Surgical Treatment
Cervical spinal surgery
Cervical spinal surgery addresses conditions related to the cervical spine, the portion of the spinal column in the neck. There are various reasons why someone might need this kind of surgery, including degenerative disorders, injuries, spinal stenosis, and tumors. Cervical spinal surgery is a major operation and it’s usually considered only after other treatments, like medication or physical therapy, have failed to provide relief.
Below are outlined standard surgical Cervical spinal surgery procedures:
Anterior cervical discectomy is a surgical procedure that deals with cervical radiculopathy or myelopathy caused by disc herniation or osteophyte formation. The anterior approach is used to directly access the cervical spine for efficient decompression of neural elements. Indications for this procedure are determined based on clinical symptoms and imaging studies such as MRI or CT scans, which confirm nerve root or spinal cord compression.
Cervical Corpectomy is a surgical procedure that involves the removal of the vertebral body, along with adjacent intervertebral discs, for decompression of the cervical spinal cord and nerve roots. This procedure is typically indicated in cases where spinal cord compression is caused by multi-level cervical spondylotic myelopathy, tumors, fractures, or infections that a simpler discectomy cannot adequately address.
Cervical Disc Replacement is a surgical procedure designed to maintain motion in the cervical spine while alleviating symptoms associated with degenerative disc disease, herniated discs, or spondylosis that have not responded to conservative treatment. It is an alternative to the more traditional Anterior Cervical Discectomy and Fusion, especially in patients where preserving motion at the operated segment is desirable.
Cervical Foraminotomy is a surgical procedure aimed at relieving nerve root compression in the cervical spine. This compression is typically due to foraminal stenosis, often caused by degenerative changes like osteophyte formation, disc herniation, or spondylotic changes. The procedure is particularly indicated for patients presenting with radicular symptoms such as pain, numbness, or weakness in a specific nerve root distribution, where conservative treatments have not yielded adequate relief.
Cervical Laminectomy is a surgical procedure that aims to decompress the spinal cord and nerve roots in the cervical spine. It is usually performed on patients with cervical spinal stenosis, which is often caused by degenerative changes such as hypertrophy of the ligamentum flavum, osteophyte formation, or spondylotic changes that lead to spinal canal narrowing. This procedure is also used to address certain spinal tumors, infections, or congenital anomalies that cause spinal cord compression.
Cervical Laminoplasty is a surgical procedure designed to relieve pressure on the spinal cord in the neck region while maintaining spinal stability and motion. It is primarily used to treat cervical myelopathy caused by spinal canal stenosis, which can occur due to degenerative changes, congenital narrowing, or ossification of the posterior longitudinal ligament. Unlike laminectomy, which involves removing parts of the vertebrae, laminoplasty expands the spinal canal by partially cutting and hinging the laminae, which reduces the risk of postoperative instability and eliminates the need for spinal fusion.
Anterior Cervical Corpectomy and Fusion (ACCF) is a surgical procedure primarily aimed at addressing multilevel cervical spondylotic myelopathy, significant disc herniations, tumors, infections, or traumatic injuries of the cervical spine. The procedure involves the removal of one or more vertebral bodies (corpectomy) and the intervertebral discs to decompress the spinal cord and nerve roots, followed by fusion to stabilize the spine.
Anterior Cervical Discectomy and Fusion (ACDF) is a standard surgical procedure to relieve spinal cord or nerve root pressure in the cervical spine, typically caused by herniated discs, degenerative disc disease, or spondylosis. The procedure is particularly indicated for patients presenting with radiculopathy, myelopathy, or both, where conservative treatments have not provided adequate relief.
Fryckholm's technique was developed to treat cervical radiculopathy, particularly in cases where soft disc herniations or spondylotic changes caused nerve root compression. This technique of posterior decompression and nucleotomy represents a significant milestone in the evolution of cervical spine surgery because it offers a motion-preserving option for selected cases of cervical radiculopathy, particularly where direct decompression of the nerve root is required and underscores the importance of tailored surgical approaches based on individual patient pathology and the continuous evolution of spinal surgical methods.
Posterior osteosynthesis and decompression represent a cornerstone in modern spinal surgery, offering a versatile and effective solution for a range of complex spinal disorders, including spinal instability, fractures, tumors, degenerative conditions, and deformities. The technique involves stabilizing the spine (osteosynthesis) using hardware like rods and screws, combined with decompression of neural elements when spinal stenosis or nerve root compression is present.
The resection of cervical spine tumors, including primary tumors and metastases, is a complex surgical procedure aimed at achieving tumor control, decompressing neural elements, and restoring or preserving spinal stability. It represents the pinnacle of complexity in spine surgery. The procedure demands a multidisciplinary approach, meticulous surgical planning, and execution.