ANTERIOR CERVICAL DISCECTOMY

Anterior cervical discectomy is an operative procedure to relieve pressure or compression on the nerve roots and/or the spinal cord because of a herniated disc (damaged disc) or a bone spur.

Pain in the neck and extremities is a common symptom of intervertebral disc damage or herniation. During herniation, the tough, outer ring (annulus fibrosus) of the intervertebral disc breaks due to which the soft jelly-like center (nucleus pulposus) bulges out and puts pressure on the neural structures, such as nerve roots and/or the spinal cord. Bone spurs or osteophytes, bony outgrowths, which occur due to the accumulation of calcium in spine joints, may also contribute to these problems.

Discectomy refers to the removal of total or a part of an intervertebral disc. This anterior cervical discectomy involves making an incision in the front side of the neck (anterior cervical spine), followed by the removal of disc material and/or a part of the bone around the nerve roots and/or spinal cord to relieve the pressure on neural structures and provide them with additional space.

  • Indications

Compression or pressure on the neural structures- nerve roots or spinal cord- due to herniated disc or bone spur may irritate the neural structures and cause pain in the neck and/or arms, numbness or weakness in the arms, forearms or fingers, and lack of coordination. As most of the nerves of the body pass through the neck region from the brain, pressure on the spinal cord in the neck region (cervical spine) can be problematic. Patients with these symptoms are potential candidates for this surgical procedure.

  • The Procedure

An overview of what happens during anterior cervical discectomy is as follows:

  • Incision

The surgical procedure will be performed with you lying flat on a table on your back. A minor incision is made at the front of your neck to the side.

  • Exposure

Your surgeon exposes the region of compression (pressure zone) by spreading apart the soft tissues- fat and muscle, in the neck region.

  • Removal

The disc material or a portion of the bone compressing the nerve roots and/or spinal cord will be removed, to relieve the pressure on nerve structures and provide them enough space.

  • Closure

After the removal, your surgeon closes and dresses the incision.

  • Recovery

A specific post-operative recovery/exercise plan will be given by your physician to help you return to normal activity at the earliest. The duration of hospital stay depends on this treatment plan. You will be able to wake up and walk by the end of the first day after the surgery.

  • Risks and Complications

All surgeries carry risk and it is important to understand the risks of the procedure to make an informed decision to go ahead with the surgery. In addition to the anesthetic complications, spinal surgery is associated with some potential risks such as infection, blood loss, blood clots, nerve damage, and bowel and bladder problems.

Talk to your surgeon about any concerns you have about Anterior Cervical Discectomy surgery. 

 

 

ANTERIOR CERVICAL DISCECTOMY WITH FUSION (ACDF)

Anterior cervical discectomy with fusion is an operative procedure to relieve compression or pressure on nerve roots and/or the spinal cord due to a herniated disc or bone spur in the neck.

In anterior cervical discectomy with fusion, the surgeon approaches the cervical spine through a small incision in the front of the neck and removes the total disc or a part of the disc along with any bony material that is compressing or putting pressure on the nerves and producing pain. Spinal fusion implies placing a bone graft between the two affected vertebral bodies encouraging the bone growth between the vertebrae. The bone graft acts as a medium for binding the two vertebral bones, and grows as a single vertebra that stabilizes the spine. It also helps to maintain the normal disc height.

  • Indications

Herniated disc is a condition in which the soft, gel-like center of the disc (nucleus pulposus) bulges out through the damaged or broken disc’s tough, outer ring (annulus fibrosus). Besides, bony out growths also known as bone spurs or bone osteophytes are formed due to the accumulation of calcium in the spine joints. The pressure induced by a herniated disc or bone spur on nerve roots, ligaments or the spinal cord may cause pain in the neck and/or arms, numbness or weakness in the arms, forearms or fingers, and lack of coordination.

