If nonsurgical treatments fail to reduce neck pain and associated signs and symptoms, especially those related to compression of the spinal cord or nerve roots, surgery may be considered.
3 Reasons for Neck Surgery
Surgery to relieve neck-related pain is typically performed for one or more of the following reasons:
- To decompress a nerve root (by removing a damaged disc and/or other problematic structure)
- To decompress the spinal cord
- To stabilize the cervical spine
If imaging and diagnostic tests cannot confirm one of these reasons for the neck pain and/or related signs and symptoms, such as pain, tingling, or weakness that goes into the arm, surgery is unlikely to help and is not recommended.
Common Types of Surgery for Neck Pain
The two most common surgery options for neck pain are designed to remove a damaged disc and restore normal spacing within the vertebral level to decompress a nerve root and/or the spinal cord.
Anterior cervical discectomy and fusion (ACDF)
The most common surgery for neck pain involves a discectomy, which is the removal of a problematic disc in the cervical spine. Typically, the surgery is performed through the front of the neck, called anterior cervical discectomy. This procedure is done in conjunction with a cervical spinal fusion to maintain spinal stability where the disc was removed.
Another way to do a discectomy is through the back of the neck, called posterior cervical decompression or microdiscectomy, where only part of the disc is removed and no spinal fusion is needed. The location of the cervical disc herniation must be accessible with minimal manipulation of the spinal cord. If the location is too central, it is safer to use the ACDF approach.
Cervical artificial disc replacement (ADR)
A somewhat newer option is discectomy with artificial disc replacement. This surgery involves removal of the damaged disc and replacement with an artificial disc, rather than a fusion.
Compared to ACDF, a potential benefit of cervical ADR is that it retains more natural neck mobility. As a somewhat newer method, however, it is practiced by fewer surgeons than ACDF and longer-term outcomes are still being studied.
ACDF is still considered the gold standard for neck pain surgery, but cervical ADR has been gaining in popularity. In some cases, such as when advanced spinal degeneration is present, ACDF may still be an option but not cervical ADR.
Other Surgical Options for Spinal Decompression
Sometimes other surgical options may be used instead of or in conjunction with a discectomy to help relieve signs and symptoms related to cervical nerve root or spinal cord compression.
- Posterior cervical laminectomy is done through the back of the neck and involves the removal of a lamina, which is the back part of a vertebra. A potential advantage to this surgery is that more flexibility in the neck can be retained if a spinal fusion can be avoided. Sometimes a spinal fusion is still done in conjunction with laminectomy.
- Posterior cervical laminoplasty is similar to the laminectomy, except the lamina is not completely removed. Rather the lamina is cut and restructured to make more space in the spinal canal.
- Posterior cervical foraminotomy is performed through the back of the neck and a small part of the foramen is removed. If a nerve is irritated by a herniated disc, the surgeon might remove part of the disc. If a nerve is irritated by a bone spur, the surgeon chisels away that bone spur. No spinal fusion is needed.
- Anterior cervical corpectomy is similar to anterior cervical discectomy, except that it involves the removal of at least one vertebral body (the cylindrical bone at the front of a vertebra) along with the adjacent discs above and below that vertebra. After the removal, a bone graft and/or cage is placed to fill the space and set up a favorable environment for the bones to fuse together into one solid segment. This surgery is rarely done, but it may be an option for spinal cord compression at multiple spinal levels.
Similar to the discussion about posterior cervical discectomy, the location of bone spur must be approachable without significant manipulation of the spinal cord.
Neck Pain Surgery Risks
While modern neck surgery procedures are relatively safe, they still carry risks for potentially serious complications, such as infection, allergic reaction, excessive bleeding, or paralysis. If a surgical solution is considered, all appropriate nonsurgical options must have been exhausted, the patient is considered a good surgical candidate, and the surgeon has reviewed the risks, benefits and alternatives of surgical treatment with the patient as well as answering all questions.
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