Cervical Spine Surgery

Overview of Cervical Spine Surgery in India

Cervical spine surgery is typically performed on patients who have problems in the neck region of the spine, including conditions such as degenerative joint disease, trauma, and a prolapsed disc that compresses the nerve roots. Different surgical interventions can be performed, including, but not limited to, laminoplasty, cervical discectomy and fusion, disc replacement, and decompression surgery, to relieve the symptoms of severe neck pain, muscle weakness, numbness, reduced range of motion, and tingling.

Cervical spine surgery involves removing herniated discs and fusing vertebrae, plus other surgeries designed to remove tumours, treat infections, or correct other spinal deformities. Cervical spine surgeries are performed by a skilled surgeon using minimally invasive techniques to limit the amount of scarring on the body and speed up recovery times. Cervical spine surgery is a type of surgery performed on the cervical area of your spine, or neck. 

The cervix is named the cervix, because it attaches the head and upper body to the lower part of your body (the thoracic/lumbosacral sections). In cervical spine surgery, a physician may repair or replace disks or vertebrae, or address fractured or bony injuries from trauma. The cervical spine can be opened or done with robotics.

Types of Cervical Spine Surgery:

Spondylosis

Degenerative disc disease, also known as spondylosis, is the progressive degeneration of the spinal discs. Forty to fifty percent of people in their forties and fifties suffer from this common condition. It usually affects the lower back, or lumbar spine. This anomaly causes the discs to contract and lose their typical height. Surgery may occasionally be required for DDD. Among the non-surgical treatments are physical therapy and anti-inflammatory drugs. In place of the spine, a prosthetic disc can be inserted at the level of the degenerating disc.

Disc that has slipped

It is a condition where a weakness in the disc's outer surface causes the disc's inner, more delicate parts to swell outward. This condition manifests as pinpricks, backache, and pain in the arms or limbs. Two alternatives for treating this problem are disc replacement and keyhole surgery, also known as microdiscectomy spine surgery. This surgery is used when there is a prolapsed disc in the lower back.

Spondylolisthesis

It is a rare disease characterised by one vertebra bending forward on top of another. The vertebral slippage that occurs forward is usually observed in the lumbar (lower back) part of the spine. Such disc slippage causes the nerve roots attached to the consequent vertebrae to be pressed, thus leading to pain and dysfunction. Spondylolisthesis is classified into three types: congenital, isthmic, and degenerative.

Scoliosis

A spine typically consists of a straight column in the front and normal curvature of varying amounts on the sides. In scoliosis, the front side of the spine develops curvatures under certain conditions. Scoliosis results in a spine that is curved in the shape of an "S" or "C". The most common type of curvature is adolescent idiopathic scoliosis. When the curve is severe, surgery is recommended. Instrumentation is indicated to correct the deformity and facilitate fusion, thereby preventing future curves.

Tumour of the Spine

Any abnormal growths in the spine, malignant or otherwise, can apply pressure on nerves, causing pain, neurological symptoms, and paralysis. Symptoms may include muscle weakness, difficulty walking, and loss of bladder control. The treatment for this is Total Spondylectomy, which involves removing the entire vertebra in a perfect curve.

Injuries to the spine

A spinal cord injury occurs when the spinal cord is damaged from trauma or accident, loss of normal blood circulation, or a tumour eruption. There are two types of spine injuries: complete and incomplete injuries. Complete injuries result in loss of all functions below the level of injury. Incomplete injuries may result in loss of some functions below the level of injury. The purpose of the procedure is to stabilise the spine. Janet's contracture is a type of revision surgery, depending on the kind of condition a patient has. This procedure is done utilising the front and back of the neck.

Procedure:

Arthrodesis (Anterior Cervical Spinal Fusion Surgery)

Arthrodesis, or joint fusion, is a surgical procedure that connects specific bones in the neck. This procedure intends to provide a pain-free state, stabilise the bone, and restore alignment in individuals with advanced arthritis. Arthrodesis is not an option for everyone with an arthritic joint. In some posterior decompression surgeries, and in addition to the decompression itself, arthrodesis and/or lateral mass plates may need to be utilised as well. In cases of upper cervical spine instability, a posterior arthrodesis with occipital plating may be necessary.

Anterior Cervical Corpectomy Spine Surgery

Suppose the cervical disease extends beyond the disc space into the vertebral body. In that case, the spine surgeon may recommend resection of the vertebral body in addition to the removal of the disc spaces at each end of the canal to decompress the canal. A cervical corpectomy is most often performed for multi-level cervical stenosis, in which the spinal cord is compressed due to the formation of bone spurs (osteophytes) that restrict the spinal canal. The cervical corpectomy procedure is identical to that of a discectomy (anterior approach), except a larger, more vertical incision in the neck is often made to provide wider exposure.

Posterior Cervical Decompression (Microdisectomy) Surgery

Several spine surgeons opt to perform a cervical discectomy from behind the neck. An example of this is when a surgeon will perform a microdiscectomy to treat a large lateral soft disc herniation. A microdiscectomy is a surgical procedure to treat a herniated lumbar disc. Microdiscectomy is better at alleviating leg pain than lower back pain. Microdiscectomy is accomplished by making a small incision in the midline of the lower back.

Posterior Cervical Laminectomy

Cervical stenosis can compress the spinal cord and can be treated by surgery called a posterior cervical laminectomy if the majority of the compression is posterior. A posterior cervical laminectomy removes the lamina and allows for more space for the spinal cord. The results of a laminectomy vary from patient to patient. Most patients expect some improvement in their spinal cord function, as well as in their hand function and ability to walk, after undergoing a laminectomy.

Foraminotomy 

The procedure involves widening the foramina, or spaces where the nerve roots pass, to create a decompressing effect on the compromised nerve segment, thereby reducing tension on it and improving or alleviating symptoms. 

Cervical Disc Replacement 

This procedure entails the removal of the herniated/damaged piece of disc situated between two (2) adjoining vertebral bodies and replacing it with an artificial disc, relieving the symptoms and allowing for additional mobility in the cervical spine.

Here is a general outline of the cervical spine surgery procedure:

Incision under anaesthesia:  After the pre-operative preparation is completed, the surgeon gives either a full or local anaesthesia to the patient in the appropriate area for the procedure. The surgeon will make an incision from the front or back to expose the cervical spine at the vertebrae.

Accessing the spine: The surgeon will work carefully to manipulate the muscle, bone or disc of the cervical spine away from the access area to reach the target.

Decompression of the spinal cord or nerve roots: This step involves removing the vertebrae, herniated disc material, and/or bone with thickened tissue that is causing compression in the spinal cord or nerve roots.

Fusion (optional): Depending on the procedure, a spinal fusion is the next step to provide stability for abnormal movement from surface bone or muscle. Depending on the surgeon, fusion may involve the use of bone grafts, implants, fasteners, or rods to stabilise the affected areas, allowing for available motion between the vertebrae while also stabilising the area.

Closure: The surgeon closes the incision and is responsible for providing medication to avoid infection.

Post-operative care: The patient will receive medication to manage pain and blood thinners. Physical therapy is an essential part of the patient's care to facilitate maximum recovery.