FAQ Category: Cervical Spine

Even with a multilevel cervical fusion, you will still have quite a bit of neck movement. You might notice some change when you are looking back over your shoulder or if you try to look under your armpit. Neither one of those motions are essential for everyday activities. Or they can be done with the help of a mirror.

With cervical myelopathy (CM) the spinal cord is being compressed by a narrowing of the spinal canal. The spinal canal is the opening where the spinal cord travels from the skull down to the lumbar spine. CM specifically refers to the location of this problem in the neck region.

Besides pressure on the spinal cord and spinal nerves, CM can also twist or distort the neural tissue. Loss of blood supply from tugging and pulling on the blood vessels can lead to further damage.

Change in the position of the spine can result in pinching of the ligament along the back of the spine when the head and neck are extended. Over time, this has the effect of causing microtrauma to the soft tissues. The condition can get worse and worse.

Surgery to take pressure off the spinal cord also involves lining the bones up and fusing them in a good position. This relieves the pain and stabilizes the neck. Hopefully, the patient also gets increased function with less risk of long-term problems. Left untreated, the condition can progress to the point of irreversible symptoms and even paralysis in some cases.

Your surgeon would not advise you to have this surgery is you weren’t a good candidate for it. But it’s always best to go into an operation with a clear mind and a positive outlook. So perhaps before you make that final decision, ask your surgeon to explain what will be done, how it will be done, and why you are a good patient for that procedure.

There are many different ways to decompress the spinal cord. The surgeon will be planning all the details of what approach to take, what kind of incision to make, what materials to use to fuse the spine, and so on.

In all cases, the goal is to take pressure off the nerve tissue, reduce your pain, and stabilize the neck. The surgeon will also be concerned about preventing any complications or problems during and after the operation.

Studies show that there are what are called prognotic indicators for who should or shouldn’t have this operation.

Reasons to have the procedure done include:

Over the years, surgeons have tried many different methods of stabilizing a broken neck. The danger of damage to the spinal cord makes this kind of injury difficult to treat.

Hooks, wires, screws, plates, rods, and combinations of one or more of these devices have been used to hold the bones together. Fixation can be used to stabilize the neck while waiting for healing to occur.

Instrumentation of this kind has its own problems. It can pull out or migrate (move). It can also break. There’s always the risk of damage to the nerve tissue as the hardware is installed in place.

Results of fusion with screws have been good. Improvements in the hardware, better screws, and imaging during the procedure have all contributed to an improved outcome.

Newer techniques and updated materials like the translaminar screw will continue to improve this operative technique. Diving and contact sports are no longer allowed for your brother. With the right kind of rehab program and regular activity, your brother should have a very positive result.

Spine fusion is commonly done with good results. Bone growth factors such as rhBMP-2 used as a bone graft substitute work well with the lumbar spine and have been approved by the FDA.

However, the use of rhBMP-2 is not approved yet for use with the cervical spine. The manufacturer has even issued a safety alert about this product. Swelling at the front of the neck can occur causing breathing and swallowing problems.

A formal study was done by surgeons at two universities separate from the manufacturing company of this product. Patients ranging in ages from 12 to 81 years old were included. All had an anterior cervical fusion. Some received the rhBMP-2 bone substitute. Others did not.

The rhBMP-2 group had 10 times the cases of anterior neck swelling compared to the group who did not have this treatment. Complications were severe enough to keep people in the hospital longer. Some patients had to come back to the hospital for further treatment after going home.

More studies are needed before this product can be used safely in cervical spine fusions. Ask your surgeon for his or her input. It may not be an option in your area. Other methods of cervical spine fusion may be more reliable with a better safety record.

Local swelling after cervical spine (neck) fusion is a common occurrence. But this usually happens soon after the operation and is easily treated. A delayed reaction strong enough to send your father to the hospital may be something altogether different.

Did he have a bone graft using donated bone tissue? Perhaps he’s having a reaction to that. Did they use a bone graft substitute such as rhBMP-2? Reports of problems using this product in the cervical spine have been published.

Treatment may include drainage of the fluid (if there is any to drain). Many times the swelling is all through the muscles and soft tissues. There isn’t a pocket of fluid in one spot that can be drained. A CT scan will help show where the swelling located exactly.

Drugs such as steroids to reduce swelling may be given. Ice and keeping the head and neck up away from a flat position are advised. With severe breathing problems, the patient may have to have a breathing tube put in place.

With careful observation and treatment, the patient often goes home without further problems.

In the past, wearing a collar to immobilize the cervical spine (neck) wouldn’t have been recommended for this problem. Today we know that some patients can benefit from this type of treatment. Symptoms can be managed and the condition can even improve over time.

