Usually pain in the neck arises from diseases of the cervical spine, typically presented as restricted, painful movement and stiffness in neck. With nerve root getting compressed, the pain may radiate to shoulder and in severe cases, pain and numbness can also occur.
Etiology of Cervcal (Neck) Pain:
- Trauma to the cervical spine (fracture or automobile accidents) can happen at any age.
- For many old patients, degenerative disc disease is very common and it can happen due to the slow deterioration of the spine over time.
- Also, due to other factors, over time the elasticity wears and the disc begins to lose shape and elasticity. When this happens, a bulging disc, herniated disc or protruding disc can occur.
Cervical spine surgery is usually recommended for persisting symptoms like neck pain, numbness, tingling and weakness, and or to restore nerve function, even after taking non-surgical treatments, such as physical therapy and other standard of care.
Types of Cervical Spine Surgeries
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. The surgeon makes a small incision either in the front (anterior discectomy) or back (posterior discectomy) of the neck under anesthesia, depending upon where the disc is located. A similar technique, microdiscectomy, removes the disc through a smaller incision using a microscope or other magnifying device.
The other procedures focus is on to close the space that is left after the disc is removed and to restore the spine to its original height as listed below:
- Artificial cervical disc replacement
- Cervical fusion
An artificial cervical disc replacement ensures a similar artificial disc is inserted between the two vertebrae in the neck to replace the damaged disc, to preserve motion at the disc space. The advantage of the procedure is that people are often able to return to work more quickly. However, the surgery to replace the disc does take longer and can lead to more blood loss and it is also not known how long it will last over a long time period. People who get an artificial disc can always do cervical fusion later. But if a patient has cervical fusion first, it is not possible to do an artificial disc replacement later in the same spot.
In the cervical fusion surgery, the damaged disc is removed and a bone graft (either taken from a cadaver or patient’s hip) is used to make a bridge between adjacent vertebrae. A metal plate may be used to secure the vertebrae above and below the graft to hold the bone in place during heling and to fuses with the vertebrae. Discectomy with cervical fusion can often help to relieve the neck pain, although albeit may result in loss of some degree of movement in their neck.
Laminectomy. The laminae are bony plates on the posterior side of the vertebrae which covers and protects the spinal cord. In this procedure, the laminae are removed to reduce pressure on the spinal cord and nerves. Sometimes, sections of herniated disk and bone spurs may also be removed through the new opening in the vertebrae. This procedure relieves pressure on the nerve roots or spinal cord, and thus relieves the neck pain.
Laminoplasty. In this surgical procedure, the doctor restructures the vertebral laminae to enlarge the spinal canal, by making an incision from the back of the neck. This creates more space for the spinal cord and nerve roots by reliving pressure on the spinal cord.
Risks of Cervical Disc Surgeries
Although cervical disc surgery is generally safe, it does have a few risks, including:
- Infection, example of a bone graft or the area around the spine
- Excessive bleeding, due to damage to one of the large arteries and veins that go through the neck into the brain
- Reaction to anesthesia
- Chronic neck pain
- Damage to the nerves, spinal cord, oesophagus, or vocal cords
- Failure to heal
- Displacement of the bone graft before fusion can occur
- Failure of two vertebrae to fuse together
Recovering From Cervical Disc Surgery
- Patients are 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. The pain in the area operated on eases over time.
- Patients may need to wear a neck brace or other protective equipment to support the neck and keep it still during healing
- The fusion can take anywhere from few months to a year to fuse after surgery. The doctor might recommend wearing a cervical collar to support the neck for the first four to six weeks. Healing is fast with a healthy diet, regular exercise, and good posture.
How is Revision Surgery different?
- Revision surgery often requires correcting a deformity. This depends on the type of problem.
- The incidence of complications from cervical spine revision surgery is higher than the first-time procedures. Patients should also be aware that the chance of having long-term neck pain increases with revision surgery.