As most nerves to the body (e.g., arms, chest, abdomen, and legs) pass through the neck region from the brain, pressure on the spinal cord in the neck region (cervical spine) can be very problematic. Patients with these symptoms are potential candidates for anterior cervical discectomy procedure but only after non-surgical treatment methods fail. Cervical discectomy can reduce the pressure on the nerve roots and provides pain relief.

Before recommending surgery, your surgeon considers several factors such as your health condition, age, lifestyle and anticipated level of activity following surgery. A thorough discussion with your surgeon regarding this treatment option is advised before scheduling the surgery.

  • Procedure

Your surgeon makes a small incision in the front side of the neck and locates the source of neural compression (pressure zone). Then, the intervertebral disc that is compressing the nerve root will be removed. Afterwards, a bone graft will be placed between the two vertebral bodies. In certain instances, metal plates or pins may be used for providing enough support and stability, and to ease the fusion of the vertebrae.

  • Recovery

A specific post-operative recovery/exercise plan will be given by your physician to help you return to normal activity at the earliest possible. The duration of hospital stay depends on this treatment plan. You will be able to wake up and walk by the end of the first day after the surgery. You would be able to resume your work within 3-6 weeks, depending on your body’s healing status and the type of work/activity that you plan to resume. Discuss with your spinal surgeon and follow the instructions for optimized healing and appropriate recovery after the procedure.

  • Risks and Complications

Treatment results are different for each patient. In addition to the anesthetic complications, spinal surgery is associated with some potential risks such as infection, blood loss, blood clots, nerve damage, and bowel and bladder problems. Failure to fuse the vertebral bones with the bone graft (fusion failure) is an important complication of spinal fusion which requires an additional surgery.

Please take your physician’s advice for a complete list of indications, clinical results, adverse effects, warnings and precautions, and other relevant medical information about the anterior cervical discectomy with fusion surgery.

 

 

CERVICAL CORPECTOMY

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An anterior cervical corpectomy and fusion is an operative procedure to relieve pressure on the spinal cord and spinal nerves by removing the damaged vertebral bone and/or intervertebral disc material (decompression) at the cervical spine, or neck.

Anterior cervical corpectomy involves removing the vertebral bone or disc material by approaching the cervical spine from the front side (anterior position) of the neck. Spinal fusion implies placing a bone graft between the two affected vertebral bodies, encouraging bone growth between the vertebrae. Spinal fusion helps in achieving adequate decompression of the neural structures. The bone graft acts as a medium for binding the two vertebral bones, and grows as a single vertebra which stabilizes the spine. It also helps to maintain the normal disc height.

  • Indications

Degenerative spinal conditions like herniated discs and bone spurs results in spinal nerve compression. In addition, spinal fractures, infection or tumors may also put pressure on the spinal nerve structures. Nerve compression in the neck region (cervical spine) can cause neck pain and/or pain, weakness or numbness that radiates down to the arms. Your surgeon recommends you for anterior cervical corpectomy and fusion surgery after examining your spine, medical history, and imaging results of cervical vertebrae such as X-ray, CT (computed tomography) scan or MRI (magnetic resonance imaging). Surgery is recommended only after non-surgical treatment approaches fail. Before recommending surgery, your surgeon considers several factors such as your health condition, age, lifestyle and anticipated level of activity following surgery. A thorough discussion with your surgeon regarding this treatment option is advised before scheduling the surgery.

  • Procedure

Your surgeon makes a small incision at the front of your neck to the side and locates the source of neural compression. Then, the vertebral body or intervertebral disc that is compressing the nerve root will be removed to relieve the compression. Afterwards, a bone graft will be placed at the site of decompression. In addition, instruments such as plates and screws are used to provide additional support and stability and to ease healing and fusion of the vertebrae.

