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A Vote for Doing Select Neck Surgeries through the Back of the Neck

Much debate continues about the best way to do surgery on the neck (cervical spine). Should the surgeon go through the front (anterior) or back (posterior) of the neck? This study reports the pros and cons for both and reviews the results of 19 patients treated with the posterior method.

Neck, arm, and hand pain can occur as a result of problems in the cervical spine. Aging or injury can cause damage to the discs between the bones (vertebrae) of the neck. The disc may push out of its space and press against the spinal cord or spinal nerve roots. Besides severe pain, the patient may have numbness, weakness, and loss of hand and arm function.

When all other treatments fail, surgery is an option. The disc can be removed and the neck fused in place. This is when the doctor must decide to work from the front or back. The anterior approach works well for the middle section of the cervical spine. But positions high up (near the skull) or down low (at the shoulder level) pose some problems. Soft tissues and blood vessels in these areas must be moved out of the way.

The posterior approach has been given "thumbs down" by some doctors for several reasons. There is a chance the neck could become unstable and even end up in a deformity where the neck bends too far forward. There is also a greater risk of infection or puncture of the lining around the spinal cord with this method.

Many doctors and studies support the use of the anterior approach to cervical spine surgery. However, the authors of this study report excellent results using a posterior approach when the disc presses out to one side. The "back door" method gives the doctor a better view of the area and more room to work. If less than 50 percent of the joint is removed, the neck remains stable. They conclude that the posterior approach is both safe and effective for some patients.

References: James S. Harrop, MD, et al. Cervicothoracic Radiculopathy Treated Using Posterior Cervical Foraminotomy/Discectomy. In Journal of Neurosurgery: Spine. March 2003. Vol. 98. No. 3. Pp. 131-136.

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