What are the main types of cervical disc surgery. How is an anterior cervical discectomy and fusion (ACDF) performed. What are the benefits and risks of artificial cervical disc replacement. How long does recovery typically take after cervical disc surgery. What lifestyle factors can help improve outcomes after spinal fusion.

Understanding Cervical Disc Disease and Treatment Options

Cervical disc disease occurs when the cushioning discs between the vertebrae in the neck become damaged, leading to pain, inflammation, and potential nerve compression. While over 90% of cases improve with conservative treatments, surgery may be necessary for persistent or worsening symptoms, especially if neurological deficits develop.

The two primary surgical approaches for cervical disc disease are:

• Discectomy – Removal of the damaged disc
• Fusion or artificial disc replacement – Restoring spine stability after discectomy

Anterior Cervical Discectomy and Fusion (ACDF) Procedure

Anterior cervical discectomy and fusion (ACDF) is one of the most common surgical treatments for cervical disc disorders. This procedure involves:

1. Making an incision in the front of the neck
2. Removing the damaged disc
3. Placing a bone graft between the vertebrae
4. Securing the graft with metal plates and screws

ACDF aims to decompress nerve roots, stabilize the spine, and promote fusion of the vertebrae. While highly effective for pain relief, this procedure may result in some loss of neck mobility.

Is ACDF right for you?

ACDF may be recommended if you have:

• Persistent neck pain unresponsive to conservative treatments
• Radiating arm pain or numbness
• Evidence of disc herniation or degeneration on imaging studies
• Signs of spinal cord compression (myelopathy)

Artificial Cervical Disc Replacement: A Motion-Preserving Alternative

Artificial cervical disc replacement has emerged as an alternative to fusion surgery. This procedure involves removing the damaged disc and replacing it with an artificial disc device made of metal or plastic components.

Benefits of Artificial Disc Replacement

Compared to fusion surgery, artificial disc replacement offers several potential advantages:

• Preservation of neck motion
• Reduced stress on adjacent disc levels
• Faster return to work and activities
• Comparable pain relief and functional outcomes

However, not all patients are candidates for artificial disc replacement. Factors like osteoporosis, severe facet joint disease, or certain spinal deformities may preclude this option.

Weighing the Risks and Benefits of Cervical Disc Surgery

While cervical disc surgery is generally safe and effective, it’s important to understand the potential risks and complications, which may include:

• Infection
• Bleeding
• Nerve or spinal cord injury
• Persistent pain
• Difficulty swallowing
• Hardware failure or implant migration
• Adjacent segment disease

Patients should discuss these risks thoroughly with their surgeon and weigh them against the potential benefits of surgery.

Adjacent Segment Disease: A Long-Term Consideration

One concern with cervical fusion surgery is the development of adjacent segment disease, where disc problems occur at levels above or below the fused segment. Studies suggest this may affect up to 12% of patients within 20 years of the initial surgery. The impact of artificial disc replacement on adjacent segment disease is still being studied, but early results are promising.

Recovery and Rehabilitation After Cervical Disc Surgery

Recovery time and protocols vary depending on the specific procedure and individual factors. However, some general guidelines include:

• Hospital stay: Typically 1-2 days for most cervical disc surgeries
• Initial recovery: 4-6 weeks of limited activity and possible use of a cervical collar
• Return to work: Often possible within 2-6 weeks for sedentary jobs, longer for physically demanding occupations
• Full recovery: Can take 3-12 months, especially for fusion procedures

Physical therapy and gradual return to activities play crucial roles in optimizing outcomes and regaining function after surgery.

Factors Influencing Recovery and Fusion Success

Several lifestyle factors can impact the success of spinal fusion and overall recovery:

• Nutrition: A balanced diet rich in calcium and vitamin D supports bone healing
• Smoking cessation: Nicotine impairs bone fusion and wound healing
• Exercise: Gentle, guided activities promote circulation and maintain muscle strength
• Posture: Proper ergonomics and body mechanics reduce stress on the healing spine

Advances in Minimally Invasive Cervical Disc Surgery

Technological innovations have led to the development of minimally invasive approaches for cervical disc surgery. These techniques aim to achieve similar outcomes to traditional open surgery while minimizing tissue damage and accelerating recovery.

Benefits of Minimally Invasive Cervical Disc Surgery

• Smaller incisions
• Less muscle and soft tissue disruption
• Reduced blood loss
• Shorter hospital stays
• Faster return to daily activities

Examples of minimally invasive cervical disc procedures include endoscopic discectomy and percutaneous laser disc decompression. While promising, these techniques may not be suitable for all patients or conditions.

Non-Surgical Alternatives for Cervical Disc Disease

Before considering surgery, patients with cervical disc disease typically undergo a course of conservative treatments. These may include:

• Physical therapy and exercise
• Medications (NSAIDs, muscle relaxants, nerve pain medications)
• Cervical traction
• Massage and manual therapy
• Acupuncture
• Epidural steroid injections

Many patients experience significant improvement with these non-invasive approaches, avoiding the need for surgery altogether.

When is Surgery Necessary?

Surgery for cervical disc disease is typically considered when:

• Conservative treatments fail to provide adequate relief after 6-12 weeks
• Neurological symptoms worsen or persist
• There is evidence of spinal cord compression (myelopathy)
• Severe or progressive weakness in the arms or legs develops

Future Directions in Cervical Disc Treatment

Research in the field of cervical disc surgery continues to evolve, with several promising avenues for future treatments:

Biological Therapies

Scientists are exploring the use of stem cells, growth factors, and tissue engineering techniques to regenerate damaged discs or promote fusion. These approaches could potentially offer less invasive alternatives to traditional surgery.

Advanced Imaging and Navigation

Improved intraoperative imaging and computer-assisted navigation systems are enhancing the precision and safety of cervical disc procedures. These technologies allow for more accurate implant placement and reduced radiation exposure.

Artificial Intelligence in Surgical Planning

AI algorithms are being developed to assist surgeons in preoperative planning and decision-making. These tools can analyze patient data, imaging studies, and outcomes from similar cases to optimize treatment strategies.

Novel Biomaterials

Researchers are working on next-generation artificial disc designs and fusion materials with improved biocompatibility, durability, and biomechanical properties. These advancements aim to enhance long-term outcomes and reduce complications.

Making an Informed Decision About Cervical Disc Surgery

Deciding whether to undergo cervical disc surgery is a complex and personal choice. Patients should consider several factors:

• Severity and duration of symptoms
• Impact on quality of life and daily activities
• Response to conservative treatments
• Overall health and medical history
• Surgeon’s experience and recommendations
• Personal goals and expectations

Open communication with healthcare providers and a thorough understanding of the available options are essential for making an informed decision.

Questions to Ask Your Surgeon

Before proceeding with cervical disc surgery, consider asking your surgeon the following questions:

• What specific procedure do you recommend and why?
• What are the expected outcomes and potential risks?
• How many of these procedures have you performed?
• What is the typical recovery process and timeline?
• Are there any alternative treatments we haven’t explored?
• How will this surgery affect my long-term spinal health and mobility?

By gathering comprehensive information and carefully weighing the pros and cons, patients can make confident decisions about their cervical disc treatment options.

Neck Pain and Cervical Disc Surgery

The vast majority of people — more than 90% — with pain from cervical disc disease will get better on their own over time with simple, conservative treatments. Surgery, however, may help if other treatments fail or if symptoms worsen to the point that weakness in your arms and or legs develop. This is called a cervical myelopathy and surgery is recommended.

Cervical disc disease is caused by an abnormality in one or more discs — the cushions — that lie between the neck bones (vertebrae). When a disc is damaged — due to degenerative disc disease (or DDD) or an unknown cause — it can lead to neck pain from inflammation or muscle spasm. In severe cases, pain and numbness can occur in the arms from pressure on the cervical nerve roots or spinal cord.

Surgery for cervical disc disease typically involves removing the disc that is pinching the nerve or pressing on the spinal cord. This surgery is called a discectomy. Depending on where the disc is located, the surgeon can remove it through a small incision either in the front (anterior discectomy) or back (posterior discectomy) of the neck while you are under anesthesia. A similar technique, microdiscectomy, removes the disc through a smaller incision using a microscope or other magnifying device.

Often, a procedure is performed to close the space that’s left when the disc is removed and restore the spine to its original length. Patients have two options:

• Artificial cervical disc replacement
• Cervical fusion

In 2007, the FDA approved the first artificial disc, the Prestige Cervical disc, which looks and moves much like the real thing but is made of metal. Since then, several artificial cervical discs have been developed and approved. Ongoing research has shown that the artificial disc can improve neck and arm pain as safely and effectively as cervical fusion while allowing for range of motion that is as good or better than with cervical fusion. People who get the artificial disc are often able to return to work more quickly as well. The surgery to replace the disc, however, does take longer and can lead to more blood loss than with cervical fusion. It’s also not known how the artificial discs will last over time. People who get an artificial disc can always opt for cervical fusion later. But if a patient has cervical fusion first, it’s not possible to later put an artificial disc in the same spot.

Not everyone is a candidate for the artificial disc, however. Those with osteoporosis, joint disease, infection, inflammation at the site, or an allergy to stainless steel may not be candidates for disc replacement surgery.

With cervical fusion surgery, the surgeon removes the damaged disc and places a bone graft (which is taken either from the patient’s hip or from a cadaver) in the space between the vertebrae. The bone graft will eventually fuse to the vertebrae above and below it. A metal plate may be screwed into the vertebrae above and below the graft to hold the bone in place while it heals and fuses with the vertebrae. Discectomy with cervical fusion can often help relieve the pain of spinal disc disease. The only caveat is that after the surgery, many people find that they lose some degree of movement in their neck.

Risks of Cervical Disc Surgeries

Although cervical disc surgery is generally safe, it does have a few risks, including:

• Infection
• Excessive bleeding
• Reaction to anesthesia
• Chronic neck pain
• Damage to the nerves, blood vessels, spinal cord, esophagus, or vocal cords
• Failure to heal

After cervical fusion surgery, some people can develop cervical disc problems above and/or below the previously affected disc. One study found that about 12% of the patients developed new cervical disease that required a second surgery over a 20 year period after the first surgery. It is not yet known if the artificial disc will cause this same problem.

Recovering From Cervical Disc Surgery

You’ll likely be able to get up and move around within a few hours of your cervical disc surgery and then either go home from the hospital the same day or the following morning. You’ll feel some pain in the area operated on, but it should ease over time.

The fusion can take anywhere from three months to a year to become solid after surgery, and you could still have some symptoms during that time. Your doctor might recommend that you wear a cervical collar to support your neck for the first four to six weeks. You may help speed the process by eating a healthy diet, avoid smoking, getting regular exercise, and practicing good posture. Check with your surgeon to see what activity level is right for you before starting any exercise after surgery.

Anterior Cervical Discectomy & Fusion

Overview

Anterior cervical discectomy and fusion (ACDF) is a surgery to remove a herniated or degenerative disc in the neck. An incision is made in the throat area to reach and remove the disc. A graft is inserted to fuse together the bones above and below the disc. ACDF surgery may be an option if physical therapy or medications fail to relieve your neck or arm pain caused by pinched nerves. Patients typically go home the same day.

Figure 1. (top view of vertebra) Degenerative disc disease causes the discs (purple) to dry out. Tears in the disc annulus can allow the gel-filled nucleus material to escape and compress the spinal cord causing numbness and weakness. Bone spurs may develop which can lead to a narrowing of the nerve root canal (foraminal stenosis). The pinched spinal nerve becomes swollen and painful.

What is an anterior cervical discectomy & fusion?

Discectomy literally means “cutting out the disc.” A discectomy can be performed anywhere along the spine from the neck (cervical) to the low back (lumbar). The surgeon reaches the damaged disc from the front (anterior) of the spine through the throat area. By moving aside the neck muscles, trachea, and esophagus, the disc and bony vertebrae are exposed. Surgery from the front of the neck is more accessible than from the back (posterior) because the disc can be reached without disturbing the spinal cord, spinal nerves, and the strong neck muscles. Depending on your particular symptoms, one disc (single-level) or more (multi-level) may be removed.

After the disc is removed, the space between the bony vertebrae is empty. To prevent the vertebrae from collapsing and rubbing together, a spacer bone graft is inserted to fill the open disc space. The graft serves as a bridge between the two vertebrae to create a spinal fusion. The bone graft and vertebrae are fixed in place with metal plates and screws. Following surgery the body begins its natural healing process and new bone cells grow around the graft. After 3 to 6 months, the bone graft should join the two vertebrae and form one solid piece of bone. The instrumentation and fusion work together, similar to reinforced concrete.

Bone grafts come from many sources. Each type has advantages and disadvantages.

• Autograft bone comes from you. The surgeon takes your own bone cells from the hip (iliac crest). This graft has a higher rate of fusion because it has bone-growing cells and proteins. The disadvantage is the pain in your hipbone after surgery. Harvesting a bone graft from your hip is done at the same time as the spine surgery. The harvested bone is about a half inch thick – the entire thickness of bone is not removed, just the top half layer.
• Allograft bone comes from a donor (cadaver). Bone-bank bone is collected from people who have agreed to donate their organs after they die. This graft does not have bone-growing cells or proteins, yet it is readily available and eliminates the need to harvest bone from your hip. Allograft is shaped like a doughnut and the center is packed with shavings of living bone tissue taken from your spine during surgery.
• Bone graft substitute comes from man-made plastic, ceramic, or bioresorbable compounds. Often called cages, this graft material is packed with shavings of living bone tissue taken from your spine during surgery.

After fusion you may notice some range of motion loss, but this varies according to neck mobility before surgery and the number of levels fused. If only one level is fused, you may have similar or even better range of motion than before surgery. If more than two levels are fused, you may notice limits in turning your head and looking up and down. Motion-preserving artificial disc replacements have emerged as an alternative to fusion. Similar to knee replacement, the artificial disc is inserted into the damaged joint space and preserves motion, whereas fusion eliminates motion. Outcomes for artificial disc compared to ACDF are similar, but long-term results of motion preservation and adjacent level disease are not yet proven. Talk with your surgeon about whether ACDF or artificial disc replacement is most appropriate for you.

