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MRI studies of asymptomatic
individuals indicate that 40% of patients studied have disc
abnormalities. Cervical disc herniations present with symptoms that are
analogous to those produced in the lumbar spine. Pain radiating down the
arm is a hallmark of an acute disc herniation in the cervical spine. Because
of the presence of the spinal cord, severe disc herniations can cause
spinal cord dysfunction, which include weakness in the legs and balance
problems. Generally speaking though, the presentation and duration of
symptoms in the cervical spine is similar to that of the lumbar spine.
60-80% of acute symptoms will resolve in 4-6 weeks with rest and other
conservative measures.
During this time,
the spine should not be manipulated in any way. Muscle and sensory weakness
or abnormality can be increased with any manipulation except longitudinal
traction applied gently on the neck bones. Medications such as anti-inflammatories
or a short course of low dose steroids can reduce the inflammation until
the natural history of the problem until complete resolution occurs.
For patients
who remain symptomatic beyond 6-8 weeks of conservative care a decision
about interventional treatment should be discussed between the patient
and the physician. Increasing pain is a relative indication for surgery
on the cervical spine. Muscle weakness or sensory changes which continue
for 8-12 weeks or progressive neurological deficit are strong indications
for surgical intervention. Signs of spinal cord compression such as balance
or bowel and bladder problems are another strong indication for aggressive
intervention.
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| Patient with extruded disc herniation and massive arm pain. Anterior cervical discectomy and fusion using graft and plates. Patient was discharged in 24 hours, pain free. (click on xray to enlarge) |
Unlike the lumbar
spine, simple cervical discectomy is rarely indicated. Cervical disc
fragments which are completely detached and presenting in a far posterior
lateral position, may be amenable to removal by posterior techniques
without fusion. Most cervical disc herniations are best treated with
an anterior neck approach, removal of the disc fragments in the spinal
canal coupled with an anterior interbody fusion with either the patients
bone or bank bone. The decision to place plates and screws should
be individualized for each patient.
The artificial
cervical disc may be an option for certain patients. The
Prestige Artificial Disc was approved by the FDA in July, 2007.
We anticipate that The
Bryan Artificial Disc was approved by the
FDA on May 12th, 2009.
 Click
here to view some patient cases of Anterior Cervical Disectomy and Fusion
Cases and Prestige Total Disc Replacements that Dr. Pashman has performed.
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| Two level anterior cervical disectomy and fusion . (click on image to enlarge) |
The approach to the anterior neck makes use of a plane between muscles, which is very easy to recover from. If done correctly, a single level anterior cervical discectomy and fusion might be accompanied by 24-48 hour maximum hospital stay. For single level fusions, the use of the patient's own bone versus bone from a bone bank yields similar results. Although the use of a plate and screws for a single level fusion may reduce the postoperative need for a cervical collar, the ultimate result with or without a plate is probably similar. If the fusion includes more than one level, the use of the patient's own bone as well as the use of a plate independently improves both symptomatic and surgical outcome. If the cervical discectomy is done with technical proficiency, the choice between different manufacturer's plate systems is inconsequential from a mechanical standpoint. The reconstruction of a single level fusion should never rely on the plate screw system. The bone grafts should be placed with sufficient compression, that the plates and screws only act as a neutralization device, much in a similar fashion as a cast neutralizing a broken forearm bone. Plates manufactured to current standards yield little differences in outcome despite plate thickness, screw types, and screw plate interfaces. A surgeon selling a neck surgery wholly based on a particular manufacturer's plate-screw combination should be viewed with abject suspicion.
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