Cervical Procedures

The cervical spine (neck region) is one of the most important and agile parts of your body. It begins at the base of the skull and consists of seven bones separated by intervertebral discs that allow the spine to move freely. The neck has the greatest amount of movement of any area of the spine and is also responsible for protecting the spinal cord and supporting the skull. Because of its vital function in our everyday lives, injury or disease of the cervical spine is a very serious condition.

Anterior Cervical Discectomy

Anterior cervical discectomy and fusion surgery removes an intervertebral disc and/or bone spurs that are putting pressure on nerve roots and/or the spinal cord. This condition is a result of a herniated or degenerated disc and is known as nerve root or spinal cord compression. Compression can lead to pain in the neck and arms, lack of coordination, and numbness or weakness in the arms.

Once the disc is removed it may be replaced with a small bone graft or prosthetic cage that will allow the vertebrae to fuse together over time. The bone may be obtained from the spine itself, another part of the patient's own body, a bone bank utilizing donor bone or a synthetic bone graft substitute. Typically, a metal plate and screws are inserted to stabilize the spine while it heals.

As the name describes, this procedure is done through the front, or anterior, of the body. An incision is made in the front of the neck, off to one side, and the disc is removed. Removing the herniated disc relieves the pressure placed on the nerves and therefore relieves the symptoms as well. It is performed under general anesthesia.

After surgery, a hospital stay is usually required. Complete recovery time may take between six and twelve weeks. Although complications are rare, any surgical procedure carries risks. Possible risks include infection, difficulty swallowing, bleeding, reactions to anesthesia, injury to the spinal cord, pain at the treated site, damage to nerves or arteries, blood clots and paralysis. These risks can be minimized by choosing an experienced surgeon to perform your procedure, and by adhering to your surgeon's instructions before and after your procedure.

Corpectomy

A corpectomy is a surgical procedure performed to remove the vertebral body and disc spaces in order to relieve pressure on the nerves within the spine caused by stenosis or bone spurs. Patients with these conditions often experience pain in the affected area, as well as numbness, tingling or weakness in the extremities. Depending on the location and severity of the condition, symptoms may also include loss of balance and a loss of bowel and bladder control.

The vertebral corpectomy procedure is performed under general anesthesia in a hospital setting. During the procedure, an incision is made in the side of the body at the affected area, usually in the cervical or lumbar spine. Any organs or tissue will be gently moved aside to allow for greater access to the spine. In order to relieve spinal compression, the discs above and below the affected vertebra are removed, along with the middle portion of the bone.

A bone graft or prosthetic cage may be inserted to stabilize the spine after the damaged structures have been removed. The entire procedure takes approximately three to four hours to perform, depending on the severity of the condition.

After surgery, patients will stay in the hospital in order to facilitate proper healing and monitoring. There may be some pain at the incision site, although this can usually be managed through pain medications prescribed by your doctor. Symptom relief is usually noticeable right away, and will continue to improve gradually. Most patients can get up and walk around a few hours after their procedure. Your doctor will advise you as to when you can return to work and physical exercise.

Corpectomy is often effective in gradually relieving symptoms of spinal stenosis. However, as with any type of surgical procedure for the spine, corpectomy can be associated with certain risks, including infection, bleeding, damage to the spinal cord and damage to nerve roots in the area. Your doctor will discuss these risks with you prior to surgery.

Foraminotomy

Foraminotomy is a minimally invasive surgical procedure performed to expand the opening in the spinal column where the nerve roots exit the spinal canal. Its purpose is to relieve the pressure resulting from foraminal stenosis. This is a painful condition caused by a narrowing of the foramen, the opening within each of the spinal bones that allows nerve roots to pass through.

As a result of aging or other musculoskeletal conditions such as arthritis, the foramen may gradually become tightened and develop bone spurs that press on the nerves and cause pain, numbness, stiffness and weakness, and may also develop into spinal stenosis. Herniated discs and thickened ligaments and joints may also be the cause of the narrowing of the foramen.