Exact protocols for cervical immobilization with collars or braces have not been worked out yet. Some studies published so far have tried eight hours/day for three months. This was followed by another three months of intermittent use. Others tried three months of constant use followed by three months of intermittent use.

It’s best to have repeat X-rays and MRIs done to show the results of treatment. If the condition has stabilized, then the collar can start to come off gradually. If you wear it constantly, muscle atrophy and weakness may occur. A gradual weaning process will help restore muscle strength and maintain the stability you’ve gained by wearing the collar.

Your doctor can best advise you on a wearing schedule to start. Changes in the schedule will come automatically with the changes seen on imaging studies.

Surgery has been the traditional gold standard of treatment for cervical spine myelopathy (CSM). This is a condition that occurs most often with aging. As the spine degenerates, bone spurs form narrowing the spinal canal. Pressure on the spinal cord can cause significant symptoms.

Surgery to remove the bone spurs takes the compressive forces off the spinal cord. This treatment relieves symptoms and stabilizes the spine. Since this was the common belief, surgeons weren’t willing to withhold surgery in order to compare results with and without the operation.

Over the years, patients who didn’t want surgery could be compared to those who had the operation. Results showed that a significant number of patients not only didn’t get worse with conservative care, they actually got better! Conservative care ranged from bedrest to activity modification to wearing a collar of some type. Physical therapy and psychologic support have also been successful treatments.

It’s probably best to pursue nonoperative care under the supervision and management of your doctor. Follow-up X-rays and MRIs will help make sure you aren’t in any danger of disability or even death, which is possible with this condition.

Even mild CSM requires careful watching. Expect to remain under your doctor’s care for years or until you stabilize. This is one of those situations when it’s better to be safe than sorry.

People who have a pattern of getting attention through various imagined (and sometimes real) aches and pains are a challenge. As you say, it’s difficult to know when to respond.

As we age, the chances of really developing something with serious consequences increases. Your father’s age is a red flag all by itself. And the fact that he’s developing new symptoms he hasn’t had before is also important.

A visit with his primary care doctor is probably in order. If your father’s symptoms are psychologic in nature, the results of sensory or motor tests will be negative (normal). A simple X-ray of the neck and spine can give the physician quite a bit of information to help sort out the symptoms.

If finances are a concern, there are a wide variety of tests that can be done by the doctor with your father in the office that don’t cost extra. It’s probably time to take a first-look. The fact that you’re concerned tips the scales in favor of an exam at this time.

Any time a person observes a cluster of changes in function or a grouping of signs and symptoms like this, it’s a good idea to see a medical doctor. Early diagnosis and treatment can make a difference in many conditions.

Most of the things you are describing can have a neurologic basis. Since there are symptoms above and below the belt, it’s more likely the spinal cord is involved. This could be a condition called cervical myelopathy.

With aging, degenerative changes in the spine and surrounding soft tissues narrows the spinal canal. This narrowing is called stenosis. Spinal stenosis can lead to pressure on the spinal cord resulting in symptoms of cervical myelopathy. Males in their 50s do seem to be affected by this condition most often.

There are other neurologic conditions to consider. Multiple sclerosis, Lou Gehrig’s disease, and rheumatoid arthritis are possibilities. There are many other neurologic conditions with similar signs and symptoms. Special tests are really needed to differentiate one from another.

Pain relief and putting an end to other neurologic symptoms is the goal of this type of decompressive surgery. For some patients, without correction of the problem, symptoms can become permanent. Pressure on the spinal cord that’s severe enough and that lasts long enough can even cause paralysis.

Surgery to take pressure off the spinal cord is helpful if it’s done soon enough. Usually this means before irreversible damage has been done. Patients who have had these kinds of symptoms for less than a year have the best results. Advanced disease can negatively impact the outcome of surgery.

Surgeons are more careful these days when suggesting surgery if there are known risk factors that could cause poor results. They are obliged to go over any and all possible risk factors. Things like vocal cord paralysis (loss of speech), blood loss, or permanent difficulty swallowing can scare anybody off but are fairly uncommon.

Before going any further, make an appointment to discuss your concerns and questions with your surgeon. Once you understand exactly what your condition is, what is planned, and the expected outcome, you may be better able to make this important decision.

Corpectomy refers to the removal of a vertebral body in the spine. Usually the disc is taken out too. This step is called a discectomy. Discectomy and/or corpectomy are done to decompress the spinal cord. This means the disc and bone are removed to take pressure off the spinal cord as it travels through the opening for the cord called the spinal canal.

