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Cervical
Disc Herniation
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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. |
 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. The
Bryan Artificial Disc was approved by the FDA
on May 12th, 2009. |
 The approach
to the anterior neck makes use of a plane between muscles,
which is very easy to recover from. The muscles naturally
part, allowing the surgeon direct access to the spine.
The approach is made thru a small incision approximately
two inches in length. The incision is carefully made
in the natural lines of the skin to minimize scaring.
In the majority of patients, the scar is not noticable
after the initial recovery period. |
 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. |
 It
is a given that the offending compressive tissue should
be adequately removed during the surgery. Soft disc herniations
as well as bony ridges should all be removed if they
compress nerve tissue. Aside form solid, bony fusion;
one little recognized goal of any reconstruction surgery
should be the creation of normal cervical lordosis. Grafts,
which are misplaced or collapsed into kyphosis, may have
long term negative impact on the results of the surgery
over the long term. |
Related
links:
Anterior
Cervical Discectomy
Anterior
Cervical Fusion
Cervical surgery
cases perfomed by Dr. Pashman
Bryan artificial
disc
Prestige
artificial disc
Comparison of Artificial
Cervical Discs
Artificial
disc surgical procedure
Prestige artificial
disc FAQs
Neck FAQs
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