Cervical Spine Surgery and Degenerative Neck Disorders

	Tony Schnuerer, PA Consultant - Medical Devices Tall Forest Consulting, LLC Memphis, TN, USA
	Praveen V. Mummaneni, MD Associate Professor, Neurosurgery University of California, San Francisco San Francisco, CA, USA

To understand cervical spine surgery, it is important to know about neck anatomy, degenerative conditions, and surgical goals and techniques. Information about cervical degenerative conditions begins below. However, you can skip to parts 1 or 3 by clicking on the following links.

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

Part 2. Cervical Degeneration: The Cause of Many Neck Problems
Although the discs are tough structures, they are susceptible to damage. The wear and tear of normal living can cause the disc to degenerate and lead to osteoarthritis of the vertebra. This is similar to the arthritis that affects hip and knee joints.

Degeneration in the cervical spine can lead to significant changes in anatomy. These changes can cause neck pain and other symptoms due to:

1. Compression of the spinal cord and other nerve structures
2. Abnormal motion in the cervical spine
3. A combination of 1 and 2

Cervical degeneration includes distinct characteristics, some or all of which may be present in a patient.

Characteristic 1: Bulging Disc
As a disc deteriorates, it may begin to bulge, or even rupture. If it ruptures, its jelly-like middle (nucleus pulposus) may protrude. A bulge may protrude backward and press against the spinal cord or cervical nerves. Rarely, pressure on the spinal cord may cause a patient to lose hand dexterity, bowel or bladder control, and/or experience difficulty walking (myelopathy). This type of myelopathy is serious and requires immediate medical attention.

Sometimes, the degenerated disc protrudes into one of the holes (foramina) where the nerve exits from the spinal column. In this case, symptoms may occur only in the arm on the side where the disc protrusion touches the exiting nerve. Since the nerves provide arm function, the individual feels pain, numbness, tingling, or burning in the arms even though the actual problem is located in the neck. This is called radiculopathy.

Characteristic 2: Loss of Disc Height
As a disc degenerates, it loses it shock absorption capability and may cause neck pain.

Characteristic 3: Bone Spurs
As degeneration continues, the bones may begin to develop "spurs" which are called osteophytes. Osteophytes can protrude into the spinal canal or foramina, causing spinal cord or nerve compression. This may cause neck pain, arm symptoms (radiculopathy), or spinal cord dysfunction (myelopathy).

Characteristic 4: Facet Degeneration
The cartilage surfaces on the facet joint may erode away, causing facet pain.

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