoprosthesis that preserves mobility.

Possible complications

Even the simplest operation is associated with certain risks, and interventions on the spine are especially important. It is a complex anatomical structure intertwined with nerves and blood vessels of various sizes. It is this, as well as the duration of the disease, the timeliness of diagnosis, the nature of the operation and the correct course of the postoperative period that determine the magnitude of the risk.

Possible complications after surgical treatment of osteochondrosis include:

• local infectious and inflammatory processes in the area of ​​influence;
• Non-union, insufficient rate of fusion or impaired consolidation of the vertebrae when using the spinal fusion technique;
• damage during surgery to the spinal cord, blood vessels, nerve fibers;
• displacement of installed stabilizing systems or their breakdown;
• thrombophlebitis of the veins of the lower extremities, which can lead to thromboembolism.

But even 100% correct execution of each stage of surgical intervention, strict adherence to medical recommendations during the rehabilitation period and the absence of complications do not guarantee final relief from osteochondrosis. Often, while maintaining a previously formed lifestyle and habits, the disease recurs, if not in the same segment, then in others. Therefore, even after successful completion of the operation, it is important to prevent the development of osteochondrosis, undergo regular medical examinations and, if necessary, immediately contact a vertebrologist to prescribe treatment.

What operating techniques does the Gelenk Clinic offer?

Depending on the cause of the pain, surgeons at the Gelenk Clinic in Gundelfingen offer the patient various surgical techniques.

Nucleoplasty

Nucleoplasty is an endoscopic operation designed to treat incomplete intervertebral hernia. If the fibrocartilaginous tissue around the core of the intervertebral disc protrudes and compresses the spinal nerves, nucleoplasty can help cure this disease without the need for open surgery. To do this, the operating surgeon inserts a high-frequency electrode into the damaged intervertebral disc through a special puncture needle. Using an electric probe and the presence of X-ray equipment that allows you to carefully observe the movements of the instruments, the doctor reduces the size of the core of the intervertebral disc until it no longer compresses the spinal nerves. The chances of success with this minimally invasive surgery are very high. Thanks to this operation, almost 80% of patients were able to relieve pain and return to their previous lifestyle.

Intervertebral disc endoprosthetics

A cervical endoprosthesis can replace the original shape of the intervertebral disc.
© Spinal Kinetics For ten years, artificial intervertebral discs have been an effective and widespread treatment method. In addition, this operation is also a promising alternative to the proven spinal fusion, an operation that blocks individual vertebral bodies. Intervertebral disc replacement is also aimed at restoring the natural functions of the intervertebral disc. The goal of this surgery is to relieve or normalize symptoms associated with disc degeneration and herniation, such as chronic back pain and neurological disorders. The endoprosthesis replaces the real intervertebral disc, stabilizes the spine and protects it from subsequent injuries. At the Gelenk Klinik medical center, M6-C type prostheses are used during this operation. Such disc prostheses last a lifetime and do not need to be replaced.

Spinal fusion

A progressive form of wear and tear on the spine often reduces the distance between the vertebrae. Thus, the space between them narrows, which leads to destabilization of the spine and displacement of the vertebral bodies forward, backward or to the side. If conservative treatment methods do not bring the desired result and minimally invasive operations do not help the patient, the technique of immobilizing the painful area is the only solution. The combination of special screws and connecting components ensures immobility of the operated area. Thanks to modern medicine, this operation is performed minimally invasively, through small incisions. It is worth noting that spinal fusion does not provide the patient with complete relief from pain, but only reduces pain in the spine.

Conservative (non-surgical) treatment of cervical disc herniation

Most patients do not require surgery. Drug therapy includes taking anti-inflammatory drugs to reduce inflammation and swelling, muscle relaxants to reduce muscle spasm, and strong analgesics to reduce intense pain. Mild to moderate pain is treated with nonsteroidal anti-inflammatory drugs (NSAIDs). They eliminate inflammation and pain. Physiotherapy treatment may be prescribed, which includes a combination of non-surgical treatments to relieve pain and increase range of motion (cold and heat therapy, gentle massage, neck traction, etc.).