Who is a candidate?

You may be a candidate for discectomy if you have:

• diagnostic tests (MRI, CT, myelogram) show that you have a herniated or degenerative disc
• significant weakness in your hand or arm
• arm pain worse than neck pain
• symptoms that have not improved with physical therapy or medication

ACDF may be helpful in treating the following conditions:

• Bulging and herniated disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation and swelling occurs when this material squeezes out and painfully presses on a nerve.
• Degenerative disc disease: As discs naturally wear out, bone spurs form and the facet joints inflame. The discs dry out and shrink, losing their flexibility and cushioning properties. The disc spaces get smaller. These changes lead to canal stenosis or disc herniation (Fig. 1).

The surgical decision

Most herniated discs heal after a few months of nonsurgical treatment. Your doctor may recommend treatment options, but only you can decide whether surgery is right for you. Be sure to consider all the risks and benefits before making your decision. Only 10% of people with herniated disc problems have enough pain after 6 weeks of conservative treatment to consider surgery.

Your surgeon will also discuss the risks and benefits of different types of bone graft material. Autograft is the gold standard for rapid healing and fusion, but the hip incision can be painful and at times lead to complications. Allograft (bone-bank) is more commonly used and has proven to be as effective for routine 1 and 2 level fusions in non-smokers.

Who performs the procedure?

A neurosurgeon or an orthopedic surgeon can perform spine surgery. Many spine surgeons have specialized training in complex spine surgery. Ask your surgeon about their training, especially if your case is complex or you’ve had more than one spinal surgery.

What happens before surgery?

In the office, you will sign consent and other forms so that the surgeon knows your medical history (allergies, medicines/vitamins, bleeding history, anesthesia reactions, previous surgeries). Discuss all medications (prescription, over-the-counter, and herbal supplements) you are taking with your health care provider. Presurgical tests (e.g., blood test, electrocardiogram, chest X-ray) may need to be done several days before surgery. Consult your primary care physician about stopping certain medications and ensure you are cleared for surgery.

Stop taking all non-steroidal anti-inflammatory medicines (ibuprofen, Advil, etc.) and blood thinners (Coumadin, aspirin, Plavix, etc.) 7 days before surgery. Stop using nicotine and drinking alcohol 1 week before and 2 weeks after surgery to avoid bleeding and healing problems.

You may be asked to wash your skin with Hibiclens (CHG) or Dial soap before surgery. It kills bacteria and reduces surgical site infections. (Avoid getting CHG in eyes, ears, nose or genital areas.)

Stop smoking
The most important thing you can do to ensure a successful spine surgery is quit using tobacco. This includes cigarettes, vaping, cigars, pipes, chew, and snuff/dip. Nicotine prevents bone growth and decreases successful fusion. Smoking risk is serious: fusion fails in 40% of smokers compared with 8% of non-smokers [1]. Smoking also decreases blood circulation, resulting in slower wound healing and an increased risk of infection. Talk with your doctor about ways to help you quit: nicotine replacements, medications (Chantix or Zyban), and counseling programs.

Morning of surgery

• Don’t eat or drink after midnight before surgery (unless the hospital tells you otherwise). You may take permitted medicines with a small sip of water.
• Shower using antibacterial soap. Dress in freshly washed, loose-fitting clothing.
• Wear flat-heeled shoes with closed backs.
• Remove make-up, hairpins, contacts, body piercings, nail polish, etc.
• Leave all valuables and jewelry at home.
• Bring a list of medications with dosages and the times of day usually taken.
• Bring a list of allergies to medication or foods.

Arrive at the hospital 2 hours before (surgery center 1 hour before) your scheduled surgery time to complete the necessary paperwork and pre-procedure work-ups. An anesthesiologist will talk with you and explain the effects of anesthesia and its risks.

What happens during surgery?

There are seven steps to the procedure. The operation generally takes 1 to 3 hours.

Step 1: prepare the patient
You will lie on your back on the operative table and be given anesthesia. Once asleep, your neck area is cleansed and prepped. If a fusion is planned and your own bone will be used, the hip area is also prepped to obtain a bone graft. If a donor bone will be used, the hip incision is unnecessary.

Step 2: make an incision
A 2-inch skin incision is made on the right or left side of your neck (Fig. 2). The surgeon makes a tunnel to the spine by moving aside muscles in your neck and retracting the trachea, esophagus, and arteries. Finally, the muscles that support the front of the spine are lifted and held aside so the surgeon can clearly see the bony vertebrae and discs.

Figure 2. A 2-inch skin incision is made on the side of your neck.

Step 3: locate the damaged disc
With the aid of a fluoroscope (a special X-ray), the surgeon passes a thin needle into the disc to locate the affected vertebra and disc. The vertebrae bones above and below the damaged disc are spread apart with a special retractor.

Step 4: remove the disc
The outer wall of the disc is cut (Fig. 3). The surgeon removes about 2/3 of your disc using small grasping tools, and then looks through a surgical microscope to remove the rest of the disc. The ligament that runs behind the vertebrae is removed to reach the spinal canal. Any disc material pressing on the spinal nerves is removed.

Figure 3. The muscles are retracted to expose the vertebra. The disc annulus is cut open and the disc material is removed with grasping tools.

Step 5: decompress the nerve
Bone spurs that press on your nerve root are removed. The foramen, through which the spinal nerve exits, is enlarged with a drill (Fig. 4). This procedure, called a foraminotomy, gives your nerves more room to exit the spinal canal.

Figure 4. (top view) The disc annulus and nucleus are removed to decompress the spinal cord and nerve root. Bone spurs are removed and the spinal foramen is enlarged to free the nerve.

Step 6. prepare a bone graft fusion
Using a drill, the open disc space is prepared on the top and bottom by removing the outer cortical layer of bone to expose the blood-rich cancellous bone inside. This “bed” will hold the bone graft material that you and your surgeon selected:

• Bone graft from your hip. A skin and muscle incision is made over the crest of your hipbone. Next, a chisel is used to cut through the hard outer layer (cortical bone) to the inner layer (cancellous bone). The inner layer contains the bone-growing cells and proteins. The bone graft is then shaped and placed into the “bed” between the vertebrae (Fig. 5).
• Bone bank or fusion cage. A cadaver bone graft or bioplastic cage is filled with the leftover bone shavings containing bone-growing cells and proteins. The graft is then tapped into the shelf space.

Figure 5. (side view) A bone graft is shaped and inserted into the shelf space between the vertebrae.

The bone graft is often reinforced with a metal plate screwed into the vertebrae to provide stability during fusion. An x-ray is taken to verify the position of the graft, plate, and screws (Fig. 6).

  Figure 6. Illustration and x-ray showing a metal plate and four screws used to hold the bone graft between the vertebrae while fusion occurs.

Alternative option: artificial disc replacement (Fig. 7). Instead of a bone graft or fusion cage, an artificial disc device is inserted into the empty disc space. In select patients, it may be beneficial to preserve motion. Talk to your doctor – not all insurance companies will pay for this new technology and out-of-pocket expenses may be incurred.

Figure 7. Artificial disc replacement preserves motion of the spine segment.

Step 7. close the incision The spreader retractors are removed. The muscle and skin incisions are sutured together. Steri-Strips or biologic glue is placed across the incision.

What happens after surgery?

You will awaken in the postoperative recovery area. Blood pressure, heart rate, and respiration will be monitored. Any pain will be addressed. Once awake, you can increase your activity level (sitting in a chair, walking). Patients who have had bone graft taken from their hip may feel more discomfort in their hip than neck incision. Most patients having a 1 or 2 level ACDF are sent home the same day. However, if you have difficulty breathing or unstable blood pressure, you may need to stay overnight.

Follow the surgeon’s home care instructions for 2 weeks after surgery or until your follow-up appointment. In general, you can expect:

Restrictions

• Avoid bending or twisting your neck.
• Don’t lift anything heavier than 5 pounds.
• No strenuous activity including yard work, housework, and sex.
• DON’T SMOKE or use nicotine products: vape, dip, chew. It prevents new bone growth and may cause your fusion to fail.
• Don’t drive until after your follow-up visit.
• Don’t drink alcohol. It thins the blood and increases the risk of bleeding. Also, don’t mix alcohol with pain medicines.

Incision Care

• If Dermabond skin glue covers your incision, you may shower the day after surgery. Gently wash the area with soap and water every day. Don’t rub or pick at the glue. Pat dry.
• If you have staples, steri-strips or stitches, you may shower 2 days after surgery. Gently wash the area with soap and water every day. Pat dry.
• If there is drainage, cover the incision with a dry gauze dressing. If drainage soaks through two or more dressings in a day, call the office.
• Don’t soak the incision in a bath or pool.
• Don’t apply lotion/ointment on the incision.
• Dress in clean clothes after each shower. Sleep with clean bed linens. No pets in the bed until your incision heals.
• Some clear, pinkish drainage from the incision is normal. Watch for spreading redness, colored drainage, and separation.
• Staples, steri-strips, and stitches are removed at your follow-up appointment.

Medications

• Take pain medicines as directed. Reduce the amount and frequency as your pain subsides. If you don’t need the pain medicine, don’t take it.
• Narcotics can cause constipation. Drink lots of water and eat high-fiber foods. Stool softeners and laxatives can help move the bowels. Colace, Senokot, Dulcolax and Miralax are over-the-counter options.
• If painful constipation does not get better, call the doctor to discuss other medicine.
• Don’t take anti-inflammatory pain relievers (Advil, Aleve) without surgeon’s approval. They prevent new bone growth and may cause your fusion to fail.
• You may take acetaminophen (Tylenol).

Activity

• If you were given a brace, wear it at all times except when sleeping, showering, or icing.
• Ice your incision 3-4 times per day for 15-20 minutes to reduce pain and swelling.
• Get up and walk 5-10 minutes every 3-4 hours. Gradually increase walking, as you are able.

When to Call Your Doctor

• Fever over 101.5° (unrelieved by Tylenol).
• Unrelieved nausea or vomiting.
• Severe unrelieved pain.
• Signs of incision infection.
• Rash or itching at the incision (allergy to Dermabond skin glue).
• Swelling and tenderness in the calf of one leg.
• New onset of tingling, numbness, or weakness in the arms or legs.
• Dizziness, confusion, nausea or excessive sleepiness.

Recovery and prevention

Schedule a follow-up appointment with your surgeon for 2 weeks after surgery. Recovery time generally lasts 4 to 6 weeks. X-rays may be taken after several weeks to verify that fusion is occurring. The surgeon will decide when to release you back to work at your follow-up visit.

A cervical collar or brace is sometimes worn during recovery to provide support and limit motion while your neck heals or fuses (see Braces for Your Neck). Your doctor may prescribe neck stretches and exercises or physical therapy once your neck has healed.

If you had a bone graft taken from your hip, you may experience pain, soreness, and stiffness at the incision. Get up frequently (every 20 minutes) and move around or walk. Don’t sit or lie down for long periods of time.

Recurrences of neck pain are common. The key to avoiding recurrence is prevention:

• Proper lifting techniques
• Good posture during sitting, standing, moving, and sleeping
• Appropriate exercise program
• An ergonomic work area
• Healthy weight and lean body mass
• A positive attitude and relaxation techniques
• No smoking

What are the results?

Anterior cervical discectomy is successful in relieving arm pain in 92 to 100% of patients [3]. However, arm weakness and numbness may persist for weeks to months. Neck pain is relieved in 73 to 83% of patients [3]. In general, people with arm pain benefit more from ACDF than those with neck pain. Aim to keep a positive attitude and diligently perform your physical therapy exercises.

Achieving a spinal fusion varies depending on the technique used and your general health (smoker). In a study that compared three techniques: ACD, ACDF, and ACDF with plates and screws, the outcomes were [3]:

• 67% of people who underwent ACD (no bone graft) achieved fusion naturally. However, ACD alone results in an abnormal forward curving of the spine (kyphosis) compared with the other techniques.
• 93% of people who underwent ACDF with bone graft placement achieved fusion.
• 100% of people who underwent ACDF with bone graft placement and plates and screws achieved fusion.

What are the risks?

No surgery is without risks. General complications of any surgery include bleeding, infection, blood clots (deep vein thrombosis), and reactions to anesthesia. If spinal fusion is done at the same time as a discectomy, there is a greater risk of complications. Specific complications related to ACDF may include:

• Hoarseness and swallowing difficulties. In some cases, temporary hoarseness can occur. The recurrent laryngeal nerve, which controls the vocal cords, is affected during surgery. It may take several months for this nerve to recover. In rare cases (less than 1/250) hoarseness and swallowing problems may persist and need further treatment with an ear, nose and throat specialist.
• Vertebrae failing to fuse. There are many reasons why bones do not fuse together. Common ones include smoking, osteoporosis, obesity, and malnutrition. Smoking is by far the greatest factor that can prevent fusion. Nicotine is a toxin that inhibits bone-growing cells. If you continue to smoke after your spinal surgery, you could undermine the fusion process.
• Hardware fracture. Metal screws and plates used to stabilize the spine are called “hardware.” The hardware may move or break before the bones are completely fused. If this occurs, a second surgery may be needed to fix or replace the hardware.
• Bone graft migration. In rare cases (1 to 2%), the bone graft can move from the correct position between the vertebrae soon after surgery. This is more likely to occur if hardware (plates and screws) is not used or if multiple vertebral levels are fused. If this occurs, a second surgery may be necessary.
• Adjacent segment disease. Fusion of a spine segment causes extra stress and load to be transferred to the discs and bones above or below the fusion. The added wear and tear can eventually degenerate the adjacent level and cause pain.
• Nerve damage or persistent pain. Any spine surgery comes with the risk of damaging the nerves or spinal cord. Damage can cause numbness or even paralysis. However, the most common cause of persistent pain is nerve damage from the disc herniation itself. Some disc herniations may permanently damage a nerve making it unresponsive to surgery. Like furniture on the carpet, the compressed nerve doesn’t spring back. In these cases, spinal cord stimulation or other treatments may provide relief.