  • Recovery

A specific post-operative recovery/exercise plan will be given by your physician to help you return to normal activity at the earliest.  After surgery, your symptoms may improve immediately or gradually over the course of time. The duration of hospital stay depends on this treatment plan. You will be able to wake up and walk by the end of the first day after the surgery. You should be able to resume your work within 3-6 weeks, depending on your body’s healing status and the type of work/activity that you plan to resume. Discuss with your spinal surgeon and follow their instructions for optimized healing and appropriate recovery after the procedure.

  • Risks and Complications

All surgeries carry risk and it is important to understand the risks of the procedure to make an informed decision to go ahead with the surgery. In addition to the anesthetic complications, spinal surgery is associated with some potential risks such as infection, blood loss, blood clots, nerve damage, and bowel and bladder problems. Failure to fuse the vertebral bones with the bone graft (fusion failure) is an important complication of spinal fusion which requires an additional surgery.

Please take your physician’s advice for a complete list of indications, clinical results, adverse effects, warnings and precautions, and other relevant medical information about the anterior cervical discectomy with fusion surgery.

 

 

CERVICAL DISC REPLACEMENT

The cervical spine is in the neck region and consists of seven bones arranged one on top of the other. Cushioning tissue called vertebral discs located between the vertebrae act as shock absorbers, allowing easy movement of the neck. Wear and tear and advancing age can damage these discs, leading to pain and disability. Artificial cervical disc replacement surgery is a procedure where the damaged intervertebral disc is removed and replaced with an artificial implant. The surgery relieves neck pain as well as restores the normal range of motion of the neck.

Cervical disc replacement surgery is an alternative to the traditional cervical spine fusion surgery, which involves the permanent fusion of two vertebral bodies, eliminating movement between them. Artificial cervical disc replacement is usually indicated when conservative treatments do not help relieve the following:

  • Neck stiffness and pain

  • Pain, weakness or numbness of the arms and legs

  • Difficulty walking

  • Headache

Artificial cervical disc replacement is contraindicated in the presence of rheumatoid arthritis, pregnancy, morbid obesity, significant osteoporosis or an active malignancy, insulin-dependent diabetes and allergies to stainless steel.

The procedure is performed under general anesthesia and is guided with the help of X-ray imaging (fluoroscopy). You will lie face up on the operating table. Your surgeon approaches the cervical spine from the front or side of your neck through a small incision. The important structures in your neck are gently moved to the side to access the cervical spine. The damaged disc along with any loose disc fragments or bone spurs are identified and removed. The artificial disc device is sized and placed in the prepared disc space, restoring its normal height and relieving any pressure over the spinal nerves. The incisions are closed and covered with a dressing.

Following surgery, your neck may be immobilized in a collar. You will need to keep the incision area clean and dry. Refrain from hot tubs, swimming, heavy lifting, driving and smoking. You can initiate physical therapy as directed by your surgeon. Take medications as recommended by your doctor. Arrange for a follow-up appointment with your doctor. You may be able to resume light activities in a week or two, and complete normal activities in six weeks.

The potential risks associated with artificial disc replacement surgery may include infection, bleeding, nerve injury, difficulty breathing or swallowing, change in your voice, leakage of spinal fluid, or a break or loosening of the prosthesis, requiring further surgery. Call your doctor if the incision site shows signs of infection such as pain, redness, swelling, or alteration in the quantity of smell of the drainage, or if you develop fever over 101° F.

The advantages of artificial cervical disc replacement include:

  • Maintains normal neck movement

  • Lowers the risk of degeneration of adjacent segments

  • Does not require bone graft

  • Allows early neck motion after surgery

  • Faster return to daily activities

 

 

CERVICAL FORAMINOTOMY

Cervical foraminotomy is an operative procedure to relieve the symptoms of pinched or compressed spinal nerve by enlarging the neural foramen, an opening for the nerve roots to exit from the spine and travel throughout the body. The neural foramen forms a protective passageway for nerves that transmit signals among the spinal cord and the rest of the body parts.

Cervical foraminotomy can also be done through a minimal invasive approach. It does not require cutting and stripping the muscles from the spine region, unlike the conventional open spine surgery which requires spine muscles to be cut or stripped.

