Cervical Spine Surgery: Surgical Techniques to Treat Neck Pain and Symptoms

Part 1. Cervical anatomy
Part 2. Cervical degenerative conditions
Part 3: Cervical surgery options

Part 3. 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 two overall surgical techniques:

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

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 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. The main 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).

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 two 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. Some surgeons also may use a biological substance, such as rhBMP-2 (recombinant human Bone Morphogenetic Protein; stimulates bone cell production) to create a fusion. However, this use of BMP is not FDA-approved.

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. The FDA has approved wires and cables; screws with rods are not FDA-approved in the back of neck but are used anyway.

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: A New 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 two or more vertebrae fused, neck motion would be greatly reduced. Cervical discs still are a fairly new technology; however, early results are encouraging.

Conclusion
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 symptoms.