Cervical Spine Surgery

About Cervical Spine Surgery

Cervical Spine Surgery refers to a group of surgical procedures performed on the cervical (neck) region of the spine, typically between the first seven vertebrae (C1–C7). This surgery is done to treat neck pain, spinal cord compression, disc herniation, cervical instability, and degenerative disc disease. The primary goals are to relieve nerve or spinal cord pressure, restore spinal stability, and improve neck movement and quality of life.

Depending on the condition, cervical spine surgery can be done from the front (anterior), back (posterior), or both.

Types of Cervical Spine Surgery

1. Anterior Cervical Discectomy and Fusion (ACDF):
   The most common cervical surgery. The damaged disc is removed through an incision in the front of the neck, and the vertebrae are fused using a bone graft or cage. It relieves nerve compression and stabilizes the spine.
2. Cervical Disc Replacement (Arthroplasty):
   An alternative to fusion, where a damaged disc is replaced with an artificial one. This helps maintain neck mobility and reduces the risk of adjacent segment degeneration.
3. Posterior Cervical Laminectomy:
   Involves removing the lamina (back part of the vertebra) to relieve spinal cord compression. Often done in cases of cervical stenosis.
4. Posterior Cervical Foraminotomy:
   This procedure widens the space through which spinal nerves exit the spinal canal, relieving pinched nerves caused by herniated discs or bone spurs.
5. Cervical Corpectomy:
   Removes a vertebral body and adjacent discs to decompress the spinal cord and nerves, followed by fusion. Usually done in severe or multi-level compression cases.
6. Minimally Invasive Cervical Spine Surgery (MIS):
   Performed through small incisions using advanced tools and imaging, resulting in faster recovery, less blood loss, and smaller scars.

Symptoms

Cervical spine conditions may cause:

• Neck pain and stiffness
• Radiating pain to shoulders, arms, or hands
• Numbness or tingling in upper limbs
• Muscle weakness
• Headaches (often at the base of the skull)
• Loss of balance or coordination
• Difficulty with fine motor skills

Risk Factors

• Nerve Damage: A rare but serious complication causing weakness, numbness, or loss of function.
•  Spinal Cord Injury: May occur during surgery, leading to serious neurological consequences.
• Infection: May develop at the incision site or deeper tissues, potentially requiring antibiotics or further surgery.
• Hardware Complications: Implants or screws may shift, loosen, or break over time.
• Dysphagia (Swallowing Difficulties): Especially common after anterior surgeries. Usually temporary.
• Vocal Cord Paralysis: Can cause hoarseness or voice changes if the recurrent laryngeal nerve is affected.
• Adjacent Segment Disease: Degeneration of discs above or below the fused level over time.
• Nonunion or Failed Fusion: Sometimes the bones fail to heal properly, requiring revision surgery.

Investigations

Before surgery, comprehensive tests are done to assess the condition and decide the appropriate surgical approach:

• X-rays: To view alignment and detect instability.
• MRI (Magnetic Resonance Imaging): Shows soft tissue, spinal cord, and nerve compression.
• CT Scan (Computed Tomography): Offers detailed images of bone structures.
• Electromyography (EMG): Evaluates nerve and muscle function.
• Discography or Myelography: In selected cases to further assess disc issues or spinal cord involvement.

Side Effects

Side effects vary based on the type of surgery but may include:

• Neck stiffness or soreness
• Temporary hoarseness or difficulty swallowing
• Muscle spasms
• Minor bleeding or bruising
• Headache or fatigue
• Risk of blood clots or anesthesia-related issues

Most side effects are temporary and manageable with medications and physiotherapy.

Success Rate

Cervical spine surgery has a high success rate, especially when performed for nerve compression, herniated discs, or degenerative disc disease:

• ACDF has a success rate of 85–95% in relieving symptoms like arm pain and numbness.
• Artificial disc replacement helps maintain motion and has shown excellent long-term outcomes.
• Recovery time varies: most patients return to normal activities within 4 to 6 weeks, with full recovery in 3 to 6 months depending on the procedure.

Postoperative physiotherapy and regular follow-up are critical to achieving long-term success.