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Cervical Spine Surgery

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Evolution of Cervical Spine Surgery

Initial treatment of SCDD involves a trial of non-operative management usually for 6-12 weeks, with physical therapy, medications and occasionally injections as the mainstay of treatment. If the symptoms fail to resolve or if the neurological symptoms are severe and/or progressive, then surgical management is indicated. Depending on the cause of symptomatic cervical disc disease, various surgical procedures may be used.

Patients that have a herniated disc isolated to only one side may be candidates for posterior discectomy (AKA lamino-foraminotomy), which is performed from the back of the neck and involves removing a small section of bone. This creates more space for the nerves, relieving the pressure that is causing the symptoms. However, the most common procedure both historically as well as in today’s practice for symptomatic cervical disc disease is anterior cervical discectomy and fusion (ACDF).

This involves accessing the spine through the front of the neck, removing the disrupted disc entirely, filling the void with a space-occupying substitute (e.g. bone graft, metal cage, medical grade plastic), and then fusing the two adjacent vertebrae together. Although this eliminates any movement between the two adjacent vertebral bodies thus eliminating pain caused by bone-on-bone friction, there are some drawbacks. By eliminating movement between the vertebrae, it is thought that this may potentiate degeneration of the vertebral bodies above and below the fusion as a result of the increased torque applied to these respective joints.

Fusing the two vertebrae together requires a metal plate applied to the front of the bones that can often result in esophageal irritation, although this often times transient. There is also risk for failure of the bones to fuse together (non-union), necessitating further operative management. Following the procedure, patients require immobilization in a cervical collar for 6wks to help mitigate the risk of non-union. Overall, the complication rate of this procedure is low, which is why it is the “gold standard” in today’s practice.

Although this procedure has decades of clinical follow up demonstrating good long-term outcome, there has been a shift in interest to procedures that are motion-preserving. A novel technique that is has gained popularity in last several years is Total Disc Replacement/Arthroplasty, which creates an artificial motion-preserving joint between the two bones.

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