Dr. Abel Ferrés Pijoan
Neurosurgeon · Spine, neuro-oncology and skull base
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Spinal pathology
Cervical spine surgery: disc herniation, stenosis and myelopathy
Microsurgical and minimally invasive treatment of cervical pathology: disc herniation, spinal stenosis, spondylotic myelopathy, traumatic pathology. Motion preservation with arthroplasty where possible.
What is it?
Cervical spine surgery: disc herniation, stenosis and myelopathy
Cervical spine surgery treats conditions that cause radicular pain or myelopathy due to neural compression. Cervical disc herniation is the most common cause in younger adults; cervical spinal stenosis and spondylotic myelopathy are more typical from the age of 50. The most commonly used techniques are ACDF (discectomy and fusion) and, in selected cases, cervical arthroplasty with a disc prosthesis that preserves motion.
1-3%
of back pain consultations are cervical in origin
90-95%
of cervical herniations improve with conservative treatment
>85%
resolution of radicular pain after well-indicated surgery
Symptoms
When to see a neurosurgeon?
The most common symptoms include:
- Neck pain radiating to the arm along a dermatomal pattern (cervicobrachialgia)
- Tingling, numbness or weakness in the arm or hand
- Progressive hand clumsiness (early sign of myelopathy)
- Balance or gait disturbance
- Leg spasticity and brisk reflexes (sign of spinal cord involvement)
- Urinary incontinence in severe cases
- Neck creaking or stiffness with limited range of motion
Urgent attention: Rapidly progressive weakness, falls due to balance disturbance, or incontinence are signs of myelopathy requiring urgent neurosurgical assessment.
Surgical treatments
Techniques we use in cervical spine surgery
Anterior cervical discectomy (ACDF)
What it involves: anterior approach to remove the affected disc and decompress the spinal cord or nerve roots, followed by fusion.
- Excellent decompression
- Immediate stability
Indications: cervical disc herniation, myelopathy, stenosis.
Cervical arthrodesis
What it involves: fusion of two or more vertebrae using implants.
- Vertebral stability
- Prevention of recurrence
Indications: instability, advanced degeneration.
Cervical laminoplasty
What it involves: expansion of the spinal canal without completely removing posterior structures.
- Preserves mobility
- Reduces instability risk
Indications: multi-level myelopathy.
MIS cervical laminectomy
What it involves: posterior canal decompression via a minimally invasive approach.
- Less muscle damage
- Faster recovery
Indications: cervical stenosis.
Cervical endoscopic surgery
What it involves: treatment of herniations or compressions via a percutaneous endoscopic approach.
- Minimal incisions
- Early discharge
Indications: selected disc herniation, foraminal stenosis.
Posterior cervical fixation
What it involves: placement of screws and rods for vertebral stabilisation.
- High stability
- Structural correction
Indications: trauma, tumours, instability.
Robotic cervical surgery (Alaya)
What it involves: robotic assistance for cervical screw placement.
- Millimetric precision
- Enhanced safety
Indications: complex surgery, revision procedures.
Our protocol
How we approach each case
Every patient with cervicobrachialgia is assessed with a cervical MRI and, when required, a CT scan for bony study. Suspected myelopathy is evaluated using the mJOA scale and electromyography. Initial treatment is conservative (physiotherapy, NSAIDs, guided injections) for 6-8 weeks before considering surgery. In progressive myelopathy, surgery is indicated early to prevent permanent spinal cord damage. The choice between ACDF, arthroplasty and posterior approach is individualised according to age, number of levels, morphology and cervical alignment.
Perioperative protocol
How we organise each case
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1 · Preoperative workup
Cervical MRI, CT for bony study, dynamic flexion-extension radiographs, neurological assessment with mJOA and Nurick scales for myelopathy.
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2 · Surgery
Anterior approach (ACDF, arthroplasty) or posterior approach (laminoplasty, laminectomy with fixation) according to pathology. Neurophysiological monitoring in myelopathy.
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3 · Immediate postoperative period
Early mobilisation with soft cervical collar for 1-3 weeks. Radiographs at 6 weeks, 3 and 6 months.
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4 · Discharge and follow-up
Discharge within 24-48h after ACDF or arthroplasty, 3-5 days after posterior surgery. Physiotherapy from week 4.
Team
Neurosurgeons who treat this condition
Dr. Pedro Roldán Ramos
Neurosurgeon · Spine, functional and brain surgery
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Dr. Jorge Torales
Neurosurgeon · Skull base and spinal endoscopy
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Dr. Jhon A. Hoyos Castro
Neurosurgeon · Spine, peripheral nerve and skull base
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Dr. María Elena Filadoro
Neurosurgeon · Functional, epilepsy and spine
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Dr. M. Noelia Sosa Echeverría
Neurosurgeon · Functional and stereotaxy
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Dr. Giulia Guizzardi
Neurosurgeon · Minimally invasive and skull base
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Outcomes
Prognosis and recovery
ACDF for cervical disc herniation with radiculopathy achieves resolution of radicular pain in 85-90% of patients. Cervical arthroplasty has demonstrated non-inferiority to fusion in long-term follow-up, with advantages in motion preservation and reduced adjacent segment disease. In cervical myelopathy, early surgery stabilises or improves function in 70-80% of cases. Hospital stay is 1-3 days and return to work 3-6 weeks (office) or 3 months (physical work).
