Cervical Spine Anatomy

Read about the Anatomical Structure of the Cervical Spine – Click here

 

Anterior Cervical Discectomy and Fusion

Causes of Pain in cervical spine

  • Cervical spondylitis: Also known as cervical Osteoarthritis. Degenerative disease caused by wearing of cartilage, results in pain and swelling.,
  • Spinal stenosis: It is characterized by narrowing of spinal canal might be due to herniation of cervical disc. Narrowing of spinal canal compress the spinal cord called myelopathy (causes problem in hand and leg Coordination)
  • Herniation and rupture: Rupture or Herniation of one or more cervical disc is the most common reason for neck pain. Annulus (outer layer) of the vertebrae tears and nucleus (inner jelly like materials) is forced  out of the cracks and tears of outer layer . As a result, compression of nerve root or spinal cord occurs. Patient may feel pain in neck, shoulder and arms. It might be due to aging or sudden trauma.
  • Cervical foraminal stenosis: Foraminal canal is a small opening in the cervical spine for the passage of nerves to exit the spine. Cervical foraminal stenosis is narrowing of foraminal canal leading to pinching or trapping the nerves causing chronic pain.
  • Spondylithiosis: Condition in which on vertebrae the slides over the other, might be due to Fracture or advanced degenerative disease of cervical spine.
  • Other causes of pain may be due to infection, fibromyalgia, sprain and strain, spinal tumor, myofacial pain.

Symptoms of neck pain

  • Sharp shooting pain
  • Difficulty in swallowing
  • Stiffness of neck
  • Soreness
  • Pain radiating to shoulder, arms and back.
  • Numbness and tingling sensation
  • Head ache
  • Weakness of arm.

Management

  • Rest
  • Medications – Analgesics, muscle relaxants, anti-inflammatory drugs.
  • Physiotherapy
  • Alternative therapy
  • Injecting corticosteroids
  • Surgery

Cervical disc replacement: In this surgery damaged cervical disc is removed and replaced with artificial disc.

Anterior cervical corpectomy: Indicated in patients with spinal stenosis. In this procedure, one or more cervical body is the removed along with disc on either side, and a graft is placed.

Posterior cervical foraminotomy: Indicated in cervical foraminal stenosis, part of foraminal is cut to relive the compression of nerves.

Posterior cervical laminectomy: It is a decompression procedure. Indicated in patients with cervical stenosis. Surgery is performed from the back of neck. In this procedure lamina, the back surface of cervical vertebrae is removed to give more space for spinal cord.

Posterior cervical laminoplasty: It is like laminectomy, only difference is lamina is not removed completely. Part of lamina is cut and repaired to relieve Compression.

Anterior cervical discectomy and fusion: Indicated in herniated or ruptured disc. It is a decompression surgery done to remove damaged disc to relive spinal cord compression, along with spinal fusion to bring stability.

Anterior cervical discectomy and fusion

Indication:

  • Herniated disc
  • Ruptured disc
  • When Non-surgical treatments failed to relieve symptoms.
  • Surgery

Prior to surgery the doctor will perform a complete physical examination, blood test and other investigations to make sure the patient is medically fit to undergo surgery.

Just Minutes before the surgery general anesthesia is administered to the patient by anesthetist and the patient’s vitals are monitored continuously by the anesthetist till the surgery is complete.

Incision is made on the front of neck and soft tissues are retracted to expose the cervical vertebrae. Surgeon cut and removes the damaged cervical disc. The open space is filled bone graft to increase stability. The bone graft is reinforced with screws and plates. Bone graft usually taken from hip bone is used. This process of bone graft joining the vertebrae is called fusion.

 Recovery

The patient is taken in a ICU for post-operative follow up for a couple of hours and later shifted to the respective ward. Most patients are discharged within a few days of surgery. Patients are advised to wear a cervical collar to support and limit the movement of neck. In addition, physiotherapy is recommended to promote healing and strengthen the neck muscle. Complete recovery from surgery will take around 4 to 6 months.

Prognosis

Anterior cervical discectomy and fusion is a very successful procedure with 92 percent success rate.

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