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Cervical Spine Surgery FAQ's: |
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| What causes neck pain? | |
| What is a herniated disc? | |
| What is the difference between a herniated disc and a bulging disc? | |
| Are bulging or herniated discs normal? | |
| Does whiplash cause herniated discs? | |
| Should I have a MRI if I have pain? | |
| What can I do to avoid surgery? | |
| Are there alternative therapies available to help me deal with my pain? | |
| When do I need surgery? | |
| Will I have irreversible damage if I delay surgery? | |
| When do I need a fusion? | |
| Why is surgery often done through the front of the neck? | |
| What effect does a fusion have on the rest of the cervical spine? | |
| Should I have allograft or autograft bone? | |
| Will the surgery lessen my mobility? | |
| Will I have pain after my surgery? | |
| What are my chances for success? | |
| What are my risks? | |
| Will I have to wear a collar after surgery? | |
| When will I be back to my normal activities? Driving? | |
| Can I have an MRI or CT scan after fusion surgery? | |
| Will my surgery be photographed or video taped? | |
| Review stories of patient's who have had cervical spine surgery. | |
| What causes neck pain? | |
| Neck pain
has a variety of causes. Poor body mechanics, herniated discs, spinal fracture,
muscle spasms, spinal deformity, and osteoarthritis are a few reasons. Your
physician will determine if the pain is mechanical, (coming from the joint
or the disc); radicular, (coming from a nerve or nerve root); or myelopathic,
(coming from the spinal cord) and determine a treatment plan. |
|
| What is a herniated disc? | |
| A
disc is the fibrous cartilage pads that lie between the spinal vertebrae;
each is made up of two parts: a jelly-like center (the nucleus pulposus)
that loses moisture with age, and a tough outer ring (the annulus fibrosus)
that can split with age or injury A herniated disc occurs when the disc's
jelly-like center (the nucleus pulposus) ruptures the tough, fibrous outer
ring (the annulus fibrosus) oozing through small openings in the vertebrae
where nerves enter the spinal column. |
|
| What is the difference between a herniated disc and a bulging disc? | |
| A
bulging disc is a slight protrusion of the center of the disc (nucleus pulposus)
into the spinal canal. In a bulging disc, the annulus fibrosus (outer ring)
has not been ruptured. A disc herniation is a large protrusion of the nucleus pulposus (center of the disc), which has burst through the annulus fiborsus (outer ring of the disc) into the spinal canal, invading the surrounding nerves and causing pain in the neck, shoulders or arms. |
|
| Are bulging or herniated discs normal? | |
| No,
they are not "normal" in that we are not born with herniated or bulging
discs. They are very common and occur with age and natural dehydration and
degeneration of the disc. MRI studies of asymptomatic patients showed that
approximately 40% of the population has herniated or bulging discs. |
|
| Does whiplash cause herniated discs? | |
| Whiplash
refers to a sprain or strain of the muscles in the neck. This occurs when
there is a sudden flexion and extension of the neck. A disc that is bulging
or predisposed to herniation may become herniated at the time of trauma.
|
|
| Should I have a MRI if I have pain? | |
| Your
physician will determine is an MRI is necessary. Generally, an MRI is ordered
for patients that have failed conservative therapy, or have persistent pain
in the neck, shoulder, or arms, or exhibit weakness in the arms. |
|
| What can I do to avoid surgery? | |
| The
best way to avoid surgery is to keep physically fit, maintain a healthy
weight, avoid smoking, avoid repetitive motion, and use proper body mechanics.
