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Cervical Spine Surgery

Cervical spine refers to the spinal column of the neck, which is a very mobile part of the body and holds the head on to the chest. The cervical spine has a very complex anatomy subject to stressful activities and trauma on a daily basis. Cervical spine problems can lead to neck pain with or without arm pain, numbness in hands and also weakness. In severe cases it might even affect the balance while walking and difficulty in doing fine movements with our hands.

Various types of surgeries need to be performed on the cervical spine depending on the nature of one’s pathology. It is recommended to have a good discussion with your doctor regarding the various surgical options.

Some commonly done cervical spine surgeries include :

1. Anterior Cervical Discectomy And Fusion (ACDF)
2. Cervical Disc Replacement (Cervical Arthroplasty)
3. Cervical Laminectomy
4. Cervical Laminoplasty

Anterior Cervical Discectomy And Fusion (ACDF)

It is done from the front of neck and involves complete removal of the damaged/prolapsed disc, replacement with a piece of bone or plastic spacer for support and then supplementation of the vertebral bodies with a metal plate and screws. This causes joining (fusion) of the adjacent vertebrae into one solid block. It can be done at one or multiple levels depending on the extent of involvement.

• Common indications of (reasons for performing) this procedure include
  • Cervical disc prolapse / slip disc : This is a condition in which there is a tear in the outer layer of the disc causing the jelly like material inside to come out and press upon the spinal cord and nerves. This causes shooting pain down the arm associated with feeling of pins and needles. In severe cases it might be associated with numbness and weakness of muscles supplied by that nerve. Surgery is indicated when symptoms fail to improve with conservative (medical) treatment or there is progressive (increasing) weakness of the muscles due to ongoing (worsening) nerve compression or myelopathy(damage) affecting balance of the body and fine movements of the hand.
  • Spinal Stenosis : age related (or ongoing) degeneration (wear and tear) causes reduction in height of disc spaces and arthritic changes in the small joints (Uncovertebral joints) of the cervical spine. This results in compression of the exiting nerves causing a feeling of pins and needles in the arm and in severe cases may be associated with numbness and weakness of specific group of muscles.
  • Sometimes for infections, traumatic injuries and tumors around the spine.
• What to expect after the surgery?
  There is significant improvement in arm pain and feeling of pins and needles immediately after the surgery and these continue to improve further on. Numbness and weakness of muscles associated with severe compression that has been for a long duration take around 3-6 months to recover.
• Risks and Complications
  All surgical procedures carry some risk of a complication. They can be minor or major. But overall with advancement in surgical techniques, equipment and preoperative assessment their incidence is very low.

  • Risks of anaesthesia : Since all spine surgeries are done under general anaesthesia there could be some soreness of voice after the surgery. Very rarely there could be an allergic reaction to the anaesthetic agent. Please speak to your doctor in detail about any allergies you have before planning the surgery.
  • Risks of surgery : Since this surgery is done from front of the neck in some patients after the surgery the voice becomes heavy and less loud. This happens to due to pull on the nerves to the speech cords (vocal cords) during the surgery in the neck and recovers in 1-2 weeks after the surgery. Some patients also complain of difficulty in swallowing liquids and food after the surgery which recovers in a few days after the surgery. It happens due retraction of food pipe (oesophagus) during the surgery and because of the irritation by the plate fixed onto the vertebrae. Overall there is a minor risk of superficial skin infection, excessive bleeding, or injury to the nerve roots causing weakness of specific group of muscles. Very rarely one of the outer layers of the nerve or spinal cord might be injured during the surgery which can cause leakage of spinal fluid. All surgeries are done under the cover of antibiotics but still there is a very rare possibility of an infection after the surgery which requires further course of antibiotics. In extremely rare situations due to injury to the spinal cord or nerve roots there can be paralysis of limbs or weakness of specific group of muscles.
  • Postoperative period : After the surgery there is a minor risk of temporary worsening of any pre-existing medical condition like diabetes, asthma or hypertension (BP). But we always involve a physician both before and after the surgery to take care of these medical conditions.
  • Exceptionally rarely there is the possibility of bladder infections, DVT (clotting of blood in the calves) or serious medical conditions like stroke, pneumonia, cardiac or kidney failure.
  • In fusion surgeries of the spine there always is a rare possibility of non – fusion (pseudoarthrosis) in which the bone fails to join to the adjacent bone. Not always does it require a repeat surgery. Its incidence is more in smokers, patients having multiple level surgeries or those who have had radiation therapy for cancers.

