Neck Surgery Procedures
Prior to undergoing any type of neck surgery, the patient should understand the purpose of the surgery and have clear and realistic expectations of outcome. They have a right to a second opinion if they are unhappy with the proposed course of treatment and should only agree to a procedure if they fully comprehend its scope and likely outcome. No single surgical method works for every person or every cause of neck pain and, as such, there are myriad surgical procedures, some of which are outlined below.
Anterior Cervical Discectomy and Posterior Laminotomy
In surgery an ‘ectomy’ of any kind involves removal of some part or other, in this case it is the removal of part of a disc, and sometimes some bone around the nerves, usually to relieve pressure on nerves or neck pain.
An anterior cervical discectomy is where the surgery is conducted from the front of the neck rather than the posterior, or back, of the neck. Anterior cervical discectomy with fusion is where a bone graft is put in place to encourage vertebrae to fuse together and strengthen the spine after removal of a disc or part of the disc and bone. For more detailed information please visit our Cervical Discectomy page.
A posterior cervical laminotomy is a procedure done from the back of the neck to remove a small fragment of bone and provide better access to a problematic disc. It may precede further spinal surgical procedures such as those detailed below.
Vertebroplasty, Kyphoplasty and Larger Surgical Procedures
Surgeons may conduct a vertebroplasty, where a special cement is injected into broken vertebrae to improve its strength. Similarly a kyphoplasty is where a tube containing a deflated balloon is eased inside a fractured vertebra and then inflated allowing the injection of cement into the space reopened to restore the proper height of the collapsed vertebrae.
An extensive surgery that may be conducted in cases of spinal stenosis or cervical myelopathy is to remove the front of the spinal canal. This involves removal of substantial amounts of several vertebrae and their corresponding discs. The procedure is called a corpectomy and the resulting void is usually filled with a bone graft, often fixed in some fashion to the remaining vertebrae. The patient is likely to be placed in a restrictive jacket/corset to hold their head perfectly still while the vertebrae fuse together.
A cervical foraminotomy is used to open up the space that nerves have to travel through as they leave the spinal column. If this space is compressed, due to osteophyte growth, calcified and thickened ligaments and other bone, disc, and tissue abnormalities then the nerves can be ‘pinched’ causing the pain and paraesthesia associated with neck and
spine conditions. In this procedure an incision is made to reach the affected area (located using x-rays), the muscles around the spine are dissected or retracted to allow access to the problem area and the bone spurs, disc or ligament are removed in part or as a whole to improve the space available for the nerve roots.
‘Corpus’ means body in Latin; a corpectomy, therefore, is the removal of a large body or structure such as vertebrae and discs. In this procedure the patient has two incisions made on either side of the neck and the discs above and below the problematic vertebrae are removed along with the middle portion of the vertebrae itself (often saved for fusion later in the procedure). The underlying spinal cord and nerve roots are decompressed by this surgery, thereby relieving the source of neck pain in the majority of cases. Where the bone is defective a graft or strut is placed to provide support. Usually this is the patient’s own bone taken from the iliac crest, but sometimes bone from a bone bank is used (an allograft). Metal plates and screws may also be utilized to provide extra support and facilitate fusion. For more detailed information please visit our Corpectomy page.
There are numerous procedures surgeons may employ in the pursuit of improving a patient’s standard of living; The previous information should not be considered an exhaustive list of surgical options. The importance of post-surgical care and the potential problems involved in spinal surgery should also be thoroughly understood by those with neck pain considering their neck pain treatment options.