Cervical
Treatments and Procedures
At Northern Neurosurgery and Spine, patients and health care providers are able to learn about spine anatomy, different spinal conditions, and the vast array of traditional and minimally invasive treatment options. We offer a full spectrum of spine information, ranging from simple, basic descriptions to up-to-date information from recent medical journal articles, so that you may learn as much as possible about the spine.
Anterior cervical discectomy and fusion (ACDF)
Anterior cervical discectomy and fusion (ACDF) is a type of neck surgery that involves removing a damaged disc to relieve spinal cord or nerve root pressure and alleviate corresponding pain, weakness, numbness, and tingling. A discectomy is a form of surgical decompression, so the procedure may also be called an anterior cervical decompression.
ACDF surgery can usually be done in 1 to 2 hours, but may take up to 3 or more hours. The time depends on how many discs will be removed, how badly the discs or vertebrae are diseased, and other factors. Your surgeon will give you a general idea about how long your surgery might last.
Most patients are able to go home 1-2 days after surgery. Before patients go home, physical therapists and occupational therapists work with patients and instruct them on proper techniques of getting in and out of bed and walking independently. Patients are instructed to avoid bending and twisting of the neck in the early postoperative period (first 2-4 weeks). Patients can gradually begin to bend and twist their neck after 2-4 weeks as the pain subsides and the neck and back muscles get stronger. Patients are also instructed to avoid heavy lifting in the early postoperative period (first 2-4 weeks).
Posterior Cervical Discectomy
Posterior cervical spinal fusion is fixing the bones in your neck together to steady it or prevent movement. The surgeon removes the back portion of the spine called the lamina, in order to open up the area for your spinal cord and nerves. Screws are then placed into the bones of the neck from behind and connected together with a rod along each side. The pressure on the spinal cord and/or nerves is relieved by taking out any disc or bony material that might be pushing on them before the neck is fused together.
Posterior cervical microforaminotomy/discectomy surgery is done from the back side (posterior side) of the neck. In this technique, the patient lies face down on the operating table. A small incision is done along the back of the neck. The muscle which lies behind the spine is cut and the affected part of the spine bone is exposed. Miniature surgical instruments are inserted through the incision and expose the compressed nerve or herniated disc. A small amount of bone surrounding the nerve root is carefully removed. This is called microforaminotomy. Any bulging or herniated portion of the disc will be removed, if it continues to bulge against the nerve root, which is known as microdiscectomy. Once after the nerve root is decompressed the muscles are re-approximated and the incision is closed with sutures.
Most patients stay in the hospital for 1-3 days. Before you can go home, you need to be able to:
1. Control your pain by taking oral pain medications
2. Get up and walk around on your own
3. Empty your bladder.
If you are unable to do these activities or if you have any problems from your surgery, you may need to stay in the hospital longer.
Posterior Cervical Decompression/Laminectomy
Posterior Cervical Laminectomy. Cervical stenosis can place pressure on the spinal cord. If most of the compression is in the back, the cervical stenosis can be treated with a posterior cervical laminectomy. The objective of this procedure is to remove the lamina (and spinous process) to give the spinal cord more room.
A cervical laminectomy is performed under general anesthesia. An incision is made down the middle of the back of the neck to allow the surgeon to access the back of the cervical spine. The surgeon then removes the lamina. Removing the lamina relieves the pressure on the spinal cord.
Usually, the spinal cord and nerves heal slowly and the recovery process takes some time. Your incision will be closed with sutures and will usually be taken around 2 weeks after surgery: You should take sponge baths until the sutures are removed, then you may shower. You should not soak in a tub for at least 2 weeks.
Posterior Cervical Fusion
Many neck problems are due to degenerative changes that occur in the intervertebral discs of the cervical spine and the joints between each vertebra. Other problems are the result of injury to parts of the spine or complications of earlier surgeries. The vast majority of patients who have neck problems will not require any type of operation. However, if the non-operative treatments fail to control your pain or problems, your spine surgeon may suggest a posterior cervical fusion to treat your neck problem.
In the posterior fusion, the bone graft is placed on the backside of the vertebrae. During the healing process, the vertebrae grow together, creating a solid piece of bone out of the two vertebrae. This type of fusion is used in the cervical spine for fractures and dislocations of the cervical spine, and to correct deformities in the neck such as cervical kyphosis.
- Patients usually remain in the hospital for several days after posterior cervical fusion surgery.
- Postoperative pain control will be achieved with the use of IV pain medication and/or oral pain medications. Patients are discharged home on oral pain medication.
- A catheter is typically placed in the bladder and is removed in the first one to two days after surgery.
- Patients begin a physical therapy walking program the day after surgery, and a physical therapist works with the patient to learn how to get out of bed and walk safely.
- Patients need to be comfortable with walking, climbing stairs, and getting in and out of bed before going home.
- The final goal is to make sure the gastrointestinal and urinary systems are working appropriately.
- Patients must be able to tolerate foods and urinate without difficulty prior to leaving the hospital.
Cervical Disc Replacement (Arthroplasty) using Mobi C
In a surgery with the Mobi-C Cervical Disc, the unhealthy disc is removed, but instead of a bone spacer or plastic implant along with a plate and screws, a Mobi-C is implanted into the disc space. Where a fusion procedure is intended to eliminate motion at the surgery levels, the goal of a surgery with Mobi-C is to allow motion at those levels.
The total surgery time is approximately an hour, depending on the number of spinal levels involved.
Most patients return to work within six weeks of surgery. In the U.S. Mobi–C clinical trial, the return to work time was 20.9 days shorter for Mobi–C patients compared to fusion patients for two-level surgery and 7.5 days shorter for Mobi–C patients compared to fusion for one-level surgery.
Combined Anterior and Posterior Cervical Fusion
Anterior cervical discectomy and fusion (ACDF) is a type of neck surgery that involves removing a damaged disc to relieve spinal cord or nerve root pressure and alleviate corresponding pain, weakness, numbness, and tingling. A discectomy is a form of surgical decompression, so the procedure may also be called an anterior cervical decompression.
The total surgery time is approximately 2 to 3 hours, depending on the number of spinal levels involved.
Usually, you will be able to return to your normal activities within three to six months. Neck fusion surgery recovery varies depending on how quickly the bone graft is able to fuse.