Sources & links

If you have more questions, please contact Mayfield Brain & Spine at 800-325-7787 or 513-221-1100.

Sources

1. Bose B: Anterior cervical instrumentation enhances fusion rates in multilevel reconstruction in smokers. J Spinal Disord 14:3-9, 2001.
2. Hilibrand AS, et al.: Impact of smoking on the outcome of anterior cervical arthrodesis with interbody or strut-grafting. J Bone Joint Surg Am 83-A:668-73, 2001.
3. Xie JC, Hurlbert RJ. Discectomy versus discectomy with fusion versus discectomy with fusion and instrumentation: a prospective randomized study. Neurosurgery 61:107-16, 2007.

Links

www.spine-health.com
www.spineuniverse.com
www.knowyourback.org

allograft: a portion of living tissue taken from one person (the donor) and implanted in another (the recipient) for the purpose of fusing two tissues together.

autograft (autologous): a portion of living tissue taken from a part of ones own body and transferred to another for the purpose of fusing two tissues together.

bone graft: bone harvested from ones self (autograft) or from another (allograft) for the purpose of fusing or repairing a defect.

discectomy: a type of surgery in which herniated disc material is removed so that it no longer irritates and compresses the nerve root.

foraminotomy: surgical enlargement of the intervertebral foramen through which the spinal nerves pass from the spinal cord to the body.

fusion: to join together two separate bones into one to provide stability.

interbody cage: a device made of titanium, carbon-fiber, or polyetheretherketone (PEEK) that is placed in the disc space between two vertebrae.

Mayfield Certified Health Info materials are written and developed by the Mayfield Clinic. This information is not intended to replace the medical advice of your health care provider.

Cervical Spine Surgery: An Overview

What is Cervical Spine Surgery?
Your orthopaedic surgeon or neurosurgeon may recommend cervical spine surgery to relieve neck pain, numbness, tingling and weakness, restore nerve function and stop or prevent abnormal motion in your neck.
A spine surgeon reviews a patient’s cervical x-ray.Your surgeon does this by removing a disc or a bone and fusing the vertebrae together with a bone graft either in front of or behind the spine. The bone graft may be one of two types: an autograft (bone taken from your body) or an allograft (donor bone from a bone bank). Sometimes metal plates and screws are also used to further stabilize the spine. These techniques are called instrumentation. When the vertebrae have been surgically stabilized, abnormal motion is stopped and function is restored to the spinal nerves. An alternative to spinal fusion is a cervical disc replacement using an artificial disc that enables neck motion and stabilizes the spine.

What are the Reasons for Cervical Spine Surgery?
Cervical spine surgery may be indicated for a variety of spinal neck problems. Generally, surgery may be performed for degenerative disorders, trauma or instability. These conditions may produce pressure on the spinal cord or on the nerves coming from the spine.
 

CAPTION:Detailed illustration of the bones, nerves, discs, and blood vessels in the cervical spine.What Conditions are Treated with Cervical Spine Surgery?

Degenerative Disc Disease
In degenerative disease the discs or cushion pads between your vertebrae shrink, causing wearing of the disc, which may lead to herniation. You may also have arthritic areas in your spine. This degeneration can cause pain, numbness, tingling and weakness from the pressure on the spinal nerves.
The potential causes of nerve compression is depicted in this illustration showing a bone spur, herniated disc and thickened spinal ligament.Cervical Deformity
Patients with a deformity in their cervical spine, such as hyperlordosis or swan neck deformity, may benefit from surgery to straighten and stabilize the spine. Upper neck disorders, also called craniocervical or craniovertebral junction abnormalities can affect the cervical spine.

Since the neck is so flexible it is vulnerable to injury. Some injuries can cause a fracture and or dislocation of the cervical vertebra. In a severe injury, the spinal cord may also be damaged. Patients with a fracture, especially with spinal cord damage, undergo surgery to relieve pressure on the spinal cord and stabilize the spine.

What are the Potential Complications of Cervical Spine Surgery?
As with any operation, there are risks involved with cervical spine surgery. Possible complications include injury to your spinal cord, nerves, esophagus, carotid artery or vocal cords; non-healing of the bony fusion; failure to improve; instrumentation breakage and/or failure; infection; bone graft site pain. Any of these complications may lead to more surgery.

Other complications may include phlebitis in your legs, blood clots in the lungs or urinary problems. Rare complications include paralysis and possibly death. Your surgeon will discuss potential risks with you before asking you to sign a consent form.

How is Revision Surgery different?
Revision surgery often requires correcting a deformity. The type of revision depends on the type of problem. The procedure may include operating on both the front and back of the neck.

The incidence of complications from cervical spine revision surgery is higher than in first-time procedures. It is also more difficult to relieve pain and restore nerve function in revision surgery. Patients should also be aware that the chance of having long-term neck pain is increased with revision surgery.

Will You Need Surgery for Your Neck Pain

To understand cervical spine surgery, it is important to know about neck anatomy, spinal conditions that can affect the cervical spine, and surgical goals and techniques used to address neck pain. This article will review that information, and it begins with a quick cervical spine anatomy lesson.  It’s important to know how your neck is supposed to function in order to better understand why you have pain, as well as what will be done to address your condition in surgery.

It’s important to know how your neck is supposed to function in order to better understand why you have pain.

Basic Anatomy of the Neck (Cervical Spine)

Bones
The cervical spine contains 7 bones, called the cervical vertebrae. These bones are stacked on top of one another and linked by discs, ligaments, and muscles.

The vertebrae are numbered C1 through C7. The first vertebra, C1, is also called the atlas because it joins with the base of the skull and supports the head (just as Atlas supported the weight of the world in Greek mythology). C2, the second vertebra, is called the axis because the head and C1 swivel around it. These two vertebrae enable most neck movement.

The vertebrae below C2 are only referred to by number; however, all of them have the same basic structure including:

• The vertebral body: a cube-shaped bone
• Lateral masses: small columns of dense bone on the sides of the vertebral bodies
• Facet joints: smooth areas lined with cartilage that help faciliate movement
• Lamina: a thin semi-circle arch of bone behind the vertebral body; it forms the “roof” of the spinal canal and helps protect the spinal cord as it travels down the spine.

Spinal Cord and Nerves
The spinal cord runs through the cervical spine. It is protected in front by the vertebral bodies and behind by the lamina. Nerves that control arm function branch off from the spinal cord in the cervical spine.

The nerves exit the cervical spine through small holes called foramina.

Intervertebral Discs
Starting at C2-C3, an intervertebral disc sits between each vertebra. Intervertebral discs are pillow-like structures, with a tough outer ring (the annulus fibrosus) and a dense, jelly-like center (nucleus pulposus).

Intervertebral discs perform 2 important functions:

• They act as shock absorbers between the vertebral bodies
• They function as flexible pivots to help provide motion between the vertebrae

Cervical Degeneration: The Cause of Many Neck Problems

Although the discs are tough structures, they are susceptible to damage. The wear and tear of normal living can cause the disc to degenerate and lead to osteoarthritis (spondylosis) of the vertebra. This is similar to the arthritis that affects hip and knee joints.

Degeneration in the cervical spine can lead to significant changes in anatomy. These changes can cause neck pain and other symptoms due to:

1. Compression of the spinal cord and other nerve structures
2. Abnormal motion in the cervical spine
3. A combination of 1 and 2

Cervical degeneration includes distinct characteristics, some or all of which may be present in a neck pain patient.

The lumbar spine is illustrated above, along with disc problems.

Characteristic 1: Bulging Disc (or Even a Herniated Disc)
As a disc deteriorates, it may begin to bulge, or even rupture. If it ruptures, its jelly-like middle (nucleus pulposus) may protrude. A bulge may protrude backward and press against the spinal cord or cervical nerves. Rarely, pressure on the spinal cord may cause a patient to lose hand dexterity, bowel or bladder control, and/or experience difficulty walking (myelopathy). This type of myelopathy is serious and requires immediate medical attention.

Sometimes, the degenerated disc protrudes into one of the holes (foramina) where the nerve exits from the spinal column. In this case, symptoms may occur only in the arm on the side where the disc protrusion touches the exiting nerve. Since the nerves provide arm function, the individual feels pain, numbness, tingling, or burning in the arms even though the actual problem is located in the neck. This is called radiculopathy.

Characteristic 2: Loss of Disc Height
As a disc degenerates, it loses it shock absorption capability and may cause neck pain since the joints can no longer move as effectively or safely.

Characteristic 3: Bone Spurs
As degeneration continues, the bones may begin to develop “spurs” which are called osteophytes. Osteophytes can protrude into the spinal canal or foramina, causing spinal cord or nerve compression. This may cause neck pain, arm symptoms (radiculopathy), or spinal cord dysfunction (myelopathy).

Characteristic 4: Facet Degeneration
The cartilage surfaces on the facet joint may erode away, causing facet pain.

Non-surgical Neck Pain Treatments You May Try Before Surgery

Cervical Spine Surgery: Goals and Techniques

If cervical degeneration causes myelopathy (spinal cord dysfunction), radiculopathy (dysfunction of nerves to the neck or arms), neck pain, or abnormal neck motion, surgery may be necessary. The surgical goal is to reduce pain and restore spinal stability.

Surgeons use 2 overall surgical techniques to address neck pain:

• Decompression: the removal of tissue pressing against a nerve structure
• Stabilization: the limitation of motion between vertebrae.

These 2 techniques may be used in combination, or you may just have a decompression surgery or just a stabilization surgery.

Understanding Decompression Surgery
Decompression procedures can be done from the front (anterior) or back (posterior) of the spine, depending on how and where the nerve tissue is being compressed.

In decompression, the tissue pressing against the nerve or spinal cord is surgically removed, or more space is created for the nerve tissue to remain unobstructed. The main types of surgical decompressions are:

Foraminotomy: If intervertebral disc material or a bone spur is pressing on a nerve as it exits through the foramen, a foraminotomy may be done. Otomy is the medical term for making an opening. Therefore, a foraminotomy is making the opening of the foramen larger, so the nerve can exit without being compressed.

Laminotomy: Similar to foraminotomy (see above) but involves making a hole in the lamina to create more space for the spinal cord.

Laminectomy: Ectomy is the medical term meaning removal of. A laminectomy removes part or all the lamina to reduce pressure on the spinal cord.

Facetectomy: Involves removal of the facet joint to reduce pressure on the exiting nerve root.

Laminoplasty: Plasty means to shape an anatomical structure to restore form or function. In this case, laminoplasty refers shaping the lamina surgically to create more room for the spinal cord.

Each of the decompression techniques above are performed from the back (posterior) of the spine. However, sometimes a surgeon must perform a decompression from the front (anterior) of the spine. For example, if a disc bulges into the spinal canal, it sometimes cannot be removed from behind because the spinal cord is in the way. Therefore, the decompression is usually performed from the front (anterior) of the neck.

Types of anterior decompression techniques are:

Discectomy: Surgical removal of all or part of the herniated disc.

Corpectomy: Occasionally disc material becomes lodged between the vertebral body and the spinal cord, and cannot be removed by a discectomy alone. In other cases, bone spurs form between the vertebral body and spinal cord. In these situations, the entire vertebral body may need to be removed to gain access to the disc material. This procedure is called a corpectomy (corpus means body and ectomy refers to removal).

TransCorporeal MicroDecompression (TCMD): TCMD is a minimally invasive procedure that accesses the cervical spine from the front of the neck (anterior). The procedure is performed through a small channel made in the vertebral body to access and decompress the spinal cord and nerve. TCMD can be performed as a stand-alone procedure or with Anterior Cervical Discectomy and Fusion (ACDF) and/or total disc replacement.

Understanding Spinal Stabilization
Discectomies and corpectomies usually result in an unstable spine. Instability denotes abnormal motion in the spinal column, raising the potential for serious neurological injury. In these situations, the spine is often surgically restabilized. The main restabilization surgical techniques are:

Fusion: Fusion is the bonding together of bones, usually with the aid of bone graft or a biological substance. A fusion stops motion between 2 vertebrae and provides long-term stabilization. It is very similar to natural fracture healing.

In a cervical fusion, adjacent vertebral bodies, facets, and/or the lamina may be fused together.

If the fusion is done from behind (posterior), the surgeon typically will lay strips of bone graft from one lamina, or lateral (side) mass to the lamina, or lateral mass below. Usually, bone graft will fuse across these structures over time and stabilize the two vertebrae. The surgeon may use a similar technique to fuse the facet joints together, too.

Instrumentation: Posterior cervical fusions can be supplemented by specially designed fixation devices such as wires, cables, screws, rods, and plates. These devices increase stability and facilitate fusion.

Understanding Decompression and Fusion
Sometimes, a surgeon will perform both a decompression and a fusion. For example, after a discectomy, a gap will exist between the vertebral bodies. This gap is typically filled with a bone graft (from the patient’s pelvis or from a bone bank), or spacer that supports the spine and promotes fusion. This type of procedure is called an anterior cervical discectomy and fusion or ACDF.

Today, many surgeons apply fixation devices (plates with screws) to the anterior spine when performing an ACDF or cervical corpectomy. These devices help to promote stability while the fusion heals.

Artificial Discs: Another Surgical Option
Recently, many spine surgeons are using a new technology in their cervical spine surgery. Instead of fusing the spine after a discectomy, surgeons are implanting an artificial cervical disc. The advantage is that an artificial disc enables a patient to retain normal neck movement after surgery. Previously, if the patient had 2 or more vertebrae fused, neck motion would be greatly reduced.

Conclusion:  Cervical Spine Surgery May Be an Option for You
If your surgeon recommends cervical surgery, you can be encouraged that cervical decompression and stabilization procedures are some of the most successful operations spine surgeons perform today. Patients generally have rapid recovery and quickly return to activities of daily living with complete resolution of their neck pain and other symptoms.

