What Is Cervical Spine Surgery?

Anatomy of the cervical spine

 

The spine, also known as the vertebral column, stretches from the base of the skull to the lower back. It is a collection of 33 irregularly shaped bones, called vertebrae, stacked on top of one another. Vertebrae are separated by intervertebral discs and are connected by ligaments, muscles, and tendons, which provide stability and support to the spine. 

 

The uppermost part of the spine, extending from the first to the seventh vertebra is called the cervical spine. The first vertebra, C1, is known as the atlas, and the second vertebra, C2, is known as the axis. These two vertebrae are unique in their shape and function, allowing for a greater range of motion in the neck. The atlas supports the head and allows for nodding, while the axis allows for rotation of the head.

 

The cervical spine is responsible for protecting the spinal cord as it travels from the brain to the rest of the body, supporting the head and allowing for the movement of the neck. The cervical spine is also home to several important structures, including the vertebral arteries, which supply blood to the brain, and the cervical nerve roots, which control sensation and movement in the arms and hands.

 

What conditions most often affect the cervical spine?

 

Due to the important functions of the cervical spine, conditions affecting the area can be very dangerous. Treatment options depend on the severity of the condition and the symptoms experienced. Mild cases can often be treated with physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), or other non-surgical interventions. The most common conditions that affect the cervical spine include:

 

Cervical Disc Herniation: 

 

An intervertebral disc herniation is when the intervertebral disc between two vertebrae ruptures and protrudes. The protruding part puts pressure on the spinal cord. When this happens in the neck, it can cause neck pain that radiates to the shoulders, arms, and hands, as well as weakness, numbness or tingling sensations in the upper extremities. In severe cases, cervical intervertebral disc herniations can cause difficulty with coordination, difficulty walking, or even paralysis.

 

Cervical Spondylosis: 

 

Cervical spondylosis is a condition where the spinal discs and joints in the neck lose moisture and become less flexible, leading to degeneration. The primary cause of cervical spondylosis is the natural ageing process and normal wear and tear.  

 

Common symptoms of cervical spondylosis include pain in the neck, shoulders, and arms, stiffness in the neck and upper back, and reduced mobility and flexibility. In some cases, this condition can also cause headaches, dizziness, and tingling or numbness in the arms and hands.

 

Cervical Radiculopathy: 

 

Cervical Radiculopathy is a condition where a nerve in the neck is compressed or irritated due to a herniated disc, bone spurs, or other conditions that narrow the spinal canal. 

 

Common symptoms of cervical radiculopathy include pain in the neck, shoulder, or arm, tingling or numbness in the arms, hands, or fingers, weakness in the arms, and difficulty with fine motor movements or grip strength. These symptoms can be mild or severe, depending on the degree of nerve compression or irritation.

 

Cervical Stenosis: 

 

Cervical stenosis is when the spinal canal in the neck becomes narrowed, leading to compression of the spinal cord and nerve roots. This can be caused by a variety of factors, including ageing, injury, or degenerative changes in the spine. As the spinal canal narrows, pressure is placed on the spinal cord and nerves.

 

Common symptoms of cervical stenosis include pain, weakness, or numbness in the arms and legs, as well as difficulty with balance and coordination. In severe cases, cervical stenosis can lead to loss of bladder or bowel control.

 

Whiplash: 

 

Whiplash is a common condition that occurs when the neck is forcefully and suddenly jerked forward and backwards, often as a result of a car accident. This sudden movement can cause injury to the soft tissues of the neck, including muscles, ligaments, and tendons. Symptoms of whiplash may include neck pain, stiffness, and limited range of motion, as well as headaches, dizziness, and fatigue.

 

In addition to muscle strains and sprains, whiplash can also lead to disc herniation or other cervical spine injuries. 

 

Spinal Cord Injury: 

 

Trauma to the cervical spine can cause damage to the spinal cord, leading to partial or complete loss of sensation or movement in the arms and legs, as well as other complications such as difficulty breathing, changes in blood pressure, and loss of bladder or bowel control. Immediate medical attention is necessary in case of spinal cord injury, as delaying treatment can increase the risk of permanent damage to the spinal cord.