When foraminal stenosis does not respond to conservative treatments, it may require a foraminotomy. The procedure, which frees the nerve from pressure and allows it to move again within the spinal column, can be performed on any part of the spine but is most common on the cervical (neck) or lumbar (lower back) regions.

The patient is given general anesthesia and lies face down on the operating table. The surgery typically takes about two hours. An incision is made on the back to access the spine. A portion of bone is cut or shaved down to open up the passageway of the foramen. If any disk fragments are present, they are removed. Bone at the back of the vertebrae may also be taken out if that is necessary to provide more space. Foraminotomy may be combined with spinal fusion surgery to provide greater stability to the affected area of the spine.

After the surgery, you will most likely be admitted to the hospital. If the foraminotomy was in the cervical region, you will probably be required to wear a soft neck collar to limit your head and neck movement. Physical therapy may be recommended for the first several weeks after surgery. The full recovery time is typically between two and three months.

Foraminotomy has a very good success rate for relieving the symptoms of foraminal stenosis. Complications are rare, but can occur during any surgical procedure. The risks for any surgery include reactions to anesthesia, bleeding, infection, damage to a spinal nerve, pain after surgery, blood clots and the potential return of symptoms. These risks can be minimized by choosing an experienced surgeon to perform your procedure, and by adhering to your surgeon's instructions before and after your procedure.

Laminectomy

A laminectomy is a surgical procedure designed to relieve the pressure and pain caused by spinal stenosis. Spinal stenosis is a narrowing of the spinal canal that puts pressure on the nerves and causes pain throughout the spine and extremities. It can develop as a result of bone spurs, osteoarthritis or even just from aging. In this procedure, a small section of bone that covers the back of the spinal cord, called the lamina, is removed to relieve the compression. It is most commonly performed on the vertebrae in either the neck or the lower back.

The cervical spine (neck region) is one of the most important and agile parts of your body. It begins at the base of the skull and consists of eight pairs of spinal nerves and seven bones separated by intervertebral discs that allow the spine to move freely. The neck has the greatest amount of movement of any area of the spine and also protects the spinal cord and supports the skull. Because of its vital function in our everyday lives, injury or disease of the cervical spine is a very serious condition.

A laminectomy of the cervical spine is performed through the back of the spine under general anesthesia. Part or all of the lamina bones may be removed on both sides of the spine, along with the spinous process, which are projections from the back of the vertebrae. The removal of the lamina, thickened ligament, and any bone spurs relieves the pressure on the spinal cord and nerves.

If one of the vertebrae has moved over another or if there is curvature of the spine, spinal fusion may be needed for stability along with the laminectomy. The remaining spine bones can be connected by fusing vertebrae together using bone grafts or titanium metal rods with screws attached to bones on each side. The procedure can also be done without fusion.

After a laminectomy, you will most likely remain in the hospital for a short stay. Soon afterward, most patients begin a regimen of physical therapy. You will be restricted from activities that require bending and lifting for several weeks after the procedure. Generally, most people can return to work in four to eight weeks after surgery.

Laminectomy with Foraminotomy

At times, spinal stenosis is accompanied by foraminal stenosis. This condition is caused by a narrowing of the foramen, the opening within each of the spinal bones that allows nerve roots to pass through. When that is the case, a foraminotomy will be performed along with the laminectomy. Foraminotomy is a surgical procedure used to expand the opening in the spinal column where the nerve roots exit the spinal canal, with the goal of relieving the pressure that results from foraminal stenosis. Both of the procedures may be combined with spinal fusion surgery to provide greater stability to the affected area of the spine.

Due to aging or other musculoskeletal conditions such as arthritis, the foramen may gradually become clogged and develop bone spurs that press on the nerves and cause pain, numbness, stiffness and weakness. Herniated discs and thickened ligaments and joints may also be the cause of the narrowing of the foramen.