Cervical Disk Replacement Surgery | Johns Hopkins Medicine

What is cervical disk replacement surgery?

Your cervical spine is made up of the 7 bones, called cervical vertebrae, stacked on top of each other forming the neck area. The cervical disks are the cushions that lie between the cervical vertebrae. They act as shock absorbers to allow your neck to move freely.

Your cervical spine also forms a protective tunnel for the upper part of your spinal cord to pass through. This part of your spinal cord contains the spinal nerves that supply your upper body with sensation and movement.

When the space between your vertebrae becomes too narrow, part of your vertebrae or your cervical disk can press on your spinal cord or spinal nerves, causing you pain, numbness, or weakness. When these symptoms do not respond to nonsurgical types of treatment, disk surgery may be recommended.

Cervical disk replacement surgery involves removing a diseased cervical disk and replacing it with an artificial disk. Before this procedure was available, the affected disk was removed and the vertebrae above and below were fused together to prevent motion

The use of an artificial disk to replace your natural cervical disk is a new type of treatment that has recently been approved by the FDA. Disk replacement surgery may have the advantage of allowing more movement and creating less stress on your remaining vertebrae than traditional cervical disk surgery.

Why is cervical disk replacement surgery needed?

Loss of space between your cervical vertebrae from cervical disk degeneration, or wear and tear, is common. Cervical disks begin to collapse and bulge with age; this happens to most people by age 60. But health care providers don’t know why some people have more symptoms from cervical disk degeneration than others.

Symptoms may include:

• Neck pain

• Neck stiffness

• Headache

• Pain that travels down into your shoulders or into your arms

• Weakness of your shoulders, arms, hands, or legs

• Numbness or “pins and needles” feeling in your arms

What are the risks of cervical disk replacement surgery?

While any surgery carries some risk, disk replacement surgery is a relatively safe procedure. Before you have surgery, you will need to sign a consent form that explains the risks and benefits of the surgery.

Disk replacement is a new type of spine surgery so there is little information on possible long-term risks and outcomes. Discuss with your surgeon the risks and benefits of disk replacement surgery compared with more traditional types of cervical spine surgery.

Some potential risks of cervical spine surgery include:

• Reactions to the anesthesia

• Bleeding

• Infection

• Nerve injury

• Spinal fluid leak

• Voice change

• Stroke

• Difficulty breathing

• Difficulty swallowing

• Failure to relieve symptoms

• Broken or loosened artificial disk

• Need for further surgery

There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your surgeon before the procedure.

How do I get ready for cervical disk replacement surgery?

Ask your health care provider to tell you what you should do before your surgery. Below is a list of some common steps that you may be asked to do.

• Tell your surgeon about any medications you take at home including herbal supplements and over-the-counter medications. You may be asked to stop taking aspirin or other medications that thin your blood and may increase bleeding.

• Tell your surgeon if you or someone in your family has any history of reaction to general anesthesia.

• If you smoke, you may be asked to stop smoking well before surgery and avoid smoking for a time after surgery.

• Before surgery you will probably be given instructions on when to stop eating and drinking. It’s common to have nothing to eat or drink after midnight on the night before the procedure.

• Ask your surgeon if you should take your regular medications with a small sip of water on the day of the procedure.

What happens during cervical disk replacement surgery?

Just before the procedure starts you will have an intravenous line (IV) started so you can receive fluids and medications to make you relaxed and sleepy. This procedure is usually done under general anesthesia (you are asleep). Medication may be given through the IV to put you to sleep and a tube may be inserted in your throat to protect your airway and supplement your breathing. The actual procedure may last a few hours. This is what may happen once the procedure begins:

1. Monitors are placed to check your heart, blood pressure, and oxygen level.

2. The area of your neck where the incision will be made is cleaned with a special solution to kill germs on the skin.

3. A one- to two-inch incision (surgical cut) is made on the side or front of your neck.

4. The important structures of the neck are carefully moved to the side until the surgeon can see the bones of the vertebrae and the cervical disk.

5. The cervical disk that is being replaced is removed.

6. The artificial disk is secured into the empty disk space.

7. The incision is closed using absorbable sutures (stitches) under the skin. The skin is then carefully closed with sutures that minimize any scarring.

8. A small dressing is applied over the incision, a rigid or soft neck collar may be put on your neck to restrict motion, and you will be taken to the recovery area.

Some steps might be slightly different from those outlined above. Talk with your health care provider about what might happen during your procedure.

What happens after cervical disk replacement surgery?

In the recovery area, you will be observed until you recover from the anesthesia. Pain after disk replacement surgery is normal and you may be given pain medication in the recovery area.

Most people will need to spend a day or two in the hospital. This is what may happen during your hospital stay:

• Intravenous fluids may be continued until you can drink fluids well by mouth.

• Once you are able to drink normally, you will be able to start eating your normal diet.

• You’ll continue to take pain medication if you need it.

• Your nurses will check your dressing and help you to get out of bed and go to the bathroom.

• You may be given a support collar to wear in the hospital.

• You will be encouraged to get out of bed and move around as soon as you are able to.

Recovery and rehabilitation at home may be a little different for each person, but in general, here’s what you might expect:

• You may need to continue wearing a soft or rigid neck support.

• You will be able to eat your normal diet.

• You may need to return to your surgeon to have sutures removed.

• You will gradually start returning to normal activities. You should ask your surgeon about any activity restrictions and when you can take a regular shower or bath.

• You may start physical therapy after a few weeks.

• You should be able to return to full activities by 4 to 6 weeks.

You should call your surgeon if you have any of these problems:

• Fever

• Headache

• Bleeding, redness, swelling, or discharge from your incision site

• Pain that does not respond to pain medication

• Numbness or weakness

• Difficulty swallowing

• Voice change or hoarseness

• Difficulty breathing

Your health care team may give you other instructions about what you should do after your procedure.

Anterior Cervical Discectomy and Fusion (Intervertebral Spacer) – Birmingham, AL

This surgery removes a herniated or diseased disc and relieves neck and radiating arm pain caused by parts of the disc pressing on nerve roots.

What is an Anterior Cervical Discectomy with Fusion (Intervertebral Spacer)?

Your healthcare professional may recommend an ACDF if you are suffering from disc herniation or degeneration in the upper part of the spine known as the cervical area. The Anterior Cervical Discectomy is a procedure that involves surgically entering the front (Anterior) of the neck (Cervical) and removing a damaged cervical disc (Discectomy). A vertebral spacer, bone graft, and metal implants are put in place of the damaged disc and act to fuse the two vertebra together.

Who needs this procedure?

If you have some of the following conditions or symptoms, you may be a candidate for an ACDF:

• Weakness in your hand or arm.
• Arm pain that is more severe than neck pain
• Numbness/weakness in arms and extremities
• Degenerative discs or herniated discs
• Other cervical symptoms that have failed to respond to medication or physical therapy

Your healthcare provider can review the exact symptoms and causes that apply to you and why you may be a candidate for the Anterior Cervical Discectomy with Fusion with Intervertebral Spacer.

The anterior cervical discectomy with fusion procedure with intervertebral spacer

Incision

An incision is made across the front of the neck to gain access to the cervical spine.

Disc Removal

The damaged disc is removed, relieving pressure from the previously pinched nerve roots. Space is made above and below the removed disc, making room for the bone graft.

Bone Graft Insertion

An intervertebral spacer packed with bone graft is inserted between the vertebra, in the space made for it in the previous step.

Metal Plate Attachment

A metal plate may be attached to the area to hold the bones in place during the healing process.

Closure

The bone graft in the spacer binds with the vertebra, growing together to help stabilize the spine.

After Surgery and Recovery

Recovery time is specific for each patient, but your surgeon will have a recovery plan to get you back to normal after the operation. Typically, patients are walking around by the end of the day, and able to return to work in 3-6 weeks, depending on how healed they are and the level of activity involved.

Cervical Laminectomy Spine Treatment | Neurosurgery

What is a cervical laminectomy?

A cervical laminectomy is an operation done from the back of the neck to relieve pressure on the spinal cord and nerves. It involves carefully removing the bony roof (or laminae) of the spinal canal, as well as any soft tissue which may also be causing compression.

Why might I need a cervical laminectomy?

Cervical spine surgery may be needed for a variety of problems. Most commonly, this type of surgery is performed for degenerative disorders.

A cervical laminectomy is usually performed for one or more of the following reasons:

1. To treat pressure on the spinal cord (caused by cervical canal stenosis/spondylosis or an intervertebral disc prolapse).
2. To treat pressure on multiple spinal nerves in the neck (caused by foraminal stenosis, cervical spondylosis, or an intervertebral disc prolapse)
3. To treat instability of the cervical spine (this may occur due to degenerative changes, arthritis, or trauma). In this situation, a fusion using lateral mass screws is performed to stabilise the spine as well as taking pressure of the spinal cord.

Surgery is usually recommended when all reasonable conservative measures (pain medications, nerve sheath injections, physical therapies etc.) have failed. In cases of significant instability or neurological problems, surgery may be the most appropriate first treatment option.

What exactly is wrong with my neck?

The spinal canal and intervertebral foraminae are bony tunnels in the spine through which run the spinal cord and spinal nerves (nerve roots) respectively. When the size of these tunnels is reduced, there is less room for the spinal nerves and/or spinal cord, the consequence of which may be pressure on these structures.
Symptoms of neural (nerve or spinal cord) compression include pain, aching, stiffness, numbness, tingling sensations, and weakness. As spinal nerves branch out to form the peripheral nerves, these symptoms may radiate into other parts of the body. For example, cervical nerve root compression (pinched nerves in the neck) can cause symptoms in the shoulders, arms, and hands.

Disorders that can cause nerve root compression include spinal stenosis, degenerative disc disease, a bulging or prolapsed intervertebral disc, bony spurs (osteophytes), or spondylosis (osteoarthritis of the spine). Commonly, two or more of these conditions are seen together.

Intervertebral discs sit between each bone (vertebrae) in the spine. They act as shock absorbers as well as allowing normal movement between the bones in your neck. Each disc has a strong outer ring of fibres (annulus fibrosis), and a soft jelly-like central portion (nucleus pulposis). The annulus is the toughest part of the disc, and connects each vertebral bone. The soft and juicy nucleus of the disc serves as the main shock absorber. An annular tear is where the annulus fibrosis is torn, often the first event in the process of disc prolapse. An annular tear can cause neck pain with or without arm pain. A cervical disc prolapse (or herniation) occurs when the nucleus pulposis escapes from its usual position and bulges into the spinal canal, sometimes placing pressure on the nerves or spinal cord.

In degenerative disc disease the discs or cushion pads between your vertebrae shrink, causing wearing of the disc, which may lead to herniation. You may also have osteoarthritic areas in your spine. This degeneration and osteoarthritis can cause pain, numbness, tingling and weakness from pressure on the spinal nerves and/or spinal cord.

Osteophytes are abnormal bony spurs which form as part of the degenerative process or following a longstanding disc prolapse. This extra bone formation can cause spinal stenosis as well as intervertebral foraminal stenosis, resulting in compression of the spinal cord and/or spinal nerves.

Patients with a painful deformity in their cervical spine may benefit from surgery to straighten and stabilize the spine. Deformity correction is often undertaken at the same time as a decompressive surgical procedure.

As the neck is so flexible (it has to be to perform its usual functions), it is vulnerable to serious injury. Significant trauma can cause a fracture and or dislocation of the cervical spine. In a severe injury the spinal cord may also be damaged. Patients with a fractures and/or dislocations, especially with spinal cord damage, frequently require surgery to relieve pressure on the spinal cord and stabilize the spine.

Instability of the neck may cause neck pain as well as neural compression. This may be the result of trauma, rheumatoid or osteoarthritis, tumour or infection. Instability frequently mandates surgical stabilisation.

What are the alternatives to a cervical laminectomy?

A number of alternatives may exist, depending upon your individual circumstances. These include:

1. Pain medications. A number of medications may be useful for pain. These include the standard opioid and non-opioid analgesic agents, membrane stabilising agents and anticonvulsants, as well as the most recent agent to be released- Pregabalin. Special medical treatments such as Ketamine infusions may be appropriate in some situations.
2. Nerve sheath injections. Local anaesthetic may be injected through the skin of the neck, under CT scan guidance, around the compressed nerve. This is also known as a ‘foraminal block’. Patients frequently obtain a significant benefit from this procedure, and surgery can sometimes be delayed or even avoided. Unfortunately, the benefit obtained from this procedure is usually only temporary, and it tends to wear off after several days, weeks, or sometimes months. This procedure is also an excellent diagnostic tool, especially when the MRI scan suggests that multiple nerves are compressed and your neurosurgeon would like to know exactly which nerve is causing your symptoms.
3. Physical therapies. These include physiotherapy, osteopathy, hydrotherapy and massage.
4. Activity modification. Sometimes simply modifying your workplace and recreational activities, to avoid heavy lifting and repetitive neck or arm movements, allows the healing process to occur more quickly.
5. Other surgical approaches. These include foraminotomy, anterior cervical decompression and fusion (ACDF), and an artificial disc replacement. You should discuss these alternatives, together with their potential risks and benefits, with your neurosurgeon.

What are the goals (potential benefits) of surgery?

The goals of cervical spine surgery include the relief of pain, numbness, tingling and weakness; the restoration of nerve function; and prevention of abnormal motion in the spine.

The rationale, aims, and potential benefits of a cervical laminectomy may therefore include:

• Relief of neural compression (pressure on the spinal cord and nerves)
• Pain alleviation
• Medication reduction
• Prevention of deterioration
• Stabilisation of the spine and protection of the spinal cord and nerves from damage

Generally, the symptom that improves the most reliably after surgery is arm pain. Neck pain and headaches may or may not improve (very occasionally they can be worse). The next symptom to improve is usually weakness. Your strength may not return completely back to normal, however. Improvement in strength generally occurs over weeks and months. Numbness or pins and needles may or may not improve with surgery, due to the fact that the nerve fibres transmitting sensation are thinner and more vulnerable to pressure (they are more easily permanently damaged than the other nerve fibres). Numbness can take up to 12 months to improve. Your balance and ability to walk may or may not improve, depending upon whether the spinal cord is already damaged as a result of pressure.

