Cervical
Spine Surgery FAQ's:
|
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, Pilate's, 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 bony fusion grows.
The Bryan Artificial
Cervical Disc and Prestige
Artificial Disc are available, and 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 Anterior Cervical Discectomy and Fusion
cases, a collar is 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. |
After
spine surgery, do I need antibiotics before getting
my teeth cleaned?
According to a joint study by AAOS (American Association
of Orthopedic Surgeons) and the American Dental Association.
At this time antibiotics are recommended for two years
following an implant procedure. Notify your dentist
when scheduling an appointment. The dentist will prescribe
the recommended antibiotic if necessary. |
After a spinal
fusion, will the instrumentation in my body set off the
alarm at the airport?
It is recommended, but not mandatory that you advise the
TSA officer of an implanted medical devise. With the current
screening system, patients have not reported setting off
the alarm. With the advent of full body scanners, this
may change. |
Should
I donate blood before surgery?
There are pros and cons in donating blood prior to surgery. Generally, Dr.
Pashman does not require patient's to donate blood prior to a surgical procedure. More
information can be found here. |
Related links:
Cervical cases performed
by Dr. Pashman
Spinal Anatomy
Abnormal Anatomy
Cervical Anatomy
Anterior Cervical Discectomy
Anterior Cervical Fusion
Comparison of Artificial
Cervical Discs
www.NeckPainExplained.com
|