  • Indications

Conditions such as herniated discs, bone spurs, and thickened ligaments or joints can narrow the neural foramen and pinch the spinal nerves. A pinched or compressed nerve in the neck region can cause neck pain, stiffness and/or pain, tingling sensation, numbness or weakness that radiates down to the arm and hand. Patients with these symptoms who fail to show improvement with non-surgical therapy require cervical foraminotomy procedure.

  • Procedure

The procedure is done with the patient resting on his/her stomach.

  • Decompression

Your surgeon makes a small incision on the symptomatic side of your neck and approaches the spine by bringing the neck muscles apart using a retractor. Then, the bone or disc material and/or the thickened ligaments are removed, relieving the pressure on spinal nerve structures creating decompression. Afterwards, the neck muscles are brought back by removing the retractor.

  • Closure

After the procedure, your surgeon closes the incision using sutures which might develop into a small scar.

  • After the Procedure

Since the procedure is minimally invasive, most of the patients can be discharged on the day of surgery itself, but some patients may need a longer hospital stay. After surgery, the pain symptoms may improve immediately or gradually over the course of time. Compliance with your surgeon’s post-operative instructions may give better results. You will be able to resume your daily activities within a few weeks.

Your physician recommends surgery based on your condition and symptoms. Before scheduling the surgery, discuss the benefits, risks and complications of the surgical procedure with your surgeon.

 

 

CERVICAL LAMINECTOMY

A cervical laminectomy is an operative procedure of removing the bone at the neck (cervical spine) region to relieve pressure on the spinal nerves. It can also be performed to relieve the symptoms of narrowed spinal canal known as spinal stenosis.

Laminectomy refers to removal or cutting of the lamina (roof) of the vertebral bones to provide space for the nerves to exit from the spine.

  • Indications

Degeneration of the facet joints and intervertebral discs results in narrowing of the spinal canal known as spinal stenosis. In addition, the arthritic facet joints become bulkier and consume the space available for the nerve roots. Besides, bony out growths also known as bone spurs or bone osteophytes can also narrow the spinal canal. This condition of spinal stenosis, narrowing of the spinal canal, puts pressure on the spinal nerves and spinal cord, causing symptoms such as neck pain, tingling sensation, numbness or weakness that extends to the shoulders, arms and/or hands, and bowel or bladder impairment.

The objective of cervical laminectomy is to relieve pressure on the spinal nerves by removing the part of the lamina that is putting pressure on the nerves. Your surgeon recommends you for cervical laminectomy after examining your spine, medical history, and imaging results of cervical vertebrae from X-ray, CT (computed tomography) scan or MRI (magnetic resonance imaging). Surgery is recommended only after non-surgical treatment approaches fail to relieve symptoms after a reasonable period.

  • Procedure

The procedure is performed with you resting on your stomach and injected with sleep inducing medication (general anesthesia). Your surgeon makes a small incision near the center of your neck on the back side, and approaches the neck bones (cervical vertebrae) by moving the soft tissues and muscles apart. Then, the total lamina or a part of the lamina is removed to relieve the compression. Other compression sources such as bone spurs and/or disc fragments (discectomy) are also removed. After the procedure, your surgeon brings back the soft tissues and muscles to their normal place and closes the incision.

In some instances, spinal fusion may also be done along with the cervical laminectomy which involves placing bone graft or a bone graft substitute between two affected vertebrae to allow bone growth between the vertebral bodies. The bone graft acts as a medium for binding the two vertebral bones, and grows as a single vertebra which stabilizes the spine. It also helps to maintain the normal disc height.