The chance of obtaining a significant benefit from surgery depends upon a wide variety of factors. Your neurosurgeon will give you an indication of the likelihood of success in your specific case.

What are the possible outcomes if treatment is not undertaken?

If your condition is not treated appropriately (and sometimes even if it is), the possible outcomes may include:

• Ongoing pain
• Paralysis/weakness/numbness
• Functional impairment (clumsiness, poor fine motor skills and coordination)
• Problems with walking and balance

What are the specific risks of a cervical laminectomy?

Generally, surgery is fairly safe and major complications are uncommon. The chance of a minor complication is around 3 or 4%, and the risk of a major complication is 1 or 2%. Over 90% of patients should come through their surgery without complications.

The specific risks include (but are not limited to):

• Fail to benefit symptoms or to prevent deterioration
• Worsening of pain/weakness/numbness
• Infection
• Blood clot in wound requiring urgent surgery to relieve pressure
• Cerebrospinal fluid (CSF) leak
• Surgery at incorrect level (this is rare, as X-rays are used during surgery to confirm the level)
• Blood transfusion
• Implant failure, movement, or malposition (when a fusion is also done)
• Recurrent disc prolapse or nerve compression
• Nerve damage (weakness, numbness, pain) occurs in less than 1%
• Quadriplegia (paralysed arms and legs)
• Incontinence (loss of bowel/bladder control)
• Impotence (loss of erections)
• Chronic pain
• Instability or forward collapse of the neck (kyphosis) (may require further surgery)
• Stroke (loss of movement, speech etc)

What are the risks of anaesthesia and the general risks of surgery?

Having a general anesthetic is generally fairly safe, and the risk of a major catastrophe is extremely low.

All types of surgery carry certain risks, many of which are included in the list below:

• Significant scarring (‘keloid’)
• Wound breakdown
• Drug allergies
• DVT (‘economy class syndrome’)
• Pulmonary embolism (blood clot in lungs)
• Chest and urinary tract infections
• Pressure injuries to nerves in arms and legs
• Eye or teeth injuries
• Myocardial infarction (‘heart attack’)
• Stroke
• Loss of life
• Other rare complications
• What are the implications of surgery?

Most patients are admitted on the same day as their surgery; however some patients are admitted the day before. Patients admitted the day before surgery include those who: reside in country regions, interstate, or overseas; have complex medical conditions or who take warfarin; require further investigations before their surgery; are first on the operating list for the day. You will be given instructions about when to stop eating and drinking before your admission.
You will be in hospital for between 1 and 3 days after your surgery. You will be given instructions about any physical restrictions that will apply following surgery, and these are summarised later in this section.

X-rays of your neck will be taken during surgery to make sure that the correct spinal level is being operated upon. It is critical that you inform us if you are pregnant or think you could possibly be pregnant, as X-rays may be harmful to the unborn child.

There is significant variability between patients in terms of the outcome from surgery, as well as the time taken to recover. You will be given instructions about physical restrictions, as well as your return to work and resumption of recreational activities. You should not drive a motor vehicle or operate heavy machinery until instructed to do so by your neurosurgeon.

You should not sign or witness legal documents until reviewed by your GP post-operatively, as the anaesthetic can sometimes temporarily muddle your thinking.

Fusion of the cervical spine results in a degree of loss of movement in the neck, mainly in terms of bending your neck forwards and backwards. In some cases, however, a fusion cannot be avoided.

What do you need to tell the doctor before surgery?

It is important that you tell your surgeon if you:

• Have blood clotting or bleeding problems
• Have ever had blood clots in your legs (DVT or deep venous thrombosis) or lungs (pulmonary emboli)
• Are taking aspirin, warfarin, or anything else (even some herbal supplements) that might thin your blood
• Have high blood pressure
• Have any allergies
• Have any other health problems

What do I need to do before surgery?

Before you surgery it is imperative that you stop smoking, and you should not smoke for at least 12 months after (it is preferable that you cease permanently). Smoking leads to worse outcomes following surgery.
If you are fairly overweight, it is advisable that you engage in a sensible weight loss program before you surgery. Please discuss this with your GP and neurosurgeon.
In order to prevent unwanted bleeding during or after surgery, it is critical that you stop taking aspirin, and any other antiplatelet (blood-thinning) medications or substances including herbal remedies at least 2 weeks before your surgery.

If you normally take warfarin, you will usually be admitted to hospital 3 or 4 days before your surgery. Your warfarin will be ceased at that time (it takes a few days to wear off) and you may be commenced on shorter-acting anti-clotting agents for a few days. These can then be stopped a day or so before surgery.

Ideally, you should take a Zinc tablet a day, commencing one month before surgery, and continuing for 3 months after. This should help wound healing.

Will I need further investigations?

Most patients will have had X-rays of their neck, as well as a CT scan and MRI. Sometimes ‘dynamic’ X-rays of the cervical spine are performed, with X-rays taken bending the neck forwards and backwards; this is to determine the presence and site of any instability.
In some patients there is uncertainty either about the diagnosis or exactly which disc or discs in the neck are responsible for their symptoms: in those patients, nerve conduction studies and/or a nerve block may shed light on the diagnostic issues.

If you have not had an MRI for over 12 months before your surgery, or if your symptoms have changed significantly since your most recent MRI, then this investigation will need to be repeated to make sure that there are no surprises at the time of surgery!

Who will perform surgery? Who else will be involved?

Surgery will be carried out by your Precision Neurosurgery surgeon. A surgical assistant will be present and an experienced consultant anaesthetist will be responsible for your general anaesthetic.

How is a cervical laminectomy performed?

A general anaesthetic will be administered to put you to sleep. A breathing tube (‘endotracheal tube’) will be inserted and intravenous antibiotics and steroids injected (to prevent infection and post-operative nausea). Calf compression devices will be used throughout surgery to minimise the risk of developing blood clots in your legs.
Your skin will be cleaned with antiseptic solution and some local anaesthetic will be injected.

The skin incision is about 5-7cm down the back of your neck. It is vertical and in the midline. The muscles at the back of the neck are gently separated from the spinal bones, and the bony roof over the spinal cord is carefully removed using small drills and other fine instruments. Any soft tissue causing compression is also removed.

The spinal cord is decompressed once the bone and other tissues have been removed and discarded. Each nerve root (when appropriate) is identified and carefully decompressed (this is known as a ‘rhizolysis’).

In some cases, instrumentation (rods and screws) will also be used to add stability to the spine. This is known as a lateral mass fusion, and generally does not require bone to be taken from the hip (the bone removed from the back of the spine can be used in this case).

Another X-ray is performed to confirm satisfactory cage, plate and screw positioning, as well as cervical spine alignment.

The wound is closed with sutures and staples. In some cases a wound drain may be used for 24-48 hours post-operatively.

What happens immediately after surgery?

It is usual to feel some pain after surgery, especially at the incision site. Pain medications are usually given to help control the pain.
Most patients are up and moving around within a few hours of surgery. In fact, this is encouraged in order to keep circulation normal and avoid blood clot formation in the legs. You will be able to drink after 4 hours, and should be able to eat a small amount later in the day.

You may have X-rays or a CT scan a day or so after surgery, and can be discharged home when you are comfortable.

What happens after discharge?

You should be ready for discharge from hospital 2-4 days after surgery. Your GP should check your wounds 4 days after discharge. Your staples require removal around 10 days after surgery, and this can be done by your GP or the Precision Neurosurgery Registered Nurse.
You will need to take it easy for 6 weeks, but should walk for at least an hour every day.
Bear in mind that the amount of time it takes to return to normal activities is different for every patient. Discomfort should decrease a little each day. Increases in energy and activity are signs that your post-operative recovery is progressing well. Maintaining a positive attitude, a healthy and well-balanced diet, and ensuring plenty of rest are excellent ways to speed up your recovery.

Signs of infection such as swelling, redness or discharge from the incision, and fever should be brought to the surgeon’s attention immediately.

A firm neck brace (‘Aspen collar’) is sometimes used after surgery (if you have had a fusion). This is generally worn for 6 weeks.

You will be reviewed after 6-8 weeks by your neurosurgeon. Until then, you should not lift objects weighing more than 2-3kg, and should not engage in repetitive neck or arm movements.

You should continue wearing your TED stockings for a couple of weeks after surgery.

Detailed discharge instructions are as follows:

Diet:

Maintain normal healthy diet, high in fibre to avoid constipation

Medications:

You may be prescribed analgesia, muscle relaxants, and stool softeners. Be aware that analgesics tend to cause constipation. Please take only the analgesia that has been prescribed for you.

Activity:

Allowances

• Frequent short walks (at least 1-2 hours per day) or as directed by your neurosurgeon.
• Travelling by car is allowed for short distances. If you are making longer trips, break the trips up into 30-40 minute segments, getting out of the car to go for a short walk.
• Walking up and down stairs.

Restrictions

• No rapid or extreme twisting or rotating of the neck.
• Do not lift anything heavier than 2kg. Light housework only – no hanging washing out on the line, carrying baskets of clothing, no vacuuming, mowing.
• No driving until you cease wearing your collar or are advised to drive by your neurosurgeon.
• No exercising/ playing sports until you are cleared by your surgeon to commence.

Cervical Collar:

You may have a cervical collar prescribed, please use the collar as prescribed by your surgeon. You may remove it for showering at the discretion of the surgeon. Please keep your head centred and do not rotate or move your head up & down while your collar is off.

Smoking:

Smoking impairs wound healing and fusion. Stopping smoking will probably improve outcomes.

Wound Care:

• Have your GP check your wound 4 days post discharge from hospital. A new waterproof dressing will need to be applied. This is to be left on for a further 3-4 days then replaced.
• Staples are removed 10 days post-operatively.
• Keep wound dry for 3 weeks after surgery.
• Shower if the dressing is intact. If the wound becomes moist, it will need to be dried and a new dressing applied.
• When drying your wound, dab it very gently (do not rub!)
• Report any redness, discharge, persistent oozing or clear drainage from the wound to your GP or to Precision Neurosurgery.
• Avoid swimming, spas or baths until your wound has completely healed, or until your neurosurgeon advises that these can be commenced.
• Keep taking your Zinc tablets daily for 3 months after surgery (this helps wound healing.
• You should gently rub Vitamin E cream into your wound commencing 3 weeks after surgery and continuing for 6-12 months (this may reduce scarring).

What do I need to tell my surgeon about after the operation?

You should notify your neurosurgeon and should also see your GP if you experience any of the following after discharge from hospital:

• Increasing arm or leg pain, weakness or numbness
• Worsening neck pain
• Problems with your walking or balance
• Fever
• Swelling, redness, increased temperature or suspected infection of the wound
• Leakage of fluid from the wound
• Pain or swelling in your calf muscles (ie. below your knees)
• Chest pain or shortness of breath
• Any other concerns

What are the results of surgery?

Overall, 80-90% of patients will obtain a significant benefit from surgery, and this is usually maintained in the long term.
Generally, the symptom that improves the most reliably after surgery is arm pain. Neck pain and headaches may or may not improve (very occasionally they can be worse). The next symptom to improve is usually weakness. Your strength may not return completely back to normal, however. Improvement in strength generally occurs over weeks and months. Numbness or pins and needles may or may not improve with surgery, due to the fact that the nerve fibres transmitting sensation are thinner and more vulnerable to pressure (they are more easily permanently damaged than the other nerve fibres). Numbness can take up to 12 months to improve.

What are the costs of surgery?

Private patients undergoing surgery will generally have some out-of-pocket expenses.
A quotation for surgery will be issued, however this is an estimate only. The final amount charged may vary with the eventual procedure undertaken, operative findings, technical issues etc. Patients are advised to consult with their Private Health Insurance provider and Medicare to determine the extent of out-of-pocket expenses.

Separate accounts will be rendered by the anaesthetist and sometimes the assistant, and hospital bed excess charges may apply. Medical expenses may be tax deductible (you should ask your accountant).

You should fully understand the costs involved with surgery before going ahead, and should discuss any queries with your surgeon.

What is the consent process?

You will be asked to sign a consent form before surgery. This form confirms that you understand all of the treatment options, as well as the risks and potential benefits of surgery. If you are unsure, you should ask for further information and only sign the form when you are completely satisfied.

90,000 Risk of complications from cervical spine surgery

A number of complications arise with all surgical procedures. When surgery is performed near the spinal cord and spinal region, the risk of complications can be more important and serious. Cervical spine surgery is an operation that can carry several risks. However, complications from cervical spine surgery are rare but can be serious.

No one wants to have cervical spine surgery, and nearly 80% of neck problems can be resolved with nonsurgical treatment, but in some cases, long-term neck surgery may require pain.

This article is intended to explore in more detail the risks of cervical spine surgery, types of neck surgery, complications associated with neck surgery, and everything you need to know about the cervical spine.

The value of the cervical spine

The neck, also called the cervical spine, is a long flexible column that extends across most of the body. The upper part of the cervical spine is connected to the skull, and the lower part of the cervical spine is connected to the upper back at shoulder level.This area is commonly known as the spine or spine. The cervical spine or neck consists of muscles, nerves, ligaments and tendons of seven folded bones, which are separated by intervertebral discs, thanks to these discs, the spine can move freely.

However, the cervical spine is a small area, but it is one of the most challenging areas and plays several important roles in the human body, such as protecting the spinal cord, supporting head movement, and facilitating blood flow to the brain.

What is Cervical Spine Surgery?

Cervical spine surgery is usually indicated for various types of spinal problems. Neurosurgeons or orthopedic surgeons recommend cervical spine surgery to relieve long-term neck pain, stop unusual head movements, weakness and tingling sensations, numbness, and restore full nerve function.

Surgery is usually performed when the spinal cord or incoming nerves from the spine are under tremendous pressure due to trauma, instability, or degenerative disorders.for degenerative disorders, trauma or instability.

