Surgery for Neck Pain

• Non-surgical treatment is not helping—that is, you've tried a combination of chiropractic care, physical therapy, medication, massage, exercises, and more, and you're still in pain.
• You experience progressive neurological symptoms (numbness, tingling, weakness) involving your arms and legs.
• You're having trouble with balance or walking.
• You are otherwise in good health.

Generally, surgery is done for degenerative disc disease, trauma, or spinal instability. These conditions may put pressure on your spinal cord or on the nerves coming from the spine. Surgery can help relieve that pressure; that's called decompression.

Relieving the pressure on your spinal cord or other nerves aims to relieve your pain, numbness, tingling, or weakness. Other possible goals of cervical spine surgery are: to get your nerves functioning properly again or to stop and/or prevent abnormal spine motion.

Typically, surgeons use two surgical techniques for cervical spine surgery:

• Decompression, where they remove tissue pressing against a nerve structure
• Stabilization, where they work to limit motion between vertebrae

Cervical Decompression Surgery
To remove the tissue that's pressing on a cervical nerve, your spine surgeon may perform one of the following types of surgery:

• Facetectomy: The joints in your spine are called facet joints; they're what help you move. However, facet joints can put pressure on a nerve. Ectomy means "removal of." So a facetectomy involves removing the facet joint to reduce that pressure.
• Foraminotomy: If part of the disc or a bone spur (osteophyte) is pressing on a nerve as it leaves the vertebra (through an exit called the foramen), a foraminotomy may be done. Otomy means "to make an opening." So a foraminotomy is making the opening of the foramen larger, so the nerve can exit without being compressed.
• Laminectomy: At the back of each vertebra, you have a bony plate that protects your spinal canal and spinal cord; it's called the lamina. It 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.
• Laminoplasty: The bony plate (lamina) that protects your spinal canal and spinal cord may need to be re-shaped to create more room for your spinal cord. Plasty means "to shape." So a laminoplasty shapes the lamina to keep it from pressing on your spinal cord.
• Laminotomy: Similar to the foraminotomy, a laminotomy makes a larger opening, this time in your bony plate protecting your spinal canal and spinal cord (the lamina). The lamina may be pressing on your nerve, so the surgeon may make more room for the nerves using a laminotomy.

All of the above decompression techniques are done from the back of the spine (posterior). Sometimes, though, a surgeon has to do a decompression from the front of the spine (anterior). For example, a bulging disc or a herniated disc pushing into your spinal canal sometimes cannot be removed from behind because the spinal cord is in the way. In that case, the decompression procedure is usually performed from the front of the neck (anterior). The main anterior decompression techniques are:

• Discectomy: If you have a bulging disc or a herniated disc, it may be pressing on your nerves. In a discectomy, the surgeon will remove all or part of the disc.
• Corpectomy: Occasionally, surgeons will need to take out the entire vertebral body because 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 (osteophytes) 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 that's pressing on your nerve—that's a corpectomy.

Stabilization Surgery
Discectomies and corpectomies 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 discectomies and corpectomies, they often restabilize 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 your own body) 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.

As with any operation, there are risks involved with cervical spine surgery. 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 Cervical Spine 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.