What type of doctor performs the operation?

A very important element for the employees of the Gelenk Klinik orthopedic medical center in Germany is the close connection between doctors and patients. This means that your attending physician will take care of you from the day you take your medical history until the operation itself. This way, you will have a contact person who understands your situation and can answer all your questions at any time. The Gelenk Clinic's specialist in the treatment of back pain and spinal surgery is the experienced neurosurgeon Dr. Bian Ganepo.

Preparation for surgery on the cervical spine

The neurosurgeon checks the sensitivity of all sides.
To do this, he uses stimulants such as heat sensitivity, vibration or the sense of touch. © joint-surgeon First, the doctor refers the patient to a comprehensive clinical examination, the results of which become clearer after imaging diagnostics. The clinical examination consists of an interview with the patient and a physical examination. An imaging examination is an X-ray in the “lying” and “standing” positions, that is, under load. Another important diagnostic point is MRI (magnetic resonance imaging). In this way, the condition of the intervertebral discs and nerves in the spine is determined. In addition, bone density is measured to establish their stability, as well as to exclude osteoporotic changes.

Before the operation, the anesthesiologist meets with the patient and once again carefully checks the patient's health before anesthesia. As a rule, the operation is performed the next day after permission from the surgeon and anesthesiologist.

Conditions of accommodation at the Gelenk Clinic

Orthopedic medical center Gelenk-Klinik in Germany, private ward.
During your inpatient stay at the clinic, you are in a separate room with a shower and toilet. In addition, we provide you with towels, a robe and slippers. There is a TV in the room. You only need to bring your own medications, comfortable clothes and nightwear. After surgery, we guarantee 24-hour care from qualified nursing staff and experienced physiotherapists. Generally, the length of hospital stay is 4 days. Your family members can stay in a hotel, which is located a few steps from the clinic. We will be happy to take care of your hotel room reservation.

What should you pay attention to after surgery?

After surgery, the spine should be at rest. Avoid sudden movements. Within 2-3 days, a Shants collar splint is placed on the neck - a soft and elastic anatomically shaped retainer that limits head rotation to 30°. Depending on the medical indications, you will be prescribed manual therapy to eliminate functional disorders of the musculoskeletal system, which will be carried out by an experienced physiotherapist. There is no need to remove sutures, as special absorbable threads are used during the operation. Therefore, you are allowed to take a shower already on the 7th day after the intervention.

• Inpatient treatment: 4 days
• Recommended time of stay in the clinic: 10-14 days
• Possible return home: after 7 days
• Recommended return flight: after 14 days
• When is it permissible to shower: after 7 days
• When sutures are removed: not necessary (absorbable sutures)
• When can you drive again: in 2 weeks
• Outpatient physical therapy: 2 weeks

Exercises

This section describes the exercises you should do after neck surgery. Do these exercises only when your doctor or nurse confirms that it is safe to do so and that your surgical incision has healed well enough.

Do these exercises at least twice a day for three months. If you can move your shoulder and your neck has regained full range of motion before three months, ask your doctor if you can stop doing the exercises. If after three months you still cannot move your neck or shoulder, tell your doctor.

Figure 1. Twists to stretch the neck

Twists to stretch the neck

1. Gently turn your head so that you are looking to the right.
2. Place your right hand on your left cheek and jaw. Apply gentle pressure to your head to further stretch your neck muscles (see Figure 1).
3. Lower your head down and turn to the left.
4. Place your left hand on your head and apply gentle pressure (see Figure 1).
5. Repeat 10 times. Then repeat this movement in the other direction 10 times.

Figure 2. Chin retraction

Chin retraction

1. Sit or stand with your back and head resting on the wall to maintain good posture.
2. Tuck your chin in and try to press the back of your neck against the wall (see Figure 2).
3. Return to the starting position.
4. Repeat 10 times.

Figure 3. Lateral neck stretch

Side neck stretch

1. Sit or stand and extend your right arm down.
2. Place your left hand on your head.
3. Gently pull your head down and to the left to stretch the muscles on the right side of your neck (see Figure 3).
4. Hold this position for 30 seconds, then release.
5. Repeat 5 times.
6. Repeat these movements on the other side of your neck.