 

Cervical spine surgeries

 

It's important to seek medical attention if you experience symptoms relating to any of the conditions mentioned above, as prompt diagnosis and treatment can help prevent further damage and improve outcomes. Treatment plans involving surgery will also commonly involve non-surgical treatments to support surgical intervention. The following surgeries are common for the cervical spine:

 

Discectomies

 

A discectomy is a surgical procedure used to remove a portion or all of a herniated disc in the spine that is pressing on a nerve root or the spinal cord. There are several different types of discectomies, depending on the location of the affected disc, the severity of the condition and the tools used during surgery. 

 

An Endoscopic Discectomy is a minimally invasive surgery that involves making a small incision and inserting an endoscope into the affected area. An endoscope is a thin, flexible tube with a camera and light attached to the end. The camera allows the surgeon to visualize the herniated disc, and specialized instruments are used to remove the damaged portion of the disc.

 

An Anterior Cervical Discectomy and Fusion is a surgical procedure used to treat cervical spine conditions such as herniated or degenerative discs, spinal stenosis, or bone spurs that are putting pressure on the spinal cord or nerve roots. The procedure involves making a small incision in the front of the neck and removing the affected disc. The space left by the removal of the disc is then filled with a bone graft or implant, which promotes the fusion of the two adjacent vertebrae over time.

 

A Posterior Cervical Discectomy is a surgical procedure used to remove a damaged or herniated disc in the cervical spine that is compressing the spinal cord or nerve roots. Unlike an anterior cervical discectomy and fusion which is performed from the front of the neck, a posterior cervical discectomy is performed through the back of the neck. After the disc is removed, the surgeon may also perform a spinal fusion to stabilize the spine and prevent future disc herniation. 

 

Disc replacement

 

Some conditions such as herniated discs, degenerative disc disease, or spinal stenosis can be treated by removing the affected disc and replacing it with an artificial disc implant. Intervertebral disc implants are designed to mimic the natural movement and shock absorption of a healthy disc and are typically made of metal or a combination of metal and plastic.

 

Cervical artificial disc replacement is considered an alternative to traditional cervical spine fusion surgery, which eliminates motion at the affected spinal segment. It allows for the preservation of motion at the treated segment, potentially reducing the risk of further degeneration of adjacent intervertebral discs and improving patient outcomes.

 

Laminectomies

 

A cervical laminectomy is used to relieve pressure on the spinal cord or nerve roots in the cervical spine by removing the lamina, a bony arch that covers the back of the spinal canal.

 

A procedure is an open surgery that involves an incision in the back of the neck. The muscles and tissues are gently moved aside to expose the vertebrae, and the lamina is carefully removed using specialized instruments. The removal of the lamina allows the surgeon to access the spinal canal and remove any tissue or bone that may be compressing the spinal cord or nerve roots, such as herniated discs, bone spurs, or tumours.

 

Foraminotomy

 

A foramen is a small hole in a bone that allows nerves to travel through. Spinal nerves exit the spinal column through various foramina in the stacked vertebrae, extending from the neck to the lower back. 

 

A foraminotomy involves widening a foramen, in order to relieve pressure on the spinal nerves that run through it. During the procedure, the surgeon removes a small portion of bone or tissue from the foramen to create more space for the nerve root and alleviate pressure. 

 

The procedure is typically done under general anaesthesia and may be performed using traditional open surgery or minimally invasive techniques. A foraminotomy is often used to treat conditions such as herniated discs, spinal stenosis, bone spurs, or other degenerative changes that cause nerve compression and lead to pain, numbness, or weakness in the arms or legs.

 

Conclusion

 

Several conditions can affect the cervical spine, including cervical disc herniation, cervical spondylosis, cervical radiculopathy, and cervical stenosis. These conditions can cause pain, weakness, numbness, and even paralysis in severe cases. Treatment options for these conditions depend on the severity of the condition and the symptoms experienced by the patient. Surgical treatment plans will also commonly involve non-surgical treatments to support the surgical intervention, such as physical therapy, medications, or lifestyle changes.