  • Recovery

A specific post-operative recovery/exercise plan will be given by your physician to help you return to normal activity at the earliest.  After surgery, your symptoms may improve immediately or gradually over the course of time. The duration of hospital stay depends on this treatment plan. In a few instances, surgery may also be performed on an outpatient basis. You will be able to wake up and walk by the end of the first day after the surgery. Your return to work will depend on your body’s healing status and the type of work/activity that you plan to resume. Discuss with your spinal surgeon and follow the instructions for optimized healing and appropriate recovery after the procedure.

  • Risks and Complications

All surgeries carry risk and it is important to understand the risks of the procedure to make an informed decision to go ahead with the surgery. In addition to the anesthetic complications, spinal surgery is associated with some potential risks such as infection, blood loss, blood clots, nerve damage, and bowel and bladder problems. Failure to fuse the vertebral bones with the bone graft (fusion failure) is an important complication of spinal fusion which requires an additional surgery.

Please take your physician’s advice for a complete list of indications, clinical results, adverse effects, warnings and precautions, and other relevant medical information about cervical laminectomy procedure.

 

 

CERVICAL LAMINOPLASTY

A cervical laminoplasty is an operative procedure that involves reshaping/repositioning the bone at the neck region (cervical spine) to relieve excess pressure on the spinal nerves. It can also be performed to relieve the symptoms of narrowed spinal canal known as spinal stenosis.

Laminoplasty involves repositioning or reshaping of the lamina (roof), unlike laminectomy which involves removal of the lamina.

  • Indications

Degeneration of the facet joints and intervertebral discs that connect vertebrae to one another results in narrowing of the spinal canal, known as spinal stenosis. In addition, the arthritic facet joints become bulkier and consume the space existing for the nerve roots. Besides, thickened ligaments and bony out growths also known as bone osteophytes or bone spurs can also narrow the spinal canal. The condition of spinal stenosis, narrowing of the spinal canal, puts pressure on the spinal nerves and spinal cord, causing symptoms such as neck pain, tingling sensation, numbness or weakness that extends to the shoulders, arms and/or hands and bowel or bladder impairment.

The objective of cervical laminoplasty is to relieve pressure on the spinal nerves by removing the source of pressure without disturbing the stability of the posterior elements of the vertebrae. This procedure is also called an “open door laminoplasty,” because it involves “hinging” one side of the vertebrae and cutting the other side forming a “door”, which is opened and placed with wedges made up of bone and instrumentation. Your surgeon recommends you for cervical laminoplasty after examining your spine, medical history, and imaging results of cervical vertebrae such as X-ray, CT (computed tomography) scan or MRI (magnetic resonance imaging). Surgery is recommended only after non-surgical treatment approaches fail to relieve symptoms after a reasonable period.

  • Procedure

The procedure is performed with you resting on your stomach and injected with sleep inducing medication (general anesthesia). Your surgeon makes a small incision near the center of your neck on the back side, and approaches the neck bones (cervical vertebrae) by moving the soft tissues and muscles apart. The spinal processes of the vertebra are removed. Then, a side of the cervical vertebra is cut making a “hinge” and later the other side is also cut allowing the bones to open like a “door”. The back of each vertebra is bent back to remove pressure on the spinal structures such as spinal cord and spinal nerves. Other compression sources such as bone spurs, excess ligaments and/or disc fragments (discectomy) are also removed. Small wedges are placed in the “open” space of the door and sealed with proper instrumentation. After the procedure, your surgeon brings back the soft tissues and muscles to their normal place and closes the incision.

  • Recovery

A specific post-operative recovery/exercise plan will be given by your physician to help you return to normal activity at the earliest.  After surgery, your symptoms may improve immediately or gradually over the course of time. The duration of hospital stay depends on this treatment plan. In a few instances, surgery may also be performed on an outpatient basis. You will be able to wake up and walk by the end of the first day after the surgery. Your return to work will depend on your body’s healing status and the type of work/activity that you plan to resume. Discuss with your spinal surgeon and follow his instructions for optimized healing and appropriate recovery after the procedure.

