Surgery for Whiplash

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Neck Pain IllustrationWhiplash treatment rarely requires surgery. However, surgery is appropriate in severe cases if you have persistent neck or shoulder pain. If your condition hasn't improved after extensive non-surgical treatment, an operation may be your best option.

Your spine surgeon will recommend the best surgical procedure for your injury. Make sure to ask plenty of questions about the procedure so that you fully understand how it's done, what the outcome will be, how long the recovery time is, etc. When it comes down to it, surgery is your decision alone: the surgeon can recommend it, but you have the final say.

The type of surgery depends on what parts of your cervical spine have been injured.

Ruptured or Herniated Disc
During your accident, you may have ruptured or herniated an intervertebral disc, which is located between the vertebrae. This can produce persistent arm pain, numbness, or weakness. In this case, disc removal is sometimes necessary. The surgeon removes all or part of the damaged disc in a process called a discectomy.

After the discectomy, your doctor may need to permanently stabilize the area. Discectomies usually result in an unstable spine, meaning that it moves in abnormal ways. That makes you more at risk for serious neurological injury. So when surgeons do a discectomy, they often restabilize the spine.

To stabilize the spine, the surgeon may use:

  • Artificial Cervical Disc: This is a new—and very exciting—development in spine surgery. Recently, surgeons have begun implanting an artificial cervical disc after the discectomy. They're using this instead of fusion and spinal instrumentation. The advantage is that an artificial disc enables a patient to retain normal neck movement after surgery. Previously, if the patient had two or more vertebrae fused, neck motion would be greatly reduced. Cervical discs still are a fairly new technology; however, early results are encouraging.
  • Fusion and Spinal Instrumentation: This kind of spine stabilization surgery has been has been common for many years. It can be done alone or at the same time as a decompression surgery. In spine stabilization, the surgeon creates an environment where the bones in your spine will fuse together over time (usually over several months or longer). The surgeon uses a bone graft (usually using bone from a donor) or a biological substance (which will stimulate bone growth). Your surgeon may use spinal instrumentation—wires, cables, screws, rods, and plates—to increase stability and help fuse the bones. The fusion will stop movement between the vertebrae, providing long-term stability.

Spinal Stenosis
Surgery may also be necessary if the injury causes a narrowing of the spinal canal in your neck. In this case, a cervical corpectomy might be performed to remove a portion of the vertebra and the intervertebral disc to reduce the pressure on the spinal cord and nerves. Your surgeon may also do a laminectomy or a laminoplasty. Both of those surgeries focus on the lamina, the bony plate that's at the back of each vertebra. It protects your spinal cord and spinal canal. The lamina may be pressing on your spinal cord, so the surgeon may make more room for the cord by removing all or part of the lamina—that's a laminectomy.

In a laminoplasty, the surgeon will re-shape the lamina to create more room for your spinal cord. Plasty means "to shape."

If there is a narrowing of the space where the nerve exits the spinal canal, a cervical foraminotomy may be performed. In this procedure, the foramen (the area where the nerve roots exit the spinal canal) is removed to increase the size of the nerve pathway. A larger pathway makes it less likely that the nerve will be pinched or compressed.

Surgical Complications
As with any operation, there are risks involved with cervical spine surgery to treat whiplash symptoms. Your doctor will discuss potential risks with you before asking you to sign a surgical consent form. Possible complications include, but are not limited to:

  • injury to your spinal cord, nerves, esophagus, carotid artery or vocal cords
  • non-healing of the bony fusion (pseudoarthrosis)
  • failure to improve
  • instrumentation breakage/failure
  • infection and/or bone graft site pain
  • pain and swelling in your leg veins (phlebitis)
  • blood clots in your lung
  • urinary problems
  • very rare complications: paralysis and possibly death

Complications could lead to more surgery, so again—make sure that you completely understand your surgery and the risks before proceeding. The decision for surgery is yours and yours alone.

Recovery from Whiplash Surgery
After your surgery, you aren't going to be instantly better. You will most likely be out of bed within 24 hours, and you'll be on pain medications for 2 to 4 weeks. After the surgery, you'll receive instructions on how to carefully sit, rise, and stand. It's important to give your body time to heal, so your doctor will probably recommend that you restrict your activities: in general, don't do anything that moves your neck too much. You should avoid contact sports, twisting, or heavy lifting while you recover.

After surgery, be vigilant. Report any problems—such as fever, increased pain, or infection—to your doctor right away.

Updated on: 03/16/16
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Drugs and Medications for Whiplash
Jason M. Highsmith, MD
This article was reviewed by Jason M. Highsmith, MD.
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