Cervical Disc Replacement (Cervical Arthroplasty)

It is done for cervical disc problems in relatively younger individuals. It involves complete removal of the disc and replacing it with a prosthesis made up of metal and plastic. Its advantage is that it preserves the mobility of the involved vertebrae.

• Common indications of this procedure include
  • Cervical disc prolapse/slip disc : It is a condition in which there is a tear in the outer layer of the disc causing the jelly like material inside to come out and irritate the spinal cord and nerves. In the cervical spine it causes shooting pain running down the arm associated with feeling of pins and needles. In severe cases it might be associated with numbness and weakness of muscles supplied by that nerve. Surgery is indicated when symptoms fail to improve with conservative treatment or there is progressive weakness of muscles due to ongoing nerve compression or myelopathy affecting balance of the body and fine movements of the hand.
• What to expect after the surgery?
  There is significant improvement in arm pain and feeling of pins and needles after the surgery and the improvement continues for 6-12 months. Numbness and weakness of muscles associated with severe compression for a longer duration take around 3-6 months to recover.
• Risks and Complications
  All surgical procedures carry a risk of complication. They can be minor or major. But overall with advancement in surgical techniques and equipment and preoperative assessment their incidence is very low.

  • Risks of anaesthesia : Since all spine surgeries are done under general anaesthesia there could be some soreness of voice after the surgery. Very rarely there could be an allergic reaction to the anaesthetic agent. Please speak to your doctor in detail about any allergies you have before planning the surgery.
  • Risks of surgery : Since this surgery is done from front of the neck in some patients after the surgery their voice becomes heavy and less loud. This happens to due to retraction of the nerve to the speech cords (vocal cords) in the neck and recovers in 1-2 weeks after the surgery. Some patients also complain of difficulty in swallowing liquids and food after the surgery which recovers in few days after the surgery. It happens due retraction of food pipe (oesophagus) during the surgery and because of the irritation by the plate fixed onto the vertebrae. Overall there is a minor risk of superficial skin infection, excessive bleeding, or injury to the nerve roots causing weakness of specific group of muscles. Very rarely one of outer layers of the nerve or spinal cord might be injured during the surgery which can cause leakage of spinal fluid. All surgeries are done under the cover of antibiotics but still there is a very rare possibility of an infection after the surgery which requires further course of antibiotics. In extremely rare situations due to injury to the spinal cord or nerve roots it can cause paralysis of limbs or weakness of specific group of muscles.
  • Postoperative period : After the surgery there is a minor risk of worsening of any medical condition you had before like diabetes, asthma or hypertension (BP). But we always involve a physician both before and after the surgery to take care of these medical conditions.
  • Rare possibility bladder infections, DVT (clotting of blood in the calves) or serious medical conditions like stroke, pneumonia or kidney failure.

Cervical Laminectomy

It is a procedure done from back of the neck in which part of the lamina (bony enclosure of spinal cord) is removed thereby increasing space for the cord and reducing the pressure on it.

• Common indications of this procedure include
  • Cervical Myelopathy : It is a condition in which the space for the cervical spinal cord is reduced at single or multiple levels causing severe compression of the cord leading to imbalance while walking, loss of fine hand movements like buttoning your shirt or writing, changes in your handwriting and in severe cases weakness of arms and legs with problems passing urine and controlling bowels. It requires early surgery.
  • Infections and tumors around the spine
• What to expect after the surgery?
  Since myelopathy is a long standing problem surgery is mainly indicated to prevent further worsening of the spinal cord function thereby limiting disability. Recovery of weakness and improvement in numbness happens at a different rate in different individuals based on the duration and severity of compression.
• Risks and Complications
  All surgical procedures carry a risk of complication. They can be minor or major. But overall with advancement in surgical techniques and equipment and preoperative assessment their incidence is very low.