  • Risks and Complications

Treatment results are different for each patient. All surgeries carry risk and it is important to understand the risks of the procedure to make an informed decision to go ahead with the surgery. In addition to the anesthetic complications, spinal surgery is associated with some potential risks such as infection, blood loss, blood clots, nerve damage, and bowel and bladder problems. Failure to fuse the vertebral bones with the bone graft (fusion failure) is an important complication of spinal fusion which requires an additional surgery.

Please take your physician’s advice for a complete list of indications, clinical results, adverse effects, warnings and precautions, and other relevant medical information about cervical laminoplasty procedure.

 

 

MINIMALLY INVASIVE CERVICAL DISCECTOMY

A cervical discectomy is an operative procedure which relieves pressure on the spinal nerves and/or spinal cord by removing the total or a part of the damaged intervertebral disc. Cervical discectomy is performed using minimally invasive approach in selected patients, if appropriate.

Cervical discectomy is a surgical procedure which relieves compression on the nerve roots and/or the spinal cord because of a herniated disc or a bone spur. This procedure involves making an incision on the front side of the neck (anterior cervical spine), followed by the removal of disc material and/or a portion of the bone around the nerve roots and/or spinal cord to relieve the compression on neural structures and provide them with an additional space.

Cervical discectomy is also referred to as decompressive spinal procedure as the surgeon removes compression on nerve roots by removing the total or a part of the disc and/or bony material that is causing pain. Your surgeon may choose a minimally invasive approach based on your condition and the specific surgical goals.

Minimally invasive cervical discectomy involves a small incision(s) and muscle dilation to separate the muscle fibers surrounding the spine, unlike conventional open spine surgery which requires muscles to be cut or stripped.

  • Indications

Herniated disc is a condition in which the soft, gel-like center of the disc (nucleus pulposus) has pushed out through the disc’s tough, outer ring (annulus fibrosus). Besides, bony out growths also known as bone spurs or bone osteophytes are formed due to the accumulation of calcium in the spine joints. The pressure induced by a herniated disc or bone spur on nerve roots, ligaments or the spinal cord may cause pain in the neck and/or arms, numbness or weakness in the arms, forearms or fingers, and lack of coordination.

As most nerves to the body (e.g., arms, chest, abdomen and legs) pass through the neck region from the brain, pressure on the spinal cord in the neck region (cervical spine) can be very problematic. Patients with these symptoms are candidates for cervical discectomy procedure only after non-surgical treatment methods fail. Cervical discectomy can reduce the pressure on the nerve roots leading to pain relief.

Your surgeon recommends you for minimally invasive cervical discectomy procedure after examining your spine, medical history, and imaging results of cervical vertebrae such as X-ray, CT (computed tomography) scan or MRI (magnetic resonance imaging). Surgery is recommended only after non-surgical treatment approaches fail. Before recommending surgery, your surgeon considers several factors such as your health condition, age, lifestyle and anticipated level of activity following surgery. A thorough discussion with your surgeon regarding this treatment option is advised before scheduling the surgery.

  • Procedure

The procedure is performed with you resting on your back after injecting the sleep inducing medication (general anesthesia). Your physician makes a very small incision at the center of your neck on the front side, and gently separates the muscles and soft structures apart. Then a series of small tubes called dilators are inserted through the incision towards the spine. The sources of compression such as bone spurs and/or disc material are removed. Finally, after the procedure, your surgeon removes the tubes, brings back the soft tissues and muscles to their normal place, and closes the incision.

Sometimes, spinal fusion may also be done along with cervical discectomy which involves placing bone graft or bone graft substitute between two affected vertebrae to allow bone to grow between the vertebral bodies. The bone graft acts as a platform or a medium for binding the two vertebral bones, and grows as a single vertebra which stabilizes the spine. Spinal fusion also may be performed through the minimal invasive approach using “tubes”.

In some instances, your surgeon performs the surgery using a posterior approach that requires the incision to be made on the back of your neck. Posterior cervical discectomy may also be done using minimally invasive surgical technique.

