Cervical Surgery

While the vast majority of neck problems will respond to non-surgical treatment, you may be in the small minority of patients that benefit from surgical treatment of your problem. Decisions about surgery should be made after careful consideration of the potential benefits of the surgery compared to the risks of the surgery and the chance that the operation will not relieve your pain.

The best chance of a successful outcome is when the problem in your neck is clearly defined as the cause of your pain. For example, if your MRI shows a herniated cervical disc that is pushing on a specific nerve route, and the physical exam confirms this, then you would probably benefit from removal of the disc and decompression of the nerve route. If your pain is all over your neck and the changes on the MRI or x-ray are "uncertain", then it may be advisable to continue with a non-surgical treatment program rather than to "just try" a surgery to see if you get better. In most instances, a carefully planned surgery for the correct indications will give you significant improvement in your symptoms.

The most common operation used for the treatment of degenerative cervical disc disease is an anterior cervical discectomy. This may be combined with a fusion at the level that the disc is removed. Not every patient that has a disc removed needs to have a fusion at the same level. You should discuss the pros and cons of doing a fusion with your doctor.

Anterior cervical discectomy is an operation where the cervical spine is reached through a small incision in the front of your neck. After the soft tissues of the neck are separated, the intervertebral disc and bone spurs are removed. The space left between the vertebrae may be left open or filled with a small piece of bone. In time the vertebrae may fuse, or join together.

If used, the pre-formed bone graft may be obtained from a bone bank or if the surgeon prefers, the bone graft might instead be removed from your own hip through a second incision.

Successful recovery from anterior cervical discectomy requires that you approach the operation and recovery with confidence based on a thorough understanding of each process. Your surgeon has the training and expertise to correct physical defects by performing the operation; he and the rest of the health care team will support your body's efforts to heal its damaged tissues. Full recovery will also depend on you having a strong, positive attitude, setting small, realistic goals for improvement, and working steadily to accomplish each goal.

Surgery for anterior cervical discectomy is performed with the patient lying on his or her back. A small incision is made in the front of the neck, to one side.

Cervical pain and treatment

Treatment
Most cases of neck pain originate from strain and can be treated non-surgically. Helping the patient through the acute phase addresses breaking the pain cycle. This involves relieving neck pressure and muscle spasm.

Cervical collars limit movement and support the head taking the load off the neck. Lying down has a similar affect. Limiting neck movement and reducing pressure (weight) gives muscles needed rest while healing.

Cervical traction may be prescribed for home use. This form of traction gently pulls the head, stretching neck muscles while increasing the size of the neural passageways (foramen).

Depending on the cause of the neck pain, non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and/or short-term use of narcotics may be prescribed. In some cases trigger point injections are beneficial.

Often Physical Therapy (PT) is incorporated into the treatment plan. Passive forms of PT such as heat/cold, ultrasound, and massage may help alleviate pain and stiffness. Therapeutic exercise can help build strength and increase range of motion. Therapists also educate the patient about their condition and teach posture correction and relaxation techniques.

Surgery
Seldom does neck pain require surgical intervention. Indications for surgery include, but are not limited to spinal cord dysfunction, excruciating pain unrelieved by conservative measures, and prolonged pain and/or weakness.

For example, a vertebral fracture or herniated disc may cause spinal cord compression resulting in serious neurologic deficit. Spinal stenosis, a narrowing of the foramen or neural passageways, may entrap nerve roots that may cause unrelenting pain.

The type of surgical procedure is dependent on the patient's needs. The surgeon considers the patient's medical history, age, general physical condition, occupation, and other factors. Cervical spinal surgery is delicate and requires a skilled surgeon.

Recovery
Following doctor's/physical therapist's orders along with time are often all that is needed to overcome neck pain. Whether neck pain is treated with or without surgery, eating properly, regular exercise, and weight maintenance help healing and benefit spinal health.

For patients who undergo a surgical procedure the road to recovery may be a bit longer. However, that is not reason to become discouraged. It is normal to feel tired and emotionally down following surgery. During stress such as surgery, the body cranks out extra hormones - after surgery the level drops, which may result in a 'down' period.

Prevention can be a key to avoiding neck pain in the future. Remember the neck - although very mobile, it has limitations. Avoid activities that cause the neck to hyperflex or hyperextend, maintain good posture, and take frequent stretch breaks from desk/computer work. Incorporate neck safety into your activities of work and play.