If nonsurgical treatments fail to reduce neck pain symptoms, especially those related to compression of the spinal cord or nerve roots, then surgery may be considered.
Watch: Anterior Cervical Discectomy and Fusion (ACDF) Video
3 Reasons for Neck Surgery
There are three common reasons to have surgery for a problem in the neck:
- To remove the damaged disc and/or other structures irritating a nerve root
- To stabilize the cervical spine
- To decompress the spinal cord
With the currently available diagnostic tools, exploratory spine surgery is an outdated term. The best surgical results are determined by a clear diagnosis and surgical plan.
Common Types of Surgery for Neck Pain
Here are some of the more common surgery options and what they are designed to treat:
Anterior cervical discectomy and fusion (ACDF)
The most common surgery for neck pain symptoms involves a discectomy, which is the removal of a problematic disc in the cervical spine. Typically, the surgery is done 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, so the entire surgery is called an anterior cervical discectomy and fusion, or ACDF for short.
Another way to do a discectomy is through the back of the neck, called posterior cervical decompression, where only part of the disc is removed and no spinal fusion is needed. The location of the cervical disc herniation should be accessible with minimal manipulation of the spinal cord during a posterior cervical discectomy. If the location is too central, it is safer to use the ACDF approach.
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Cervical artificial disc replacement
A somewhat newer option is discectomy with artificial disc replacement. This surgical procedure involves removal of the damaged disc and replacement with an artificial disc. This surgery is an alternative to ACDF.
A potential benefit of this surgery is that it retains more neck flexibility. As a somewhat newer method, it is practiced by fewer surgeons than ACDF and longer-term outcomes are still being studied. While preservation of motion is an exciting concept, it is still too early to say the artificial disc definitely prevents the potential for future problems related to the more traditional fusion.
There are a few different surgical options available to relieve symptoms of myelopathy and increase space in the spinal canal for the spinal cord:
- Anterior cervical corpectomy. This surgery 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 will be placed to fill the space and set up a favorable environment for the bones to fuse together into one solid segment of bone. This surgery may be done for someone who has spinal stenosis at more than one vertebra.
- Posterior cervical laminectomy. This surgery 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. However, sometimes a spinal fusion is still done in conjunction with laminectomy.
- Posterior cervical laminoplasty. This surgery is similar to the laminectomy, except the lamina isn’t completely removed. Rather the lamina is cut and restructured to make more space in the spinal canal.
Posterior cervical foraminotomy.
This surgical procedure goes through the back of the neck and a small part of the foramen is removed. If a nerve is irritated by a herniated disc, then the surgeon might remove part of the disc. If a nerve is irritated by a bone spur, then the surgeon will chisel away that bone spur. No spinal fusion is needed.
Similar to the discussion about posterior cervical discectomy, the location of bone spur must be approachable without significant manipulation of the spinal cord.
Unless the patient has a risk of permanent nerve or spinal cord injury, cervical spine surgery is almost always the patient's option, meaning that the patient can decide whether or not to have surgery and which type of surgery is preferred. It is the surgeon's role to provide education about the full range of the patient's options, both surgical and non-surgical.