  • Recovery

A specific post-operative recovery/exercise plan will be given by your physician to help you return to normal activity at the earliest.  After surgery, your symptoms may improve immediately or gradually over the course of time. The duration of hospital stay depends on the treatment plan. In a few instances, surgery may also be performed on an outpatient basis. You will be able to wake up and walk by the end of the first day after the surgery. Your return to work will depend on your body’s healing status and the type of work/activity that you plan to resume. Discuss with your spinal surgeon and follow his instructions for optimized healing and appropriate recovery after the procedure.

  • Risks and Complications

All surgeries carry risk and it is important to understand the risks of the procedure to make an informed decision to go ahead with the surgery. In addition to the anesthetic complications, spinal surgery is associated with some potential risks such as infection, blood loss, blood clots, nerve damage, and bowel and bladder problems. Failure to fuse the vertebral bones with the bone graft (fusion failure) is an important complication of spinal fusion which requires an additional surgery.

Before scheduling the surgery, discuss the benefits, risks and complications related to minimally invasive cervical discectomy procedure with your surgeon.

 

 

MULTILEVEL POSTERIOR CERVICAL LAMINECTOMY & FUSION

Posterior cervical laminectomy and fusion is an operative procedure to relieve pressure or compression on the nerve structures due to herniated disc, spinal stenosis or spondylosis. It is often performed for multilevel spinal cord compression from cervical spinal stenosis to decompress the spinal cord and nerve roots in the cervical region (neck region) of the spine.

Cervical stenosis refers to narrowing of the spinal canal in the neck region that compresses the spinal structures. The compression or pressure on the spinal structures results in neck pain, tingling sensation in the arms and/or legs, lack of coordination, and bowel and bladder problems. Disc degeneration, bulging or herniated disc, and spondylosis are the other spinal conditions that compress the spinal cord and nerve roots. Occasionally, there may be multiple disc bulges at various levels and the ligaments may bind to the spinal canal, causing spinal stenosis.

In cervical laminectomy, the lamina and spinous process are removed to create more room for the spinal cord and take the pressure off. Perhaps in patients with severe stenosis, laminectomy at three or more segments and a posterior longitudinal ligament (OPLL) resection for decompression are required. In such cases, posterior approach is preferred over anterior approach as it is technically easier to perform. Further, with multilevel laminectomy, there is a post-operative risk of developing instability that may lead to pain and deformity. To prevent this, usually a posterior fusion is also performed together with the multilevel posterior cervical laminectomy. Fusion at three or more levels from the front side can be difficult. Therefore, the procedure will be accompanied by a posterior cervical fusion to support the vertebrae with a bone graft.

  • Procedure

In posterior cervical laminectomy, a 3-4-inch-long incision is made in the midline of the back of the neck. After the muscles are elevated off the lamina (roof), the lamina along with the spinous process is removed as one piece with a high-speed burr creating more space for the spinal cord. Usually, local autograft bone harvested from the patient’s neck or bone from the iliac crest is then inserted into the empty space between the affected vertebrae to stimulate new bone growth. Instrumentation such as rods and screws are also placed into the spine to hold the vertebrae together during the healing process.

  • Risks and Complications

All major surgical procedures are associated with some risks. The potential risks of multilevel posterior cervical laminectomy and fusion include infection, bleeding, risks of anesthesia, nerve injury and fusion failure. The results of the surgery may be variable in some people with more extensive disease. Generally, most patients find improvement in their hand function and walking capabilities after the surgery.

 

 

POSTERIOR CERVICAL MICROFORAMINOTOMY

Posterior cervical microforaminotomy/discectomy is an operative procedure that relieves pressure or compression on the nerve roots at the cervical spine.