Figure 4. Shrug

Shrug

1. Raise your shoulders up towards your ears (see Figure 4).
2. Lower them.
3. Repeat 10 times.

Figure 5. Circular movements of the arms

Circular movements with hands

1. Sit or stand with your arms at your sides, palms facing forward, thumbs pointing toward the ceiling.
2. Raise your arms up and rotate them back in a circle (see Figure 5).
3. Return to the starting position.
4. Repeat 10 times.

Figure 6. Pull your arms and shoulders back

Pulling your arms and shoulders back

1. Stand or sit with your arms extended in front of you with your thumbs pointing up.
2. Extend your arms to the sides, squeezing your shoulder blades together (see Figure 6).
3. Return to the starting position.
4. Repeat 10 times.

Figure 7. Stretching the pectoral muscles in the doorway

Stretch the pectoral muscles in the doorway

1. Stand in the doorway.
2. Place your forearms and hands on the sides of the doorway at shoulder level (see Figure 7).
3. Gently step forward until you feel a slight stretch in your chest and the front of your shoulders. Keep your back straight, shoulders and neck relaxed.
4. Hold this position for 30 seconds.
5. Return to the starting position.
6. Repeat 5 times.

Figure 8. Jaw drop

Dropping of the jaw

1. Sit or stand in front of a mirror so you can see your face.
2. Place the tip of your tongue behind your upper teeth.
3. Slowly lower your lower jaw to open your mouth, keeping your tongue against the roof of your mouth (see Figure 8). Look in the mirror and make sure to open your mouth straight, without moving your jaw from side to side.
4. Shut your mouth.
5. Repeat 10 times.

Figure 9. Diaphragmatic breathing

How much does cervical spine osteoarthritis surgery cost?

In addition to the cost of surgical treatment, it is also necessary to take into account the costs of diagnostics, doctor's appointments, as well as additional resources, such as the Shants collar splint. If you are planning to undergo physiotherapy in Germany, we will be happy to arrange appointments with highly qualified physiotherapists and provide you with a preliminary cost estimate.

Information regarding the cost of hotel accommodation, as well as subsequent treatment in a rehabilitation clinic, can be found on the website of the medical institution itself. We will be happy to help you organize rehabilitation treatment in Germany.

How can a foreign patient make an appointment and the operation itself?

In order for our doctors to be able to assess the condition of the intervertebral discs, vertebrae and facet joints, they need to provide the results of imaging diagnostics - X-rays, as well as MRI of the cervical spine. After you submit all the necessary documents through our website, within 1-2 business days you will receive all the necessary information, a treatment proposal, as well as an estimate of the costs of the operation.

Foreign patients can make an appointment with a Gelenk Clinic specialist in a short time frame that suits their plans. We will be happy to assist you with obtaining a visa after the advance payment indicated in the cost estimate has been received into our account. If your visa application is refused, we will refund your advance payment in full.

For foreign patients, we try to reduce the time between the preliminary examination and the surgical examination to a minimum. This way you will not need to come to the clinic several times. During your outpatient and inpatient stay at the Gelenk Clinic, our multilingual patient management department staff (English, Russian, Spanish, Portuguese) will answer all your questions. In addition, we provide a translator (for example, into Arabic), whose services are paid for by the patient himself. We will be happy to help you organize a transfer, find a hotel and tell you how to spend your free time in Germany for you and your relatives.

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thrombophlebitis

When blood clots form in the veins of the legs, it is called deep venous thrombosis (DVT).

This is a common problem in many surgical procedures.

The risk of thrombophlebitis (DVT) is much higher during surgery, including the pelvis, and surgery, including the lower extremities. There are several reasons why the risk of DVT becomes higher after surgery. One reason is that the body is trying to stop the bleeding associated with the surgery, and the body's clotting mechanism is overactive during this period of time. Secondly, trauma to the blood vessels around the surgical area, from normal tugging and pulling during surgery, can trigger the clotting process. Finally, blood that does not move properly sits in the veins and becomes stagnant. Blood that sits in one place for a long time usually begins to thicken.