After a laminectomy with foraminotomy, you will most likely remain in the hospital for a short stay. Soon afterward, most patients begin a regimen of physical therapy. You will be restricted from activities that require bending and lifting for several weeks after the procedure. Generally, most people can return to work in four to eight weeks after surgery. The full recovery time is typically between two and three months.

Laminoplasty

A laminoplasty is a surgical procedure designed to relieve the nerve pressure and pain caused by spinal stenosis. Spinal stenosis is a narrowing of the spinal canal that puts pressure on the nerves and causes pain throughout the spine and extremities. It can develop as a result of bone spurs or just from aging.

In this procedure, a small section of bone that covers the back of the spinal cord, called the lamina, is cut into to relieve the compression. One side of the lamina is cut through completely and the other is cut partially, enabling it to swing open in a similar manner to a door. It is then held open, therefore increasing the amount of room for the spinal cord and decreasing compression on the nerves, with titanium spacers or bone graft and plates.

As symptoms of spinal stenosis worsen over time or more conservative treatments such as medication and physical therapy have failed to help, a laminoplasty may become necessary. It can provide relief from typical symptoms such as pain, numbness or weakness in one or both arms or legs.

A laminoplasty of the cervical spine is performed through the back of the neck under general anesthesia. The surgery can last between two and five hours. The typical hospital stay is two to three days. Patients are then required to wear a soft cervical collar for several weeks after surgery to promote stability and healing in the neck.

After a laminoplasty, you will most likely need to begin a regimen of physical therapy to build up the strength and flexibility in your neck muscles. You will be restricted from those activities that require bending and lifting for several weeks after the procedure. Generally, most people can return to work in two to six weeks after surgery.

Microdiscectomy

Microdiscectomy, also known as microdecompression, is a minimally invasive procedure designed to relieve pain caused by certain spinal conditions, including:

Disc bulge
Disc herniation
Spinal stenosis
Sciatica

Although this procedure targets the nerves of the spinal cord, the pain alleviated is usually in the legs. A microdiscectomy is typically reserved for patients who do not respond to more conservative methods of pain relief. Surgery is usually performed within three to six weeks of the onset of pain.

The procedure allows for the herniated nucleus to be removed without fully visualizing the spine, as temporary repositioning of the back muscles and nervous membrane allow for small surgical tools and microscopes to perform the operation with minimal soft tissue damage. In contrast to a laminectomy where the lamina is removed, the spine's shape takes little to no change, as minimal or no bone is removed during this procedure.

A microdiscectomy is generally an outpatient procedure with a very fast rate of recovery. Although it is recommended to restrict certain spine-intensive activities, such as twisting, bending and lifting, the patient's bone structure and tissue are completely unchanged and normal activity is quite feasible. The success rates vary between 90 and 95 percent with a relatively low recurrence rate of 5 to 10 percent, usually occurring in the first three months after surgery. If herniation reoccurs, the procedure may be repeated, although chances of continual reoccurrence will be much higher.

Posterior Cervical Discectomy and Fusion (PCDF)

Posterior cervical decompression and fusion surgery removes the lamina, thickened ligament, and/or bone spurs that are putting pressure on the spinal cord and nerve roots. This compression is a result of a herniated or degenerated disc, spinal stenosis, and/or spinal instability. Nerve compression can lead to pain in the neck and arms, lack of coordination, and numbness or weakness in the arms.

As the name describes, this procedure is done through the back, or posterior, of the body. An incision is made in the midline of the back of the neck, the muscles are dissected and retracted, and the compression is removed. After the decompression of the nerves and spinal cord, the spine then needs to be stabilized by screws and rods to allow the bones to fuse together.

After surgery, a hospital stay is usually required. Complete recovery time may take between eight and twelve weeks. Although complications are rare, any surgical procedure carries risks. Possible risks include infection, bleeding, reactions to anesthesia, injury to the spinal cord, pain at the treated site, damage to nerves or arteries, blood clots and paralysis. These risks can be minimized by choosing an experienced surgeon to perform your procedure, and by adhering to your surgeon's instructions before and after your procedure.

Christine Cisneros M.D.

Patient Education