Surgical approaches to the cervical spine

The cervical spine can be approached from the front, called the “anterior approach”, or from the back, called the “posterior approach”. In most cases, when both approaches are possible, surgeons prefer an anterior approach to the cervical spine. The anterior approach has less disruption and it is also easier for surgeons to maintain the normal alliance of the spine.In some cases, only posterior access is required, or even in a few cases, a combination of anterior and posterior access is required.

Types of Neck Surgery

There are several types of neck surgeries, here are some common neck surgeries:

Anterior cervical discectomy and fusion (ACDF)

Anterior Cervical Discectomy and Fusion (ACDF) is a neck surgery that removes a damaged or degenerative disc in the neck.The operation consists of two parts.

First, the ACDF is approached from the front, then the damaged disc is removed from the vertebral bones.

This phase is called anterior cervical discectomy.

Secondly, a fusion operation is performed simultaneously with a discectomy. Fusion surgery involves placing implants or bone grafts where the original disc was in order to strengthen the area and provide stability.

Fusion. This second stage is called merge.

Anterior cervical discectomy and fusion are usually performed with an anterior approach, which means that the operation is performed through the front of the neck. The frontal approach allows surgeons to have a direct view of the cervical disc and they have full access to the entire cervical spine.

This approach has less postoperative pain for patients. Surgeons prefer the frontal approach because it provides an easy path to the spine. Postoperatively, patients experience less incision pain from this approach than from the posterior one.

Anterior cervical spine surgery

Anterior cervical corectomy is a surgical procedure in which the surgeon removes the vertebral bone or intervertebral disc. The vertebral bone is one or more bones in the neck. Surgeons usually recommend this operation when there is compression of the spinal cord behind the vertebral bodies. The surgeon usually removes any bone or disc that compresses the spinal cord to relieve pressure on the spinal nerves or spinal cord.

In addition to anterior cervical discectomy and fusion, the second stage is fusion surgery to stabilize the spine. The surgeon places an implant inside an area, such as the palate or other associated instruments, to stabilize the spine.

As the name of the operation says, the surgical approach is performed from the front of the neck. In some individual cases, surgery on the back of the neck is also required, called posterior fusion of the cervix, this surgery is usually performed during the same hospitalization.

Posterior cervical laminectomy and fusion

Laminectomy means removal of the plate. The lamina is a very thin lamina of bone at the back of the neck that forms the roof of the spine and protects the spinal cord.

The purpose of this operation is to remove the plate to make room for the spinal cord.

Posterior cervical laminectomy procedure includes the following:

Surgical approach;

There will be a skin incision along the midline of the back of the neck and is 3 to 4 inches long.

Removal of the plate;

The high speed burr can be used to create a depression in a plate on both sides just before it joins the facet joint.

The plate, as in the case of spinous processes, is removed as a whole.

Removing the lamina and spinous process allows the spinal cord to slide backward and gives more room.

Complications of cervical spine surgery

No operation is without risk and there is a risk of complications from any operation, but when the operation is performed near the spine and spinal cord, these complications are very serious.

Common complications of most surgeries include infection, bleeding, blood clots, and the risk of anesthesia.

Some patients may require several additional surgeries after spinal surgery. For a list of some of the common complications, see

Anesthetic complications

Nearly all surgical procedures require some form of anesthesia before surgery. The anesthesia is such that the patient does not feel the procedure.The simplest form of anesthesia that is usually done for simple surgery is local anesthesia, and the most complex form is general anesthesia. Under general anesthesia, patients go to sleep completely during surgery. Some medications are given to patients to put them to sleep.

Since spinal surgery is a complex operation, it requires general anesthesia. A very small number of patients have some problem with general anesthesia due to the medications used.

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 is higher after surgery. One reason is that the body is trying to stop the bleeding associated with surgery and the body’s clotting mechanism is overactive during this period of time.Second, trauma to the blood vessels around the surgical area from routine pulling up and pulling up during surgery can cause 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.

Bone graft migration

In rare cases, the bone graft may have moved from the correct position between the vertebral bones very soon after surgery.This is more likely when plates or screws are not used, or if multiple levels of the vertebrae are fused. If this problem occurs, patients require additional surgery

Nerve injury or persistent pain

There is a risk of damage to the nerves or spinal cord with any spinal surgery. Damage to the nerves or spinal cord can lead to numbness or even paralysis. The most common cause of persistent pain is nerve damage from a herniated disc.Some herniated discs can damage the nerve, making it immune to surgery.

Hardware fracture

The metal plates and screws used to stabilize the spine are called “iron”. Hardware can break or even shift until the bones are completely fused. In this case, additional surgery may be required to fix or replace the hardware.

Transition Syndrome

Fusion of the spine causes additional stress and overload on the discs and bones below or above the fusion.The added wear and tear can finally degenerate an adjacent level and cause a lot of pain.

If you have further questions, please contact us.

Monib Heath is always ready to tell you what you want to know.

90,000 Everything you need to know about complications of cervical spine surgery

Complications occur in all types of operations, but vary from type to type. In the case of an injury to the cervical spine, complications arise when the surgery is performed near the spine and there is no guarantee that the patient will recover from the first surgery.

Complications occur in all types of operations, but vary from type to type. In the case of an injury to the cervical spine, complications arise when the surgery is performed near the spine and there is no guarantee that the patient will recover from the first surgery. The likelihood that the patient will undergo surgery after the first surgery is very high. Risks such as paralysis, loss of cup control, inability to feel the legs and walking are also some of the common complications.

Another form of complication is anesthetic complications in which the patient may react to the drug. Most spinal surgeries require the patient to receive general anesthesia to keep them asleep throughout the operation, and with the help of special machines, they can breathe. Lung problems will not arise if the patient is cared for after surgery. Lack of light exercise after surgery can lead to poor oxygen levels in the blood and an infection in the lungs called pneumonia.

Infections occur in almost all operations if the wounds are not properly cleaned and not cared for. If the wound becomes red and swollen, the patient should inform the doctor as soon as possible, as these are symptoms of an infected wound. As the infection in the wound increases, the pain also increases and the wound may ooze with yellow pus. Such infections can be treated with antibiotics as well as removing stitches from the skin. Some patients also have allergic reactions to antibiotics, so if you are one of them, tell your doctor right away.

The most important complication of cervical spine surgery is spinal cord injury. Every time a spine is operated on, there is a great chance that the spine will be seriously injured. As you know, the spine has many nerves that are connected to the brain. During surgery, if any of the nerves are damaged, the person may be paralyzed and the brain will no longer receive information through the nerves from the spine. The spinal cord is the human spine, the injuries caused to it do not heal quickly, and even after the operation, constant pain can occur.If the pain is uncontrollable, you should contact your doctor as soon as possible.

Complications of neck surgery

Neck surgery is often referred to as the last resort after conservative treatment has failed to relieve neck pain. Neck surgery has its own complications, and doctors explain the risks and side effects of neck surgery before recommending that a patient undergo surgery. Complications include bleeding, infections, damage to the nervous system of the spinal cord, leakage of cerebrospinal fluid from the brain, neck pain and stiffness after surgery, and other complications associated with an operation performed in the front or behind.neck. Neck surgery is not always the best solution for treating neck pain. In most cases, this is only recommended when invasive treatments have not been helpful.

Surgery of the cervical spine

Risks The risks associated with spinal surgery must be taken seriously by both the patient and the physician. The patient may develop blood clots after surgery and this may develop in a vein in the patient’s legs. After surgery, the body’s coagulation mechanism is active as it tries to stop the bleeding caused by the surgery.Coagulation occurs around the surgical site. A gap in a dural occurs when the delicate defenses covering the spinal cord and nerves are damaged during a surgical procedure. However, most of Dural’s tears tend to heal without incident. It should be noted that if you have headaches after surgery, tell your doctor about it, as you may need a second surgery to fix the ruptured dura mater. Signs you should be aware of and tell your doctor: redness and swelling in the wound area, increased pain, fever, and odor at the wound site.Types of neck surgery. There are several neck surgeries, which depend on several factors, which include the reason for the patient’s current condition, the doctor’s recommendation, and the patient’s personal preference.

Cervical spine
FusionTwo vertebrae are connected into one by means of a cervical fusion. It is used when part of the neck is unstable or when movement at the end of the affected area causes pain. Metal screws and plates are also used to hold the two vertebrae.Anterior cervical discectomy and fusion-ACDF. This type of surgery is done to treat a pinched nerve or compression of the spinal cord. In this type of surgery, an incision is made in the front of the neck and the disc or bone causing pain in the patient is removed. To stabilize the area, the spinal fusion is performed.
Anterior Cervical Correctomy and ACCF Fusion
This operation is similar to ACDF and is performed to treat spinal cord compression. In the process, as in ACDF, an incision is made in the front of the neck, but the disc is not removed here.A portion of the anterior vertebrae and any bone spurs from the surroundings are removed. The remaining space is filled with small pieces of fusion between the bones and the spine, and this process requires a longer recovery time.

Laminectomy
The operation is responsible for removing the bone region located in the spinal cord called the lamina. The goal is to relieve pressure from the spinal cord and nerves. Here, an incision is made in the back of the neck and then the bony region at the back of the vertebrae is removed.Through the removal process, the laminectomy provides ample space for the spinal cord. Usually, people who have had a laminectomy also have a spinal fusion. Laminectomy surgery has four types, namely, cervical laminectomy, lumbar laminectomy, sacral laminectomy, and thoracic laminectomy. Laminoplasty This surgical procedure has been developed as an alternative to cervical laminectomy. The term “laminoplasty” simply means “create a hinge to lift the plate.”The process of making an incision in the back of the neck is similar to that of a laminectomy. Here the surgeon makes a door hinge instead of removing the plate. They use a hinge to open the lamina and relieve compression of the spinal cord. Metal implants are used to hold the hinges in place. The advantage of this operation is that it allows for a certain range of motion, but if the motion causes neck pain, then this operation is not recommended.

Surgical approaches to the cervical spine.Cervical surgery is an applied anatomy where surgery is not performed regularly and the patient can deteriorate and even paralyze if the doctor chooses the wrong process or makes mistakes during the surgery. There are three types of approaches: Anterior approach: Here, as the name suggests, the spine is accessed from the front of the body and goes straight through the patient’s abdomen. Posterior approach: in this case, an incision is made in the patient’s back. Lateral access: in this method, the spine is accessed from the sides of the patient.But which one has the higher risk? Risky Approaches Among the three, the riskiest approaches are the front approach and the rear approach. As we read above, the anterior approach has two types, ACDF and ACCF, and the incision is made from the front of the neck. In the case of posterior access, the incision is made from the back. A slight error in the direction or depth of the incision can result in serious risks to the patient. Less risky approaches In the lateral approach, the incision is made from the sides, has fewer risks and is safer than the other two approaches.The lateral approach is more often suggested. During any operation, safety is more important, both the surgeon and the patient choose an approach that is less risky than others, and in the case of spinal surgery, the lateral approach is less risky. A detailed and accurate detail was developed about spinal surgery, complications and approaches. We hope this content has provided answers to all your questions and cleared up all your doubts about cervical spine surgery. Surgery is risky; it’s not about where and when, but what type of surgery the patient undergoes.When there are less risky approaches, it is better to take them than risk it all.

Operation on the cervical spine in Moscow in the Dikul clinic: prices, appointment

An orthopedic or neurosurgeon may recommend cervical spine surgery to relieve neck pain, numbness, tingling, and weakness, restore nerve function, and stop or prevent neck instability.

Surgery on the cervical spine may involve the removal of a disc or bone tissue, with the fusion of the vertebrae using a bone graft, either in front or behind the spinal column.A bone graft can be of one of two types: an autograft (from the patient’s own bone) or an allograft (donor bone). Sometimes metal plates and screws are also used to further stabilize the spine. These devices are called toolkits. When the vertebrae are stabilized by surgery, the excess mobility disappears and the function of the nerve roots is restored.

An alternative to fusion of the vertebrae (spinal fusion) is the replacement of the intervertebral disc in the cervical spine with an artificial disc, which allows to restore movement in the neck and stabilize the spine.

Indications for cervical spine surgery

An operation in this part of the spine can be recommended for various problems in the spine. Typically, surgery can be performed to treat degenerative disorders, trauma, or instability. These conditions can cause compression on the spinal cord or on the nerves originating from the spine (nerve roots).

Main diseases and conditions for which surgical treatment can be recommended:

Degenerative diseases

In degenerative disc disease, the distance between the vertebrae is reduced, causing disc wear, which can lead to disc herniation.

Degenerative processes can also develop in the joints of the spine (facet joints) or bone tissues with the development of spondyloarthrosis (spondylosis). Degenerative processes in the spine can lead to compression of nerve structures (spinal stenosis or compression of the root) with the development of symptoms such as pain, numbness, muscle weakness, or dysfunction of the pelvic organs.

Deformation of the cervical spine

For patients with cervical spine deformities such as hyperlordosis, surgery to straighten and stabilize the spine can significantly reduce symptoms and improve quality of life.Congenital deformities, or so-called abnormalities of the cranio-cervical or craniovertebral junction, can affect the cervical spine and be the reason for surgical treatment.

Injuries. Since the cervical spine is very flexible, it is prone to injury. Certain injuries can cause fracture and / or dislocation of the cervical vertebrae. If the neck is severely injured, the spinal cord can also be damaged. Fractured patients, especially those with spinal cord injury, undergo surgery to relieve pressure on the spinal cord and stabilize the spine.

Instability of the motor segments of the cervical spine due to various pathological processes can lead to abnormal mobility of the vertebrae and impact on the nerve structures.

Revision surgery

Revision surgery is often required to correct the deformity. The type of revision depends on the specific pathology. The operation can be with access both from the front and from the back.

The incidence of complications from revision surgery of the cervical spine is higher than with other surgical techniques.After revision surgery, it is also more difficult to relieve pain and restore nerve function. Patients should also be aware that the chance of long-term neck pain is increased with revision surgery.