The cervical region (neck area) forms the upper portion of the spine. A series of cervical vertebrae, C1-C7 connects the cervical spine to the skull. The massive nerve supply to the head, neck, and upper portions of the shoulders and arms is by the spinal nerve roots that branch out from the cervical spine.  Nerves exit spinal cord through an opening called foramen- a tunnel or space through which a spinal nerve exits the spine. Herniation of disc (disc damage) or spinal stenosis (narrowing of spinal canal) can narrow the foramen, and pinches or compresses the nerve structures in the neck region leading to pain, weakness and limited movement in the hands and arms.

Posterior cervical microforaminotomy/discectomy involves making an incision in the back side of the neck (posterior cervical spine) followed by the removal of disc material and/or a part of the bone that compresses nerve roots.

  • Indications:

Posterior Cervical Microforaminotomy is indicated in patients who experience:

  • Neck, shoulder or lower arm pain due to compression in the cervical region

  • Swollen or bulging discs

  • Bone damage caused by trauma, or conditions like arthritis or osteoporosis.

  • Throbbing pain that radiates to the fingers, hands, and lower portion of the arm

  • Weakness and restricted range of motion or movement of the neck

  • Various spinal disorders that cause foraminal narrowing include degenerative disc diseases, spinal stenosis, and spondylosis.

  • Types of cervical microforaminotomy/discectomy:

The two different types of microforaminotomy/discectomy commonly performed are:

  • Anterior cervical microforaminotomy/discectomy

  • Posterior cervical microforaminotomy/discectomy

  • Posterior cervical microforaminotomy/discectomy surgical procedure:

The goal of posterior cervical microforaminotomy/discectomy is to relieve pressure on the spinal cord and/or nerve roots. The decompression is achieved by expanding the foramen or removing the portion of the intervertebral disc (broken or bulged) that exerts pressure on the spinal nerves and causes pain.

It is a type of minimally invasive spine surgery that involves use of highly specialized small surgical instruments and very small incisions to reduce injury to the surrounding structures.

  • Method of surgery

Posterior cervical microforaminotomy/discectomy surgery is done from the back (posterior side) of the neck. In this technique, the patient lies face down on the operating table. A small incision is done along the back of the neck. The muscle which lies behind the spine is cut and the affected part of the spine bone is exposed. Miniature surgical instruments are inserted through the incision and expose the compressed nerve or herniated disc. A small amount of bone surrounding the nerve root is carefully removed. This is called microforaminotomy. Any bulging or herniated portion of the disc will be removed, if it continues to bulge against the nerve root, which is known as microdiscectomy. After the nerve root is decompressed, the muscles are re-approximated and the incision is closed with sutures.

  • Advantages over the traditional open cervical spine surgery:

Some of the benefits of posterior cervical microforaminotomy/discectomy include:

  • Very small incisions

  • Total surgery time is minimal

  • Minimal damage to the surrounding structures

  • Shorter recovery time with less post-surgical complications

  • Lower rate of infection

  • Greater range of motion with less post-operative pain

  • Post-operative care:

Following are the post-surgical guidelines to be followed after the surgery:

  • Make sure you get plenty of rest

  • Take medications and antibiotics to help alleviate pain and inflammation as prescribed by your doctor

  • Avoid neck bending or straining activities

  • Absolutely no driving for about 2 weeks or while taking pain medicines

  • Braces such as a soft cervical collar may be advised to wear after surgery to reduce the pain and stress on the neck

  • Start rehabilitation (physiotherapy) as recommended by your spine surgeon

  • Return to work and sports once the neck has regained normal strength and function

  • Risks and complications:

With any procedure, some amount of risk will always coexist. Likewise, posterior cervical microforaminotomy/discectomy has complications such as

  • Bleeding or infection

  • Unrelieved neck pain

  • Damage to spinal cord, nerves, and blood vessels

  • Spine may lose its stability

  • Need for additional surgery due to occurrence of above complications.

Discuss with your spine surgeon if you have any concerns or queries regarding posterior cervical microforaminotomy/discectomy.