When symptoms of cervical radiculopathy persist or worsen despite nonsurgical treatments, surgical options can be considered.
The goals of surgery for cervical radiculopathy are to decompress nerves, to maintain spine stability, and to provide correct alignment of the spine.
Surgery involves removing parts of bone or soft tissue (such as a herniated disk), or both. This is to create more space for the nerves and relieve pressure.
There are several surgical options to treat radiculopathy. The type of surgery that is right for you depends on several factors, including:
- The type of problem you have
- The location of the problem
- Your preference of procedure
- Your surgeon's experience
- Your medical condition and history (such as whether you have had prior neck surgery)
The type and location of your problem is the most important deciding factor.
There are usually three types of procedures that can be done for cervical radiculopathy. These include anterior cervical diskectomy and fusion, posterior cervical laminoforaminotomy, and artificial disk replacement.
Anterior Cervical Diskectomy and Fusion (ACDF)
Anterior cervical diskectomy and fusion is the most common procedure for cervical radiculopathy. It restores alignment of the spine, maintains the space available for the nerve roots to leave the spine, and limits motion across the degenerated spine segment.
"Anterior" means that your surgeon will approach your neck from the front. The surgery involves operating from the front of the neck through a 1- to 2-inch incision along the neck crease.
During the procedure, the problem disk is removed. The left over area is stretched, so that the height is similar to what it was prior to the disk wearing out. A bone graft is placed in the space where the disk was removed. This increases the space in the foramen for the nerve to leave the spine.
After the bone graft is placed, the two vertebrae next to the removed disk are fused together.
The fusion eliminates motion between the degenerated vertebrae. The goal is to lessen pain by limiting painful motion between vertebrae.
A metal plate and screws are commonly used along the front of the cervical spine. They provide stability and help increase the rate of fusion.
Animation courtesy Visual Health Solutions, Inc.
Bone graft is used to fill in the space left after the disk is removed. It is primarily used to stimulate bone healing and help the vertebrae to fuse together into a solid bone.
A bone graft can be obtained from the patient's hip. This type of graft is called an autograft.
Harvesting a bone graft requires an additional incision along the hip and lengthens surgical time. Although autografts have been used with good results, some people may experience pain at the hip for some time.
One alternative to harvesting a bone graft is an allograft, which is cadaver bone. An allograft is typically acquired through a bone bank.
The use of allograft has grown because it avoids the risk of pain at the donor site. There are risks and benefits for both types of bone grafts, which your surgeon will discuss with you.
Posterior Cervical Laminoforaminotomy
In posterior cervical laminoforaminotomy, the spine is approached from the back of the neck. A 1- to 2-inch incision is made along the midline of the neck. The parts of the bone that are compressing the nerve root are removed. If appropriate, the herniated disk is also removed from the back.
Posterior cervical laminoforaminotomy avoids spinal fusion and gives the potential for a quicker recovery. This surgery may not be an option for some patients, depending on the type and the location of the problem.
Artificial Disk Replacement (ADR)
Artificial disk replacement has relatively recently received approval from the FDA, although long-term follow up is minimal. Similar to hip or knee joint replacements, disk replacement substitutes a mechanical device for an intervertebral disk in the spine.
Artificial disks allow motion to continue after the degenerated disk is removed. The artificial disk may restore the height between the vertebral bodies. It may also widen the passageway through which the nerve roots exit the spinal canal. The artificial disk can relieve pressure on facet joints and help to maintain the natural curvature of the cervical spine.
The surgery is done from the front of the neck through a 1- to 2-inch incision created along the neck crease. The problematic disk is removed and an implant is inserted into the disk space. The implant is made of all metal or metal and plastic. It is designed to maintain the motion between the vertebral bodies.
The early results of the surgery appear promising, with results that are comparable to those of traditional surgeries. The motion is maintained, and there is a lower rate of problems at the disk levels above and below the implant. The long-term results are currently being researched.
Artificial disk replacement may not be an option for some patients, depending on the type and the location of the problem. There are risks and benefits with this procedure.
For most people, surgery can provide relief of symptoms and return to function with relatively low risks. The risks and benefits of surgery vary from person to person.
The potential risks for cervical spine surgery include:
- Injury to the nerves
- Injury to the spinal cord
- Reactions to anesthesia
- Need for additional surgery in the future
- Failure to relieve symptoms
- Tear of the sac covering the nerves (dural tear)
Anterior Cervical Spine Surgery and Disk Replacement Surgery
The potential risks with anterior cervical spine surgery and artificial disk replacement include:
- Misplaced, broken, or loosened plates, screws, or implants
- Soreness or difficulty with swallowing
- Voice changes
- Difficulty breathing
- Injury to the esophagus
The potential risks specific to anterior cervical diskectomy and fusion include:
- Donor site pain (hip pain) if an autograft is used
- Nonunion of vertebral body fusion
After the surgery, it is typical to spend 1 or 2 days in the hospital and start walking and eating on the first day. However, your specific surgery experience will depend on how you respond to the surgery and the type of surgery you receive (for example, how many disk levels were involved).
Recovery and rehabilitation will be different for each person. Your recovery will depend on several factors, including the type of surgery you have.
You may need to wear a soft or rigid collar for a short period of time. Usually by 4 to 6 weeks, you can gradually begin to do range-of-motion exercises depending on your healing. Your doctor may prescribe physical therapy during the recovery period to help restore function.
Most people are able to return to full activities by 3 to 4 months after surgery, depending on the procedure. However, healing may take longer for some people, and spinal fusion (bones to become solid) may take 6 to 12 months.
The outcome from the surgery for cervical radiculopathy is generally very good. The majority of people return to normal lifestyles after recovery.
The American Academy of Orthopaedic Surgeons
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