What is Cervical Pain?

The cervical spine is a marvelous and complex structure. It is capable of supporting a head weighing 15 or more pounds while moving in several directions. No other region of the spine has such freedom of movement. This combination however, complexity and mobility, make the neck susceptible to pain and injury.

This complex structure includes 7 small vertebrae, intervertebral discs to absorb shock, joints, the spinal cord, 8 nerve roots, vascular elements, 32 muscles, and ligaments.

The nerve roots stem from the spinal cord like tree branches through foramen in the vertebrae. Each nerve root transmits signals (nerve impulses) to and from the brain, shoulders, arms, and chest. A vascular system of 4 arteries and veins run through the neck to circulate blood between the brain and the heart. Joints, muscles, and ligaments facilitate movement and serve to stabilize the structure.

Neck mobility is matchless. It is capable of moving the head in many directions: 90 degrees of flexion (forward motion), 90 degrees of extension (backward motion), 180 degrees of rotation (side to side), and almost 120 degrees of tilt to either shoulder.

Diagnosis in India

Obtaining a proper diagnosis is paramount to determine the best course of treatment. The physician will take the patient’s medical history. The oral segment of the examination often includes many questions such as “when did the pain start?” – “what activities preceded the pain?” – “previous treatment” – “does the pain radiate or travel into other body parts?” – “what makes the pain less or greater?” and so on.

A physical examination includes observing the patient’s posture, range of motion, and physical condition. Any movement generating pain is carefully noted. The physician will palpate or feel the curvature of the spine, vertebral alignment, and detect muscle spasm. The neurological examination tests the patient’s reflexes, muscle strength, detects sensory and/or motor changes, and determines pain distribution.

Radiographic studies may be ordered. An x-ray can reveal narrowing of disc space, fracture, osteophyte formation, and osteoarthritis. Bulging discs and herniations, often responsible for neurologic symptoms, are detected using MRI.

If nerve damage is suspected, the physician may order a special test to measure how quickly nerves conduct impulses. These tests are termed nerve conduction studies and/or electromyography. Typically these studies are not performed immediately because it may take several weeks for nerve impairment to become apparent.

Types of Surgery for Precancerous Changes

• Cryosurgery : – This procedure freezes and kills the abnormal cells on the cervix. The surgeon places a thin piece of metal that has been cooled with liquid nitrogen against the cervix to cause frostbite. This freezing kills the abnormal cells on the cervix. This procedure is done in the doctor’s office. Anesthesia is usually not needed.

• Laser Therapy : – This type of surgery uses a narrow beam of light to create heat. The heat burns and destroys the lesions. You may have this procedure in your doctor’s office, usually with a local anesthetic.

• Conization : – This is considered a type of biopsy. Your doctor can do this simple procedure in his or her office on in an operating room while you’re under local anesthetic. The doctor uses a laser knife or an electric wire to remove a small cone-shaped piece of tissue from the outer part of the cervix. A pathologist examines the cells under a microscope to make sure there is no cancer. When the electric wire is used, this procedure is also known as loop electrosurgical excision procedure (LEEP).

• Simple Hysterectomy : – This is a major surgical procedure. A doctor removes the whole uterus through the abdomen or the vagina. This surgery requires regional anesthesia so you’re sedated or general anesthesia so you’re asleep. You stay at least overnight in the hospital. It is sometimes used for women who have had more than one treatment and no longer have enough tissue to perform a LEEP. Or you may have this procedure if you don’t plan to have children.

Types of Surgery for Invasive Cervical Cancer

• Conization : – This is a type of biopsy. Your doctor may use this procedure to treat a stage IA1 cancer if you want to have a baby later. He or she can do this simple procedure in the office under local anesthetic. The doctor uses a laser knife or an electric wire to remove a cone-shaped piece of tissue from the outer part of the cervix. A pathologist examines the cells under a microscope. In many cases, women are cured after one procedure. When using this treatment, though, there is a small chance that the cancer will come back. So make sure to keep all follow-up appointments with your doctor. This is more common with adenocarcinomas. When the electric wire is used, this procedure is also known as loop electrosurgical excision procedure (LEEP).

• Simple Hysterectomy (Vaginal or Abdominal) : – This is the standard treatment for early stage (stage IA1) invasive cancers. A doctor removes your whole uterus through your abdomen or vagina. This surgery requires regional or general anesthesia. You are sedated or asleep. You stay at least one night in the hospital. Women get better faster when the hysterectomy is done through the vagina. Vaginal hysterectomies, though, may be hard to do if you are obese. They may also be hard when there are other gynecologic disorders. For example if you have ovarian tumors a vaginal hysterectomy may not be the right surgery. The ovaries and fallopian tubes do not need to be removed to cure cervical cancer. Discuss risks and benefits of the removal of your ovaries and tubes with your surgeon before the operation.

• Radical Abdominal Hysterectomy : – This type of surgery is used to treat larger tumors generally confined to the cervix (stage IA2, IB1, IB2, and IIA cancers). During surgery, a doctor removes your uterus, the upper part of your vagina, and the tissue that holds your uterus in place. The surgeon also takes out the lymph nodes in the pelvic area. The doctor can remove all the structures through your abdomen. This surgery requires regional or general anesthesia. You are sedated or asleep. You spend several days in the hospital. It is not necessary to remove your ovaries in a radical hysterectomy. This is important for younger women. By keeping your ovaries, you will not enter sudden menopause. This surgery may be able to be performed in a minimally-invasive way with a laparoscope. Talk to your surgeon.

• Radical Trachelectomy : – This procedure is still considered investigational. It is, though, becoming more widely used by gynecologic oncologists. The doctor removes your cervix, pelvic lymph nodes, and upper part of your vagina. Doctors use this surgery for women with early cervical cancers who want to have children.