Surgery of the cervical spine: tasks and methods

If degenerative changes in the cervical spine lead to myelopathy (spinal cord dysfunction), radiculopathy (nerve root dysfunction), neck pain, or abnormal mobility, then surgery may be required.The goal of surgery is to relieve pain and restore spinal stability.

Surgeons use 2 main surgical methods to solve problems in the cervical spine:

• Decompression: Removal of tissue that puts pressure on the nerve structure
• Stabilization: restriction of movement between the vertebrae.

These 2 methods can be used in combination, or the patient can have simple decompression surgery or just stabilization surgery.

Understanding Decompression Surgery

Surgical decompression techniques can be performed with an anterior or posterior approach to the spine, depending on how and where the compression of the nerve tissue occurred.

During decompression, tissues pressing on the root or spinal cord are surgically removed or more space is created so that no effect is exerted on the nerve tissue. The main types of decompression surgical procedures are:

• Foraminotomy: If the material of the intervertebral disc or osteophyte exerts pressure on the root at the exit from the foraminal foramen, a foraminotomy is possible.Foraminotomy is used to enlarge the intervertebral foramen and thus relieve compression.
• Laminotomy: is similar to foraminotomy but involves creating a hole in the plate to create more space for the spinal cord.
• Laminectomy : Ectomy is the medical term for removal. A laminectomy removes part or all of the plate to relieve pressure on the spinal cord.
• Facetectomy: involves removal of the facet joint to relieve pressure on the nerve root extending from the spine.
• Laminoplasty: Plastic means the formation of an anatomical structure to restore form or function. In the case of the cervical spine, laminoplasty is the surgical formation of a lamina in order to create more space for the spinal cord.
• Each of the above decompression methods is performed from the back (back) of the spine.
• Occasionally, however, the surgeon needs to perform decompression from the front of the spine.For example, if an intervertebral disc protrudes into the spinal canal, it sometimes cannot be removed from the back because the spinal cord is obstructing access. In such cases, decompression is usually performed from the anterior approach to the neck.

Forward Decompression Techniques:

• Discectomy: Surgical removal of part or all of a disc with a herniated disc.
• Corpectomy: Sometimes disc material interferes between the vertebral body and the spinal cord and cannot be removed with discectomy alone.In other cases, bone spurs (osteophytes) form between the vertebral body and the spinal cord. In these situations, removal of the entire vertebral body may be required to access the disc. This procedure is called corpectomy (corpus means, and ectomy means removal).
• Transcorporeal Microdecompression (TCMD): TCMD is a minimally invasive procedure that is performed in the cervical spine from an anterior approach. The procedure is performed through a small canal made in the vertebral body to access and decompress the spinal cord and nerve.TCMD can be performed as a stand-alone procedure or in combination with anterior discectomy and fusion (ACDF) and / or complete disc replacement.
• Spine stabilization
• Discectomy and corpectomy usually result in instability in the cervical spine. Instability refers to abnormal mobility of the vertebrae, which increases the likelihood of serious neurological damage. In these situations, it is often necessary to surgically restore the stability of the spine.

Basic Surgical Stabilization Techniques:

• Fusion (fusion) is the fusion of bones, usually with the help of a bone graft or biological substance. Fusion removes excess movement between two vertebrae and provides long-term stabilization. The procedure is somewhat similar to bone consolidation after a fracture.
• In a fusion in the cervical spine, both adjacent vertebral bodies and facet joints or laminae can be connected.
• If fusion is performed posteriorly, the surgeon will usually place strips of bone graft from one plate or side (side) mass onto the plate or side mass below. Usually, a bone graft grows into the tissues of the fixed structures over time and stabilizes two vertebrae. The surgeon can use a similar technique to simultaneously fix the facet joints.
• Instrumentation: Posterior cervical fusions can be supplemented with specially designed retention devices such as braces, screws, rods and plates.These devices increase stability and facilitate fusion.

Decompression and Merging

Sometimes the surgeon performs decompression and fusion. For example, after a discectomy, a space appears between the vertebral bodies. This gap is usually filled with a bone graft (from the patient’s pelvis or donor bone) or a spacer that supports the spine and facilitates fusion. This type of surgery is called anterior cervical discectomy and fusion or ACDF.

Many surgeons use fixation devices (plates with screws) in the anterior surgical approach when performing ACDF or corpectomy. These devices help improve fusion stability.

Artificial discs

Recently, many surgeons have been using new technology when performing operations on the cervical spine. Instead of merging the vertebrae after discectomy, surgeons insert an artificial disc instead of the removed disc.The advantage is that the artificial disc allows the patient to maintain a normal range of neck motion after surgery. When fusion is carried out, the range of motion in the neck becomes limited.

Postoperative recovery

Surgery on the cervical spine is complex and requires careful implementation of a number of measures:

• After surgery, complete regeneration will take several months. In order to restrict neck movement and provide support, a neck brace is often recommended after surgery.Restricting the movement of the neck promotes effective fusion of the vertebrae. It is important that the patient rests.
• Patients are advised to resume slow walking as early as possible after surgery. It is necessary to gradually increase the duration of walking, and if it is difficult for the patient to walk in the first few days after surgery, then it is better to exclude walking. It is necessary to consult your doctor about the beginning of walking. It is advisable to walk for 10-15 minutes a day.
• Lifting heavy loads, straightening, overhead work, and sharp or violent neck bends should be avoided.You can not carry out any action that exerts a load on the muscles of the neck. Driving is also not allowed after surgery. The patient, 3-4 months after the operation, needs to connect exercise therapy classes. But physical exercise is possible only after the bone has been properly fusion.
• The amount of time it takes for bones to heal (fuse) completely varies from patient to patient. It also depends a lot on what method was used for the surgical fusion of the bones.If the surgeon used the patient’s own bone or instruments for surgical fusion, then the bones fuse rather quickly, after about 3-4 months. But, if a donor’s bone graft is used, then it takes a longer time for the fusion of the bones (within 6-9 months). Recovery time will be further increased if the patient is too physically active, does overhead work, and holds the neck at random in any direction. Every day, the patient experiences less discomfort.The time it takes for the patient to return to normal activities will also change. Some may take 3-6 months, while some may take a year to heal completely.
• If a patient notices any signs of infection, swelling, redness, or induration at the site of surgery or incision, it is imperative for him to see a doctor. To treat severe pain after surgery, your doctor may prescribe narcotic pain relievers.Gradually, as the pain decreases, the doctor switches to the usual analgesics. Certain pain relievers and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, naproxen, ibuprofen, and COX-2 inhibitors should be avoided for several months after surgery.
• Follow-up scheduled appointments with the treating surgeon are absolutely essential to assess the recovery process and validate the reliability of the surgical implants or artificial disc.If you have persistent pain, your doctor may order certain diagnostic tests, such as MSCT or MRI, EMG (ENMG). It is also important that the patient takes the medications prescribed by the doctor in a timely manner.
• Smoking is a big enemy on the road to recovery. Smoking should not be resumed after surgery because nicotine interferes or interferes with the bone healing process that is necessary for a successful fusion. Smoking also increases the risk of complications after surgery.
• Diet is another important aspect of recovery.The patient must follow a healthy and nutritious diet for muscle and bone regeneration to occur. It is necessary to include animal proteins in the diet, as they contain all the essential amino acids, while vegetarian sources do not contain some amino acids. A balanced diet helps in healing and recovery.
• Family members and loved ones should provide support to the patient so that he / she can get rid of emotional stress. The patient experiences a lot of stress during the operation and therefore good care and support from family members after the operation will be of immense help in relieving stress.

Risks and complications

No surgery is devoid of certain risks and complications. Since cervical spine surgery is performed using an anterior or posterior cervical approach, it is necessary to know the risks and complications associated with each of these approaches:

Risks of anterior cervical discectomy and fusion (ACDF)

• The most common complication and risk of this surgery is dysphagia, which can easily be explained by difficulty in swallowing.The esophagus, which is just in front of the spine, must be shifted and mobilized during the surgical process to prevent the condition of dysphagia. With the right treatment, dysphagia can go away within a few days or weeks. But the main threat may be that dysphagia, if it develops, may remain permanent.
• Fusion of the bone graft may not take place, with the development of pseudoarthrosis
• Failure to relieve symptoms or eliminate the cause of surgery
• Injury to the spinal cord or nerve root.However, this complication is very rare
• Bleeding may occur occasionally. It can occur if a blood vessel in the neck is damaged
• During surgery may damage the trachea or esophagus
• Possible damage to the vocal cords due to damage to the larynx
• Cerebrospinal fluid leak (liquorrhea)
• The chances of infection are minimal, but cannot be completely ignored
• Hematoma
• Seroma (leaking serum from damaged lymphatic and blood vessels)

Risks during decompression operations with rear access

• Damage to the nerve root and spinal cord
• Recurrent disc herniation
• Dural leak (a condition in which a thin covering of the spinal cord called the dura mater is damaged by a surgeon’s instrument)
• Infection can occur during surgery because the deep inner parts of the body are exposed to air for a long time
• Some blood loss is inevitable as it is a complex surgical procedure and the surgeon must dissect various tissues
• Continuing neck or surgical site pain

Surgery on the cervical spine is recommended by a doctor only if medications and other non-surgical procedures, such as physical therapy, exercise therapy, etc.do not allow to relieve symptoms or restore the stability of the motor segments.

As a rule, modern surgical techniques allow the patient to recover within a few months. Nevertheless, one must understand that any surgical intervention, especially in the cervical spine, is very stressful and does not bring the state of health to the point where the operation can no longer be avoided.

Endoscopic removal of cervical hernia

Endoscopic removal of the cervical spine hernia is a minimally invasive surgical procedure that allows you to completely remove a missing piece of disc material, as well as avoid the installation of implants and interbody cages to stabilize the spinal segment.The operation is performed through a small incision in the skin, which does not exceed 7-8 mm , which excludes visible scars on the skin after surgery and difficult rehabilitation. A spinal neurosurgeon works with modern endoscopic technology in front of a monitor with high video resolution. The image on the screen is magnified many times, a good visual overview makes the endoscopic removal of a cervical hernia the most controlled procedure. Fallen fragments of disc material are removed delicately – without damaging blood vessels, nerve endings, muscle fibers and osteochondral structures.Duration of endoscopic surgery – 30-90 minutes. After surgery, the pain disappears immediately, and after a few hours the patient can sit and walk.

Endoscopic spinal surgery is performed according to the medical indications of a neurosurgeon, since the decision on the appropriateness of this method is made by the doctor after examining the MRI data, the clinical picture of the disease and the history of a particular patient. If you have this pathology, then the question of how best to treat a hernia of the cervical spine can be answered by an experienced neurosurgeon who knows different techniques.Interventional treatment of pain (without surgery), microsurgical or endoscopic methods of treating a hernia of the cervical spine are resorted to if conservative therapy is ineffective. With the sequestration of a hernia and the manifestation of dangerous neurological symptoms (numbness, weakness of the extremities, functional disorders in the work of internal organs), urgent surgical intervention may be required.

Symptoms of a hernia of the cervical spine

An intervertebral hernia is a displacement or prolapse of disc fragments (nucleus pulposus or an element of the surrounding ruptured fibrous ring) into the spinal canal.Compression of the nerve roots and endings causes pain and discomfort.

The causes of intervertebral hernia at the C1-C7 level can be varied: from a genetic predisposition to degenerative diseases of the musculoskeletal system to external injuries and incorrect biomechanical patterns (sharp turns of the head, systematic excessive loads).

Symptoms of a hernia of the cervical spine include:

• sudden sharp neck pain;
• long and severe pain syndrome in the neck, which does not respond to conservative analgesia;
• radicular syndrome (pinched nerve roots), localized mainly in the shoulder girdle;
• spinal stenosis;
• weakness, numbness, paresis (partial paralysis) of the hands;
• muscle atrophy;
• impaired coordination of movement;
• dizziness and headaches;
• cognitive decline, memory impairment.

These symptoms may indicate the presence of a herniated disc. An MRI is needed to refute or confirm the diagnosis. If a hernia is found, but it does not bother much, and the patient has not yet been treated conservatively, you should consult a neurologist. If the pain has become chronic, and the symptoms are unbearable, you should not waste time to consult with a neurosurgeon to determine further treatment tactics.

Feature of removal of a hernia of the cervical spine

Hernias of the cervical spine are less common than lumbar hernias and are more difficult to remove.Firstly, this part of the spine is highly mobile. Second, the aesthetic consequences of surgery are more difficult to hide. Thirdly, the architecture of the cervical spine is permeated with a network of the thinnest nerve plexuses and vessels that feed the spinal cord and brain, and the vertebrae themselves are smaller than in the thoracic or lumbosacral segment. The cost of error or inaccuracy in performing such an operation is great. In this regard, preference is given to endoscopic spinal surgery to remove a hernia.However, such an operation is, unfortunately, not always possible. For example, in the presence of osteophytes in the cervical spine, significant canal stenosis, which are detected by CT (computed tomography) results, there is a risk of destabilization of the spinal segment in the future. Therefore, a microsurgical operation with the installation of an implant or a fixing interbody cage may be more expedient in this case. The choice of one or another method for removing a hernia of the cervical spine is also influenced by the localization of the pathology and the type of surgical access that is possible in this case, as well as the size and specificity of the hernial formation.

How is the operation for endoscopic removal of a cervical hernia performed

The neurosurgeon makes a small (7 mm) incision in the back of the neck. Under X-ray control, a working port is installed into the wound, into which an endoscope with a diameter of 6 mm is inserted, equipped with micro forceps, a micro camera, light and flushing channels. The hernia is removed under detailed visual control. During the intervention, the neurosurgeon gently pushes the adjacent muscles, ligaments and soft tissue fibers without injuring them.To gain access to the spinal canal and decompress the spinal root, a small foraminotomy (enlargement of the intervertebral foramen) is performed. After endoscopic removal of the cervical hernia, that is, cleansing the spinal canal, the pain goes away immediately. The neurosurgeon applies a single suture, which is removed after 10 days. Mobility returns the same day. The period of hospitalization is 1 day, after which the doctor discharges the patient from the clinic home with simple recommendations for recovery.Recovery is comfortable, so within a month the patient can return to work and normal life.