Alternative therapies may relieve the symptoms and allow patients to avoid
or delay surgical intervention. |
|
| Are there alternative therapies available to help me deal with my pain? | |
| Alternative
therapies such as light traction, acupuncture, Pilates, anti-inflammatory
medication, a short course of steroids, or trigger point injections are
often treatment options for neck pain. While these may relieve some symptoms,
there is not a "cure" for herniated discs. |
|
| When do I need surgery? | |
| Surgery
is only indicated if conservative therapy fails, the patient becomes dysfunctional,
or the patient should experience progressive neurological problems. |
|
| Will I have irreversible damage if I delay surgery? | |
| Your
physician will advise you based on your condition. In general, if there
is severe spinal cord compression or a nerve is compressed over a period
of time there may be irreversible damage. If a patient experiences an increase
in weakness, weakness in the legs, loss of balance, or loss of bladder or
bowel control, they should be reevaluated by their spine specialist immediately. |
|
| When do I need a fusion? | |
| The
treatment plan is individualized for each patient. A fusion becomes necessary
when there is instability in the spine. This may occur because of degeneration
of the disc, a spinal deformity such as spondylosis, or during as a result
of removing a disc during surgery. A fusion is performed to reconstruct
the spine's natural balance and lordosis (curvature). Instrumentation such
as screws and plates may be used to stabilize the spine while the boney
fusion grows. The Bryan Artificial Cervical Disc Clinical Trial is underway, and this may be an alternative to fusion for some patients. |
|
| Why is surgery often done through the front of the neck? | |
| The
anterior (front) approach is preferred because the muscles in the front
of the neck naturally part and offer direct access to the disc while the
spinal cord is protected by the vertebra. Because the muscles naturally
part rather than being cut, there is less trauma and a faster recovery. |
|
| What effect does a fusion have on the rest of the cervical spine? | |
| That
is an excellent question. In a one level fusion, there is little impact
on the spine. In a multilevel fusion, the major concern about performing a fusion is adjacent segment degeneration. The discs act as shock absorbers between the vertebras. When the spine is fused, the levels above or below the fusion may absorb the sheer force from every day motion, and thus wear out the discs. When the fusion is performed with the appropriate size bone graft, the balance of the spine is maintained and the adjacent segments are at less risk of degeneration. |
|
| Should I have allograft or autograft bone? | |
| This
is decided on an individualized basis. In general, I use an allograft (donor
bone) in single level fusions, and autograft (bone graft taken from the
patient's hip) for multilevel fusions. Under some circumstances in a single
level fusion, and in multilevel fusions, using bone harvested from the patient's
hip may have a higher fusion success rate. |
|
| Will the surgery lessen my mobility? | |
| A
one level fusion does not greatly limit a patient's mobility. In a multilevel
fusion, a patient may have some decreased motion. |
|
| Will I have pain after my surgery? | |
| Most
patients have minimal pain following an anterior fusion surgery. The first
few days following surgery are the most uncomfortable, and patients often
experience a sore throat. The pain is well tolerated, and easily managed
with pain medication. |
|
| What are my chances for success? | |
| The
success of the surgery is determined by the reconstruction of the balance
of the spine and the reduction/elimination of the patient's symptoms. The
outcome is dependent on the condition of the spine and surgeon performing
the surgery. |
|
| What are my risks? | |
| There
are risks associated with any surgical procedure. The risks for a cervical
surgery include but are not limited to: inter operative complications, infection,
bleeding, hardware failure, hoarseness, paralysis, and death. |
|
| Will I have to wear a collar after surgery? | |
| In
the majority of cases, a collar is not necessary. |
|
| When will I be back to my normal activities? Driving? | |
| Patients
resume normal activities when they have recovered full coordination
and experiencing minimal pain. |
|
| Can I have an MRI or CT scan after fusion surgery? | |
| MRI
or CT scans are performed on patients that have had spinal fusion with
titanium instrumentation to rule out re-herniation or to aid
the physician in diagnosing a new problem. Always inform the imaging technician
performing the MRI or CT scan that you have spinal
instrumentation. |
|
| Will my surgery be photographed or video taped? | |
| Occasionally Dr. Pashman will take interoperative
pictures for educational purposes. The photos or video do not show any
identifying features (such as name or your face). This is covered in
your surgical consent form. If you have a preference about being photographed,
please let Dr. Pashman know when you sign the consent form. |
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