SURGICAL OPTIONS for CERVICAL RADICULOPATHY
Neck surgery usually is considered a treatment for neck pain only when all other approaches have failed. Most doctors would rather a patient first try treating their neck pain using medicine, rest, and physical therapy. For one thing, with all its risks and side effects, there is no guarantee neck surgery will help. However, when successful, it can provide the pain relief you’re looking for.
There are times when surgery is the best option for treating the medical condition responsible for your neck pain. Neck surgery is generally performed for one of these reasons:
- To relieve pain caused by a nerve root that’s being pinched by bone spurs or material from a ruptured or herniated disc, a condition called cervical radiculopathy. More than 9 of 10 patients who have a herniated disc removed enjoy complete or significant relief of their pain.
- To remove pressure on the spinal cord caused by bone spurs, a condition known as spinal stenosis. This involves more complex surgery, and the success rate ranges from 50 to 90 percent, depending on the factors involved.
- To keep vertebrae from grinding together as a result of degenerative disc disease, which creates neck pain from pinched nerves.
The primary goal of surgery is to relieve your symptoms by decompressing, or relieving pressure on, the compressed nerves in your neck. Other goals of surgery include:
- Improving neck pain
- Maintaining stability of the spine
- Improving alignment of the spine
- Preserving range of motion in the neck
In most cases, surgery for cervical radiculopathy involves removing pieces of bone or soft tissue (such as a herniated disc)—or both. This relieves pressure by creating more space for the nerves to exit the spinal canal.
There are three surgical procedures commonly performed to treat cervical radiculopathy. They are:
- Anterior Cervical Discectomy and Fusion (ACDF)
- Artificial Disc Replacement (ADR)
- Posterior Cervical Laminoforaminotomy
The procedure your doctor recommends will depend on a number of factors–most importantly, the type and location of your problem. Other factors include:
- Your preference for a procedure
- Your doctor’s preference and experience
- Your overall health and medical history (including whether you have had prior neck surgery)
Anterior Cervical Discectomy and Fusion (ACDF)
ACDF is the most commonly performed procedure to treat cervical radiculopathy. The procedure involves removing the problematic disc or bone spurs and then stabilizing the spine through spinal fusion.
The goals of ACDF are to:
- Restore alignment of the spine
- Maintain the space available for the nerve roots to leave the spine
- Limit motion across the degenerated segment of the spine
Procedure. An “anterior” approach means that the doctor will approach your neck from the front. He or she will operate through a 1- to 2-inch incision along the neck crease. The exact location and length of your incision may vary depending on your specific condition.
During the procedure, your doctor will remove the problematic disc and any additional bone spurs, if necessary. The disc space is restored to the height it was prior to the disc wearing out. This makes more room for the nerves to leave the spine and aids in decompression.
Artificial Disc Replacement (ADR)
This procedure involves removing the degenerated disc and replacing it with artificial parts, as is done in hip or knee replacement. The goal of disc replacement is to allow the spinal segment to keep some flexibility and maintain more normal motion.
Similar to ACDF, your doctor will use an “anterior” approach for the surgery—making a 1- to 2-inch incision along the neck crease. The exact location and length of your incision may vary depending on your specific condition.
During the surgery, your doctor will remove your problematic disc and then insert an artificial disc implant into the disc space. The implant is made of all metal or metal and plastic. It is designed to maintain the motion between the vertebrae after the degenerated disc has been removed. The implant may help restore the height between the vertebrae and widen the passageway for the nerve roots to exit the spinal canal.
Posterior Cervical Laminoforaminotomy
“Posterior” refers to the back part of your body. In this procedure, the doctor will make a 1- to 2-inch incision along the midline of the back of the neck. The exact location and size of your scar may vary depending on your condition.
During a posterior cervical laminoforaminotomy, the doctor uses a burr and other specialized tools to thin down the lamina—the bony arch that forms the backside of the spinal canal. Removing this allows the doctor better access to the damaged nerve.
He or she then removes the bone, bone spurs, and tissues that are compressing the nerve root. If your compression is due to a herniated disc, your doctor will remove the portion of the disc that is compressing the nerve, as well.