Cervical Spine/Neck Pain Surgery: Decompression and Fusion
Two common types of surgical procedures that relieve neck pain are:
- Decompression: This technique involves removal of tissue that is causing pain by pressing against a nerve.
- Fusion: In this type of surgery, bones or other materials in the cervical spine are bonded together in order to stabilize the spine by limiting motion between vertebrae.
Some of the surgical techniques described here are a combination of decompression and fusion.
Anterior Cervical Corpectomy and Fusion (ACCF) is a procedure that removes damaged vertebrae and invertebral discs that are compressing the spinal column and spinal nerves.
ACCF is an option for patients whose experience pain that results from degeneration of the cervical spine, which has caused changes such as herniated discs and bone spurs. Such changes cause stenosis, or a narrowing of the spinal column. In clinical studies, 75 percent of patients reported satisfaction with outcomes after undergoing ACDF.
With ACCF, an incision of 2 to 4 centimeters is made in one of the neck creases. The surgeon then completely removes the cervical vertebral body and disc, including any protruding osteophytes (bone spurs) and disc fragments. This removal allows the spinal cord and nerves to return to their normal size.
The neurosurgeon then measures the resulting empty space, and an appropriate-sized cadaver bone graft is inserted into the space and attached to the vertebrae with small screws. This provides stability and promotes bone healing and fusion
TransCorporeal MicroDecompression (TCMD) is a relatively new, minimally invasive procedure for treating compressed areas of the cervical spine. TCMD is designed to maintain a patient’s full range of motion. In clinical studies, patients who had TCMD reported both function improvement and pain relief after the procedure.
With TCMD, the neurosurgeon makes a small incision through the front of the neck, and then creates a small channel in the vertebral body. This channel provides access to the spinal cord and nerve. This allows the neurosurgeon to restore normal space in the spinal cord and nerve while preserving the disc. TCMD can be performed by itself or with Anterior Cervical Discectomy and Fusion (ACDF) and/or total disc replacement.
Cervical Laminectomy is a type of decompression surgery that removes the lamina in order to enlarge the spinal canal to relieve pressure on the spinal cord or nerves caused by spinal stenosis. Cervical laminectomy has consistently been found to be effective, and safe, for relieving pain caused by degenerative disorders of the cervical spine.
The lamina is a bony arch on the back part of the vertebrae, which covers the nerve. Aging and wear can cause spinal stenosis, a slowly progressing condition that causes pinching and pressure on the spinal cord in the neck. In addition, arthritis in the spine may cause bony overgrowths within the spinal column, which also can cause pressure.
Patients who are good candidates for cervical laminectomy are those who:
- Experience pain, weakness, or numbness that radiates down the arms or legs.
- Patients whose symptoms have not been relieved by more conservative treatments, including injections, physical therapy, and medication.
- Patients whose symptoms are worsening.
In a cervical laminectomy, a surgeon makes an incision in your back over the affected vertebrae, then small instruments are used to remove the affected lamina.
Cervical laminectomy is a minimally invasive surgery, so many patients go home the day of surgery, although some patients require a short hospital stay.
Following the surgery, your neurosurgeon may:
- Recommend physical therapy to improve strength and flexibility.
- Limit activities that involve lifting, bending and stooping for several months after surgery.
- Recommend that you not return to work for a few weeks.
Cervical Laminotomy is a surgical procedure in which the neurosurgeon removes only a portion of the lamina, rather than the entire lamina as in a laminectomy.
A cervical laminotomy is often performed to relieve pressure caused by bone spurs or herniated discs. The procedure works by removing the pressure put on the nerves by the herniated disc or bone spur.
For example, a bone spur may be pressing on a nerve or narrowing the channel through which it passes. A cervical laminotomy will allow the surgeon to remove the spur and relieve the pressure. In the case of a herniated disc, the neurosurgeon removes a small area of the lamina, takes out the herniated disc and then closes the area.
Cervical Laminoplasty is a surgical treatment that relieves pain and pressure caused by degenerative change in cervical discs and the resulting narrowing of the spinal canal, a condition known as spinal stenosis.
Patients most likely to benefit from cervical laminoplasty include those who:
- Experience numbness, pain, or weakness in the arms or hands.
- Have difficulty using their hands.
- Have difficulty with balance.
With laminoplasty, a neurosurgeon will make a small incision in the back of the neck. The lamina is cut through, which immediately creates space in the spinal canal, relieving the pressure that is causing pain and other symptoms. Bone is then reconnected with small plates to enlarge the overall dimension of the canal. The surgeon removes any bone spurs at that time.
Most patients remain in the hospital for two to three days after a cervical laminoplasty. Many patients will wear a soft cervical collar for a brief period after surgery. Initial neck pain at the surgical site generally resolves within a few weeks.
After a laminoplasty, many patients have significant recovery of the nerve function within several months after surgery, if not sooner. Function may continue to improve for the next six to 18 months as the spinal cord continues to heal. Many patients will experience complete resolution of symptoms, although long-standing spinal cord compression can lead to permanent functional damage.
Foraminotomy is a minimally invasive procedure done to relieve pain caused by a bone spur or other material that is pressing on a nerve passageway. Patients report significant long-term pain relief and that movement and function were restored with foraminotomy.
The nerve passageways are called neuroforamina, and they naturally occur on the sides in the gap between vertebra.
When bone spurs or other tissue form in the neuroforamina, the resulting pressure causes pain. During a foraminotomy, the neurosurgeon removes the bone or tissue that is obstructing the passageway and pressing on the spinal nerve root.
In performing a foraminotomy, a neurosurgeon makes an incision through the skin and muscle to reach the spine. The muscles may be cut or retracted, and then bone spurs or tissues are removed, which increases the space for the nerve root.
A foraminotomy may be performed alone, or along with other surgical procedures.
Facetectomy is a procedure that involves removing the facet joint to reduce pressure on the nerve.
Facets are small joints located beneath and between each vertebra. There are two facet joints, one on each side, at each level of the vertebral column, and they provide stability to the spinal column, as well as helping us bend and move. Healthy facet joints are coated with cartilage and lubricating fluids. But because they are almost constantly in motion, facet joints often degenerate. Often, the degenerated facet joints will pinch spinal nerves, or rub against spinal nerves. Both cause pain.
Candidates for facetectomy, or removal of the facet joint, are patients who experience pain caused by facet joint degradation. Ideally, candidates should also experience one or more of these symptoms:
- Acute or chronic pain, which can be dull, sharp, deep, throbbing, shooting, or radiating to the extremities.
- Limited motor function.
- Pain that travels from the neck and into the shoulders, arms, hands, and/or fingers.
- Difficulty standing straight, walking, or sitting.
- Weakness, numbness, or a tingling sensation in the back, neck, or extremities.
- Symptoms that remain despite more conservative treatments.
In a facetectomy, which is a minimally invasive procedure, a one- to three-inch incision is made, and the neurosurgeon removes the deteriorated facet joints to ease pressure on the nerve. If a herniated or bulging disc is present, the surgeon may also perform a microdiscectomy or discectomy, which partially or completely removes the disc material. Other procedures, like a laminotomy or laminectomy, a foraminotomy or a foraminectomy, or a spinal fusion may also be performed.