The surgical neck

A badly compressed nerve can be the source of all discomfort. Nipping it in the bud instead of playing wait-and-watch is never foolhardy

Jay walked into my office wearing a cervical collar. Not the soft fluffy one that makes the neck feel cosy, but the hard sturdy one that supports the chin in front and braces the back of the head down to between the shoulder blades. It made him look like a character straight out of RoboCop. He was 6 ft-tall and able-bodied, but walked with such caution that each stride seemed programmed and motorised. I allowed him to gingerly seat himself on the examining bed while his wife and mother perched themselves on chairs in front of me.

“What happened?” I asked curiously. “I’m a civil engineer,” he introduced himself, “and I was at a construction site on the second floor,” he laid the premise. “A colleague of mine accidentally slipped off the edge of the building and luckily I was right there. As I stretched out to grab him, my neck felt a solid jerk,” he continued with minimal animation, extending his burly arm, but then wincing. “All of his 65 kilos were hanging on my left hand and I somehow managed to pull him up,” he said, heaving a sigh of relief.

“How’s he doing?” I amused Jay, wanting to know the repercussions of dangling off a building at someone’s mercy. “He’s tip-top,” he said in his Gujarati accent. “But I have severe pain in the neck going down my left arm like an electric shock and I can’t lift this arm up from the shoulder. My forearm and hand feel like there are pins and needles running through them,” he concluded, describing the classical textbook description of nerve compression. “When there was no relief for two weeks, my doctor put me in a collar, told me to get an MRI, and asked me to see you. Now, you need to decide what to do for me,” he surrendered, folding his hands in an agonising namaste.

I examined Jay to find that his left deltoid was extremely weak, as were his biceps. He could not raise his arm above the shoulder or flex his elbow easily. “This is a sign that one of your nerves is badly compressed,” I warned, and confirmed it on the MRI he had brought along. “The disc between your fourth and fifth cervical vertebra has herniated out from the impact and is pinching against the nerve responsible for shoulder abduction and elbow flexion,” I explained, drawing a framework of bones and nerves so that the civil engineer in him could understand the structural flaw and complications of something shifting. After all, the spine is the central support system of the body—physically, emotionally, and spiritually. The spine is the axis of our being.

“What do we do now?” he asked the next logical question. “If you had only pain, I would say, wait it out with the medication because over 90 per cent of patients get better with time. As you have a profound muscle weakness, I would suggest freeing up the nerve with an operation. It’s the only real hope of it recovering,” I confessed. He remained silent; patients are always suspicious of doctors who suggest surgery as the first option. “If you let it be, it’s only the Instagram-wala hope you read about in quotes,” I added, trying to make him smile. “If you didn’t have neurological dysfunction, I would have suggested that you wait and bear the pain,” I reiterated. His mother and wife nudged him to agree to surgery because they had seen him suffer, and he consented.

Two days later, we made a skin-crease incision into his neck along the normal neck lines and opened it up. Dissecting through the layers of the neck, we reached the disc space between C4 and C5. I cut into the disc and curetted out the soft jelly-like substance until I got to the part that had sneaked in under the bone to pinch the nerve. I held it with a forceps and got that migrated chunk out, happy to see the nerve bounce back into position. “That’s going to take care of everything,” I told my assistant, as we placed a titanium cage in the disc space to maintain the curvature of the spine and secured it with screws.

The next day he was absolutely pain free and there was even a slight improvement in his strength. “This will take a while to improve completely,” I explained to him, reminding him off our pre-operative discussion, which most patients tend to forget once they are completely rid of the pain. He returned three months later having recovered his arm strength completely. This time he brought along the friend whose life he had saved. “I saved his life and you saved mine,” he told me.

I asked him how he felt. “I’m perfectly fine and things are fully back to normal, except that I find it hard to sleep comfortably at night. The neck is just a little uneasy,” he tried to explain. I told him to try using a cervical pillow and warned, “Place it correctly below your neck!”

He looked perplexed at my insistence, and I decided to explain. “A few months ago, I had a young patient who came to me with neck and lower back pain,” I told him. “Her MRI was alright and I suggested that she do some physiotherapy and use a cervical pillow. She ordered one online and used it for a month and came back to me upset that it hadn’t helped. My intuition made me question how she used it. I wanted to know if she rested on the correct side of the curve. She stared at me flatly and said, ‘What do you mean show you how I use it? I put it between my legs up against my cervix!’ Professionally, I’m expected to keep a straight face, but in her case, I actually burst out laughing,” I told Jay.

“I calmy explained to her that the word cervical is derived from the Latin root word ‘cervix’ which means ‘neck’. For this reason, the word cervical pertains to many areas where tissues narrow to a neck-like passage, not only in your neck. While the neck of the uterus is also called the cervix, the cervical pillow was for her neck and not her cervix. ‘Oh,’ she said, slightly embarrassed. ‘I thought it was for the lower back pain because everything is in and around the area,’ she covered up with a goofy smile. ‘You doctors are so silly; just name different body parts differently next time!’ she said, as we all had a good laugh.”

I believe Jay got the memo. Even if he hadn’t, I was pretty sure he didn’t have a cervix.

The writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals.

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