  • Risks of anaesthesia : Since all spine surgeries are done under general anaesthesia there could be some soreness of voice after the surgery. Very rarely there could be an allergic reaction to the anaesthetic agent. Please speak to your doctor in detail about any allergies you have before planning the surgery.
  • Risks of surgery : Some patients have complaints of shooting arm and shoulder pain after a few days of surgery. This happens due to adjustment of the spinal cord (nerves) after the surgery and recovers in a few weeks’ time. Overall there is a minor risk of superficial skin infection, excessive bleeding, or injury to the nerve roots causing weakness of specific group of muscles. Very rarely one of the outer layers of the nerve or spinal cord might be injured during the surgery which can cause leakage of spinal fluid. All surgeries are done under the cover of antibiotics but still there is a very rare possibility of an infection after the surgery which requires further course of antibiotics. In extremely rare situations due to injury to the spinal cord or nerve roots there can be paralysis of limbs or weakness of specific group of muscles.
  • Postoperative period : After the surgery there is a minor risk of worsening of any medical condition you had before like diabetes, asthma or hypertension (BP). But we always involve a physician both before and after the surgery to take care of these medical conditions.
  • Rare possibility bladder infections, DVT (clotting of blood in the calves) or serious medical conditions like stroke, pneumonia or kidney failure.

Cervical Laminoplasty

It is a similar procedure as laminectomy for increasing the space for the spinal cord but with the advantage of reducing postoperative neck pain.

• Common indications of this procedure include
  • Cervical Myelopathy : It is a condition in which the space for the cervical spinal cord is reduced at single or multiple levels causing severe compression of the cord leading to imbalance while walking, loss of fine hand movements like buttoning your shirt or writing, changes in your handwriting and in severe cases weakness of arms and legs with problems passing urine and controlling bowels. It requires early surgery.
• What to expect after the surgery?
  Since myelopathy is a long standing problem surgery is mainly indicated to prevent further worsening of the spinal cord function thereby limiting disability. Recovery of weakness and improvement in numbness happens at a different rate in different individuals based on the duration and severity of compression.
• Risks and Complications
  All surgical procedures carry a risk of complication. They can be minor or major. But overall with advancement in surgical techniques and equipment and preoperative assessment their incidence is very low.

  • Risks of anaesthesia : Since all spine surgeries are done under general anaesthesia there could be some soreness of voice after the surgery. Very rarely there could be an allergic reaction to the anaesthetic agent. Please speak to your doctor in detail about any allergies you have before planning the surgery.
  • Risks of surgery : Some patients have complaints of shooting arm and shoulder pain after a few days of surgery. This happens due to adjustment of the spinal cord/nerve after the surgery and recovers in few weeks time. Overall there is a minor risk of superficial skin infection, excessive bleeding, or injury to the nerve roots causing weakness of specific group of muscles. Very rarely one of the outer layers of the nerve or spinal cord might be injured during the surgery which can cause leakage of spinal fluid. All surgeries are done under the cover of antibiotics but still there is a very rare possibility of an infection after the surgery which requires further course of antibiotics. In extremely rare situations due to injury to the spinal cord or nerve roots there can be paralysis of limbs or weakness of specific group of muscles.
  • Postoperative period : After the surgery there is a minor risk of worsening of any medical condition you had before like diabetes, asthma or hypertension (BP). But we always involve a physician both before and after the surgery to take care of these medical conditions.
  • Rare possibility bladder infections, DVT (clotting of blood in the calves) or serious medical conditions like stroke, pneumonia or kidney failure.

Other cervical spine surgeries include Posterior cervical fusion techniques, cervical corpectomy and reconstruction, occipito-cervical fusion, and posterior cervical foraminotomy. Your doctor will decide which options are best for you depending on the specific circumstances after having a good discussion with you.