Frequently asked questions
Answers to your questions
When should a cervical disc herniation be operated on?
Surgery is considered when there is persistent radicular pain for more than 6 weeks without improvement with conservative treatment (physiotherapy and medication), progressive motor deficit, or signs of myelopathy (balance disturbance, hand clumsiness, hyperreflexia). Herniations with severe motor deficit require urgent assessment.
What is ACDF (anterior cervical discectomy and fusion)?
It is the classic technique for cervical disc herniation with radicular or spinal cord compression. It is performed through a small incision in the neck; the herniated disc is removed and an interbody implant (cage or prosthesis) is placed to maintain disc height and fuse the vertebrae.
What is cervical arthroplasty?
It is an alternative to fusion in which a mobile disc prosthesis is placed instead of a fusion implant. It preserves segmental motion, reducing stress on adjacent levels. It is indicated in selected patients with isolated disc disease and without significant facet arthritis.
What is cervical myelopathy?
It is injury to the spinal cord at the cervical level due to chronic compression (generally from degenerative stenosis or disc herniation). It causes hand clumsiness, balance disturbance, leg spasticity, and sometimes bladder dysfunction. It progresses without treatment and decompressive surgery is the treatment of choice.
How long is recovery after cervical spine surgery?
Hospital stay is 1-3 days. Light activity is resumed within 1-2 weeks and office work within 3-4 weeks. Physical work or contact sports require 3 months. Recovery after arthroplasty is usually faster than after fusion.
References
What clinical guidelines say
"Surgery should be considered in progressive symptomatic cervical myelopathy to halt neurological deterioration and improve function."
"Cervical arthroplasty is a reasonable alternative to fusion in selected patients with cervical disc disease without significant facet arthritis."
Bibliography
Scientific references consulted
Studies and clinical guidelines on which we base our approach to this condition.
- Fehlings MG. et al. A Clinical Practice Guideline for the Management of Degenerative Cervical Myelopathy (AOSpine). Global Spine J. 2017. View publication
- Davis RJ. et al. Cervical total disc replacement with the Mobi-C cervical artificial disc compared with ACDF (FDA IDE trial). J Neurosurg Spine. 2013. View publication
- Kopjar B. et al. Outcomes of surgical decompression in patients with very severe degenerative cervical myelopathy. Spine. 2015. View publication
- Epstein NE. A review of laminoplasty and laminectomy with fusion for cervical spondylotic myelopathy. Surg Neurol Int. 2013. View publication
- North American Spine Society (NASS) Clinical Guidelines for Diagnosis and Treatment of Cervical Radiculopathy. NASS. 2023. View publication
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Surgical technology
Robot-assisted surgery with ALAYA
We use the ALAYA Robotic Assistant (Cyber Surgery) for the precise placement of pedicle screws in spinal fusion surgery, both open and minimally invasive.
ALAYA guides the trajectory of the surgical instruments through a patented kinematic tracking system that requires no optical navigation cameras: it avoids the classic line-of-sight problems and takes up less space in theatre. The patient's position is monitored in real time by a bone reference clamp attached directly to the tracking device, which improves the overall accuracy of the procedure.
What do we use it for?
- Pedicle screw placement in the posterior thoracic and sacro-lumbar spine.
- Spinal fusion surgery, both open and minimally invasive.
- Intraoperative 3D planning using preoperative or intraoperative 2D/3D CT.
- Implant-brand independence: compatible with any commercially available cannulated screw.
A real benefit for the patient: a reduction in mean hospital stay from 9.4 to 6.8 days documented with robotic assistance in spinal fusion, together with lower intraoperative radiation exposure for both patient and team.
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Greater accuracy
Significantly more accurate pedicle screw placement than with conventional technique.
↓
Minimally invasive
Less tissue damage, lower risk of infection and faster postoperative recovery.
⏱
Shorter operating time
An intuitive workflow and fast set-up that shorten the length of the procedure.
☢
Lower radiation
The system minimises the number of image acquisitions needed during surgery.
Patient reviews
What our patients say
High-grade glioma
"I arrived with a glioma I had been told was inoperable. Here they reviewed it at the tumour board and offered me a plan. The surgery was a success. Four years on, I am well."
Cervical disc herniation
"For years I had a cervical disc herniation, operated on by another team with no improvement. Minimally invasive surgery gave me back my mobility and took the pain away."
International patient
"I travelled from outside Spain. The team reviewed my case before I came and gave me a clear plan. Caring people and impeccable technique."
Request information
Cervical spine consultation
Send us your cervical MRI and, if available, your electromyography. We will give you a clear opinion on whether your case is a candidate for conservative or surgical treatment.