- Neck pain and and Cervical Spondylosis
- What is cervical spine surgery?
- Who needs to undergo cervical spine surgery?
- How do I prepare for cervical spine surgery?
- What happens during the procedure?
- What are the possible risks and complications of cervical spine surgery?
- How successful is cervical spine surgery?
- How do I recover from cervical spine surgery?
- How can I prevent conditions which cause neck pain?
Neck pain or discomfort is a condition which plagues many people. Pain can be anywhere from the base of the head leading up to your shoulder. It can be in the form persistent pain or pain only on movement such as when turning your head from side to side. It can lead to immense discomfort and frustration to individuals because simple actions become painful.
The causes of neck pain are vast, because it can arise as a result of abnormalities in one of any structure which is present in the neck, including the muscles, the vertebrae, the intervertebral discs or the nerves. The commonest cause of neck pain is degenerative disc disease also called cervical spondylosis. Other causes include, muscles spasms or strains, intervertebral disc herniation, leading to canal stenosis and nerve compression. Trauma is another major cause of neck pain.
Cervical spine surgeries are surgical procedures which are performed in the region of the cervical spine in order to prevent catastrophic damage to the spinal cord which can have adverse consequences. It is usually carried out in order to relieve spinal cord or nerve compression/impingement, which is done through decompression surgery, and to correct spinal instability, which is done through spinal fusion surgery.
The commonest reasons why surgery is performed in the region of the cervical spine include:
- When there is canal stenosis, where the vertebra canal which houses the spinal cord becomes narrowed and causes compression the spinal cord and the spinal nerves
- Herniation of an intervertebral disc, where the disc has been displaced into the vertebral canal again causing narrowing of the canal and impingement on the spinal nerves
- Injuries to the vertebrae making up the cervical spine either because of trauma and weakening of the bones due to infection or invasion by tumors, which lead to vertebral fractures
The different surgical procedures can either be used alone or in combination, and the latter is most frequently done because decompression may lead to spinal instability. Fusion surgeries are often combined with instrumentation such as placement of plates to reconstruct the spine.
The biggest concern that most people have is, if the option of cervical spine surgery is the best option for them. And it’s true that two people who are suffering the same condition will have two different treatment options given to them. And this is because one person was a candidate for cervical spine surgery while the other was not. The factors which make you a good candidate for surgery include:
- If the pain and disability is extensive (for example if the patient is experiencing numbness in the hands)
- If you have spinal deformities such as scoliosis or swan neck deformity
- If you have a spinal tumor
- If non-surgical methods of treatment have been unsuccessful
- If the problem lies in only one or two spinal levels
- If one is physically healthy and active
Under the above mentioned circumstances the outcomes of cervical spine surgery will be favorable. This is the reason you need to discuss all the possibilities with your doctor at length. Because he/she will be able to explain the procedure to you, reason out why surgery is a good option and help you understand the benefits of opting for surgery. This type of procedure has to have a multidisciplinary approach, and the team includes the neurosurgeon/orthopedic surgeon, who will be performing the surgery, assisted by radiologist, anesthetist and nurses.
Preparing yourself for cervical spine surgery can be daunting, and there are a few preliminaries which you need to get done before you are ready for surgery. These include:
- Discuss all the medication you are taking with your doctor, for pre-existing conditions such as hypertension and diabetes.
- Stop smoking if you do
- Cardiology check up and fitness.
- Follow the instructions given by your doctor, such as fasting for a period of 8 hours before the surgery, taking any premedication, undergoing any investigations to assess your level of fitness for surgery as well as avoiding any medication prior to surgery.
Once these aspects have been taken care of, you are ready for surgery.
Most patients are concerned about the exact way in which the surgery will be performed on them.
- In the case of spinal fusion surgery your doctor can have either an anterior approach or posterior approach, and once they reach the cervical spine, they will remove the damaged bone, and replace them with plates, screws or even bone graft, to provide more stability.
- In the case of a decompression surgery you can have three approaches, which are:
- Corpectomy - removal of the body of a vertebra and the discs
- Laminectomy - removal of a small part of the bony arches of the spinal canal called the lamina
- Laminoplasty — To open up the canal after cutting the lamina on one or both sides and fixing them apart with miniplates.
- Minimally Invasive Spine Surgery (MISS), is a procedure which is becoming increasingly popular to treat conditions like canal stenosis, degenerative disc disease and intervertebral disc herniation, because it is a less invasive procedure compared to open spine surgery and therefore causes less tissue damage. It can be done via anterior or by posterior approach depending upon the site of disease.
As with any major surgery cervical spine surgery also has its potential risks and complications, which include:
- Damage to nerves, such as recurrent laryngeal nerve which can lead to hoarseness of voice
- Damage to the esophagus leading to difficulty in swallowing
- Damage to the carotid arteries
- Formation of blood clots at the surgical site
- Infection at the surgical site
If the condition is not too complicated, then cervical spine surgery has excellent prognosis, and many people have benefitted from it. On the other hand there could be potential failures of surgery where there is failure to improve and instrument failure/breakage. MRI Cervical Spine and Xray Cervical spine (before surgery) are done to ascess the success of surgery. Sometimes once the surgeon opens you up he/she may decide that your condition cannot be surgically treated and decide not to go ahead with the planned procedure.
The recovery from cervical spine surgery depends on individual factors. Usually you will have a hospital stay of about 5-7 days, during which you will be introduced to a physical therapist, who will help you with mobility. Usually your doctor will ask you to walk unassisted the very next day following surgery although you will be asked to take things easy for about 4-6 weeks following surgery. Follow-up investigations such as X-rays and other imaging studies will be done in order to determine the success of surgery.
Spine health is an important aspect of our wellbeing, because it is our spine which is bearing the entire weight of out body. Ways by which you can prevent the development of conditions which can lead to cervical spine surgery include:
- Exercising and stretching your neck
- Carrying weights evenly
- Sleeping on your back
- Making sure your computer/book/phone/tablet is always at eye level
- Maintaining supportive posture