Advantages of endoscopic removal of cervical spine hernia

Why, being in a situation of choice, is it better to do an endoscopic surgery to remove a hernia in the cervical spine?

• No additional fixation cage or implant required.
• The mobility of the operated segment of the spine will be fully preserved.
• The integrity of the intervertebral disc itself is preserved (no need to do a dissectomy).
• The development of the adjacent segment syndrome is excluded.
• There are no risks of damage to nerve endings, blood vessels and muscle fibers.
• High controllability.
• Good cosmetic effect (there are no visible scars, which can be especially important for patients with an individual tendency to keloid and hypertrophic skin scars).

Why is it worth having an operation to remove a hernia of the spine in the Pirogov clinic?

• The Pirogov clinic on Vasilievsky Island (St. Petersburg) has accumulated the largest experience of successful spinal surgeries for hernias, stenoses and other degenerative diseases of the musculoskeletal system.
• The operation is performed by a doctor of the highest category, one of the leading * spinal neurosurgeons of St. Petersburg Amir Muratovich Meredzhi.* (according to the version of the independent site “Napopravku.ru”). View patient reviews.
• The clinic is equipped with the latest endoscopic equipment (Richard Wolf, Karl Storz, Medtronic), X-ray, radio frequency, ultrasound equipment.
• Availability of all narrow-profile specialists and our own laboratory, which allows you to quickly and without queues pass all the necessary examinations and get accurate diagnostic results (if necessary, we will send them to you by e-mail).
• We have service under VHI policies.
• Promotions and special offers (all inclusive) at reduced prices for consultations and treatment.

The need for an urgent spinal surgery can arise at any time, and if the required amount for treatment is not available, we can help with obtaining a loan or an installment plan.

WANT TO ASK A QUESTION ABOUT YOUR CASE? SEND YOUR MRI IMAGES

How to describe your complaints correctly:

1. Describe in detail: the nature and location of pain; the presence and localization of numbness and weakness in the limbs; conditions for the onset or intensification of pain; the presence of morning stiffness in the back; whether there is relief after “pacing”; Does the pain get worse after prolonged sitting or standing? what is more worried about the pain in the back / neck or leg / arm, it is advisable to evaluate both on a 10-point scale; Does the pain get worse after flexion-extension? whether there is relief after rest; whether there is an appearance / increase in weakness / numbness in the legs after walking a certain distance with relief after stopping and bending or sitting down; is there a temperature; whether there is an increase in pain at night, etc.
2. Medical history: duration of the disease, provoking factors, with which you associate the onset of the disease, treatment, dynamics of the state.
3. The presence of other diseases.
4. What’s stopping you the most? what would you like to get rid of? What are your expectations from the operation, if necessary?

Send file

How to send MRI scans correctly

MRI scans (not a doctor’s conclusion, namely, scans) must be on a disk, made on a device with a magnetic field strength of at least 1.5 Tesla.

1. Insert disc into CD-ROM.
2. Copy the folder with pictures in one file ALL to the computer (right mouse button).
3. Give the copied file your last name.
4. Add file to archive (right mouse button).
5. To upload MRI images (DICOM files), use an external cloud storage, for example, Yandex Disk, Dropbox or Google Drive. Paste the link to the file or archive from the cloud storage in the field above.

Your images will be sent to our neurosurgeon Meredzhi Amir Mratovich.

Make an appointment

Neurosurgery – Cost of services

Spinal stenosis: lumbar, cervical spine surgery

Treatment of spinal canal stenosis at MedicaMenta

Stenosis (narrowing) of the spinal canal occurs for various reasons.But it always manifests itself as painful sensations during movement, intermittent claudication, muscle weakness. Treatment is aimed at eliminating the factors that provoked it, improving the patient’s well-being. If conservative therapy is ineffective, surgical intervention is indicated.

Spinal stenosis (treatment, surgery)

WHAT WE ARE READY TO OFFER

Modern methods of treatment

When choosing the method of performing the operation, the doctor takes into account the diameter of the narrowed spinal canal, the force of compression of the nerve roots and spinal cord, as well as the degree of stability of the spine.Preference is given to minimally invasive methods, the use of which can significantly shorten the rehabilitation period … which operations we perform

Individual approach

Send us today your extracts from the medical history, MRI scans, describe your complaints and symptoms and get a remote consultation from a neurosurgeon on your disease! The doctor will study the documents and recommend the most suitable treatment specifically for you … send documents

Several types of operations can be performed to eliminate stenosis of the spinal canal:

Stenosis of the lumbar spine

In the presence of a narrowing of the canal in the lumbar spine, patients are worried about pain, lameness, increasing difficulty in movement, loss of sensitivity, muscle weakening or decreased reflexes.Surgery is often the only way to relieve pain and restore an active lifestyle. You should not be afraid of the operation! Thanks to microsurgery and high-precision endoscopic techniques, interventions on the spine have become significantly more effective and safe. Pain and weakness in the limbs disappear immediately after the operation! After minimally invasive endoscopy, you can walk on the first day.

1. Decompression and stabilization

   The essence of decompression is to remove herniated intervertebral discs or vertebral arches that compress neural structures.After decompression, the spine is stabilized. This helps to fix the vertebrae in the desired position and prevent their displacement in the future, as well as to avoid secondary stenosis and instability in the spinal motion segments.

   Main advantages of the method:

   • Minimally invasive approach
   • Minor muscle injury
   • Early activation
   • Minimal severity of postoperative pain

2. Dynamic stabilization

   Implantation of various modifications of prostheses that fix a specific area of ​​the spine without completely blocking its functional mobility.Movable implants control the movement amplitude in the stabilized region within the physiological norm.

   Main advantages of the method:

   • Minimally invasive and minimally invasive installation procedure
   • The balance of the spine is restored
   • Short hospital stay
   • Minimal severity of postoperative pain

Stenosis of the cervical spine

Stenosis of the spinal canal at the cervical level is the cause of cervical myelopathy, which causes pain in the shoulder and arm, tingling or numbness in the arms and legs, problems with walking, muscle weakness and dizziness.

1. Decompression and stabilization

   Both methods can be used in combination, or the patient can only undergo decompression or stabilization surgery. Cervical surgery can be performed through an anterior or posterior approach.

   Main advantages of the method:

   • Minimally invasive approach
   • Maintaining mobility in the cervical spine
   • Short hospital stay
   • Improved performance and overall quality of life

2. Laminoplasty

   Plastic means the formation of an anatomical structure to restore form or function.In the case of the cervical spine, laminoplasty is the surgical formation of a lamina in order to create more space for the spinal cord.

   Main advantages of the method:

   • Minimally invasive approach
   • No risk of damage to the carotid artery, esophagus and trachea
   • Short hospital stay
   • High volume spinal cord decompression

Stenosis of the thoracic spine

This localization is the rarest among all stenoses, occurs in 10% of cases.Most often it can be found in elderly people over 55-60 years old. Clinically, it is not as pronounced as compared to other localizations due to the reduced mobility of this department.

1. Decompression and stabilization

   The main goal of surgery on the thoracic spine (as well as on the lumbar or cervical) is to decompress the spinal cord and stabilize the spinal motion segment. This can be done from the posterior approach or through the chest.

   Main advantages of the method:

   • Minimally invasive approach
   • Minor muscle injury
   • Minor blood loss
   • Minimal severity of postoperative pain

Hernia of the cervical spine, types, treatment, operation, cost

24 September 2019 31098

Intervertebral hernia of the cervical spine can not only significantly reduce the quality of life and deliver severe pain, but also provoke serious and sometimes dangerous complications.Therefore, it is very important, when detecting such, to closely monitor their progression, apply conservative methods of treatment and, if indications arise, immediately remove them surgically.

Peculiarities of surgical methods for treating hernias of the cervical spine

It should be borne in mind that the operation to remove a cervical hernia of the spine is much more difficult than the one on the lumbar spine. Therefore, it should be trusted only by highly qualified surgeons with extensive practical experience, who are not by hearsay familiar with modern minimally invasive surgical methods.

These are the vertebrologists of the SL Clinic. Our specialists have years of practice behind them, deep knowledge in the field of spinal surgery and high rates of successful removal of intervertebral hernias. They are able to carry out any operation, and the latest equipment allows them to perform even the most complex technical procedures. We give every patient a chance for recovery.

In most cases, operations on the cervical spine require general anesthesia, even if similar procedures on the lumbar spine are performed under spinal anesthesia.For safety reasons, as a rule, anterior or anterolateral access type is chosen. But modern minimally invasive methods can effectively remove a hernial formation and at the same time do not involve the risk of large scars.

Indications for removal of a hernia of the cervical spine

Patients who are diagnosed with a hernial formation in the initial stages are shown complex conservative treatment, including taking individually selected medicines, physiotherapy, exercise therapy.Surgery to remove a hernia of the cervical spine is an extreme measure necessary for the complete ineffectiveness of conservative therapy, carried out for at least 1.5 months, and the progression of the disease, which is accompanied by:

• severe pain in the neck, aggravated by any movements;
• numbness or tingling in the hands;
• frequent, prolonged headaches;
• hearing and vision impairment;
• violation of the motor ability of the upper limbs.

Sometimes, when there is a serious risk to health, surgery cannot be postponed. It is performed on an emergency basis with sequestered hernias, compression by the formation of large blood vessels supplying blood to the brain, or severe compression of the nerves and spinal cord, which is fraught with disruption of their trophism and paralysis.

In such situations, based on the results of diagnostic procedures, the spinal surgeon, vertebrologist recommends one or another type of surgical intervention.Each of them has its own advantages and disadvantages, as well as well-defined indications and contraindications.

Microsurgical techniques

The latest medical achievement is the removal of a hernia in the cervical spine with subsequent prosthetics of the intervertebral disc. This means the elimination of pathological protrusion through a small cross section 1.5-2 cm long.

All manipulations are carried out under X-ray control using modern image intensifier devices.A special expander is inserted through a small incision through which the operation is performed

• The surgeon pushes the paravertebral tissue and exposes the vertebral bodies with a disc in which there is a hernia.
• A Caspar expander is inserted, the disc with a hernia is carefully removed, the endplates of the adjacent vertebrae are exposed and cleaned.
• A prosthetic disc is placed over the endplates within the vertebral bodies.
• An X-ray control is performed and the operation ends.
• Duration approx. 50 minutes. After 12 hours, you can get up, walk, sit.

Today, microsurgical operations on the neck can be performed with an anterior or posterior approach.

Anterior approach:

• is used for anterior compression of the spinal cord and roots, the most common approach, which allows you to completely solve the problem of herniated discs in the neck;
• low-trauma surgery quickly removes pain and restores damaged nerve structures;
• Short rehabilitation with the opportunity to return to work after 14 days;
• Recovery of damaged nerve endings occurs immediately after surgery.In some cases, when paralysis has already come from a hernia in the cervical spine, it takes time after the operation, which can be from a month to six.

Posterior approach:

• It is used for posterior compression or stenosis of the spinal canal.
• A low-traumatic incision through which osteophytes and ligaments pressing on the spinal cord or roots are removed
• Used for cervical myelopathy

Danger level when removing a hernia of the cervical spine

The main advantage of all the above approaches is the almost complete absence of the risk of complications.The probability of their occurrence is less than 1%. These are the most gentle methods of hernia removal known today. But the anterior or posterior approach is not shown to everyone. The indications for such operations are very strict. Moreover, their cost is higher than other surgical interventions, since it is necessary to install a disc prosthesis.

Removal of a disc herniation is indicated for sizes from 5-6 mm, severe pain syndrome, neurological complications and almost complete absence of other diseases or disorders of the spine and spinal cord.The operation gives more than 98% of the successful elimination of discomfort and allows you not to stay in the clinic for a long time. At the same time, most patients notice an instant improvement in their condition.

The most popular, safe and effective method is the installation of a disc prosthesis. The prosthesis can be static such as a cage or a dynamic prosthesis. The difference between them is small, but since there are no ideally similar diseases and conditions, the spinal surgeon will choose the most suitable option based on MRI, diagnosis, tests, age and other woman’s indicators.

Disc prosthetics

Parapharyngeal microsurgical access allows you to safely approach a herniated disc without muscle incisions. Pirogov’s triangle is a place that allows you to safely remove the protrusion of the disc and not harm the surrounding tissues. The tissues are very gently divorced with special tools, the vessels of the muscle and ligaments are pushed back. The prevertebral tissue is displaced to the side and the intervertebral disc is exposed, which is removed.

There are special models of prostheses that the vertebrologist selects during the operation, setting different sizes of the model between the bodies, after removing the disc.When the model is matched to its size, an artificial disc is installed. In this way, the anatomy of the spine is restored and the body does not feel that the disc has been removed. The dimensions of the prosthesis are the same and there is no load on the adjacent segments of the spine.

A separate instrument is used to insert the prosthesis. A Caspar distractor is installed, which pushes the vertebral bodies to the sides, and at this moment the prosthesis is easily inserted into the interbody space. Other advantages of the method are:

• Restoration of the integrity of the intervertebral disc;
• low risk of postoperative complications;
• short rehabilitation period;
• no pronounced postoperative pain.

The operation is used in the formation of a hernia on the side or in the middle of the disc. It is not contraindicated in the inflammatory process in the spinal canal, but it cannot be performed in case of its stenosis. In the latter case, the solution to the problem is possible only through posterior access or a combination of posterior and anterior access.

Prices for surgery for a herniated disc of the cervical spine

The cost of removing a herniated disc of the cervical spine is from 270,000 rubles and depends on:
– a method of removing a herniated disc (back or front)
– Firms of the manufacturer of implants.
– Clinics (where the operation will be performed) and ward class.
– Analyzes before the operation (if the examinations take place with us)
The price includes:
– Arrival at the clinic before and after the operation;
– Implants
– Operation;
– Anesthesia;
– Postoperative observation.