Changes in the cervical spine (neck) that come with aging cause stenosis or narrowing of the spinal canal. Symptoms of neck and arm pain are common. Patients also report numbness, weakness, and other neurologic signs.

Treatment for this condition is usually nonoperative at first. Nonsteroidal antiinflammatory drugs (NSAIDs) are tried along with physical therapy. The goal is to reduce any swelling and realign the soft tissues as much as possible. Strengthening the neck and arm muscles can also help maintain motion and function.

Corpectomy isn’t usually considered until the patient has had at least six months of conservative care. Once the vertebral body is removed, then bone graft or some other means of stabilizing the spine must be done. The procedure is safe and effective for properly selected patients.

Pressure on the spinal cord from disc protrusion in the neck region is called cervical myelopathy. Patients with this problem often report pain in the neck that can go down the arms.

Other symptoms can include clumsiness of the hand(s) and numbness and tingling of the hands and feet. Sometimes the legs are affected causing problems with walking. Balance and coordination can be disrupted.

If the disc isn’t removed, it can calcify or harden. The vertebral bone nearby often forms bone spurs. With both disc material and bone spurs taking up space in the spinal canal, pressure on the spinal cord occurs.

Surgery to take pressure of the spinal cord and spinal nerves is designed to reduce painful (and other) symptoms. But it also restores the natural curve of the spine needed for a stable and normally functioning spine. There is also the hope that this type of surgery will help prevent the spine above and below the area from degenerating as well.

Any surgical procedure has its challenges and potential problems. The surgeon will go over with you and your wife what to expect during and after the operation.

The operation itself is carefully planned and orchestrated right down to how the patient is positioned and where to make the first incision. Imaging technology such as fluoroscopy help guide the surgeon throughout the procedure.

Fluoroscopy is a special type of X-ray that gives the surgeon instant images during any stage of the operation. For example the fluoroscope makes it possible for the surgeon to know for sure that the correct spinal level is being operated on.

As each disc is removed, the surgeon smoothes away any bone spurs and flattens the bone back to its original shape. Traction can be applied to restore the spine to its natural length. Various methods of bone grafting can be used. The patient makes this decision with the surgeon during a preop visit.

Problems can occur with any surgical procedure. In the case of discectomy and fusion, the type of problems may depend on the approach used for the operation. Many surgeons choose to operate from the front of the neck (anterior approach). With the anterior approach, there is a chance that the vocal cords or nerve to the vocal cords can get damaged.

Difficulty swallowing and hoarseness can occur. Newer techniques developed in the last few years have decreased the incidence of these problems dramatically. Most nerve damage is temporary and only last a few weeks or months. Permanent vocal cord paralysis occurs in about three per cent of the patients.

The benefits of this surgery are reduced pain and a stable neck. Restoring the natural disc height will also prevent further damage from occurring at the level above and below the problem area. Most patients do very well and don’t even need a collar or brace after the operation.

You may be experiencing something called Lhermitte’s sign. Flexion of the head and neck causes an electric shock-like sensation. Some people describe this as shooting pains down the arms.

The pain can shoot down the spine into the arms and/or legs anytime the head and neck are bent forward or extended backward. Lhermitte’s is an indication that pressure is being placed on the spinal cord itself.

There may be other signs and symptoms noticeable only to a physician examining you. For example there may be weakness in the hands or feet, decreased muscle tone in the muscles, and changes in deep tendon reflexes (DTRs).

You may be familiar with DTRs such as the knee or ankle jerk. The doctor taps your tendon below the knee and your leg automatically straightens. Or a tap is applied to the Achilles’ tendon above the ankle and the foot points downward.

Further tests are needed to find out why there’s pressure on the spinal cord. It could be a condition called spinal stenosis. This is a narrowing of the spinal canal where the spinal cord is located. Degenerative changes from aging are the most likely cause of spinal stenosis.

It’s best to report this symptom to your doctor and find out what’s causing it. Early intervention may help reduce long-term problems.

The term myelopathy describes any condition affecting the spinal cord. This could be the formal diagnosis for the kind of problem you are describing. Your sister may have had weakness in the hands, changes in handwriting, or even balance problems that she chose to ignore.

Signs of more severe compression include noticeable weakness in the arms and/or legs. If the condition is allowed to get worse, more serious problems can develop. Patients can lose bowel and bladder function. They may lose the ability to walk alone. Loss of strength and coordination may lead to frequent falls.

Long-term studies of patients who do not have surgery for this problem report that two-thirds of the patients affected get worse over time. They may end up in a wheelchair permanently. Medical treatment (usually surgery) is advised to stabilize the neck and prevent these types of problems.

Most people seeking acupuncture treatment are after pain relief. In many cases, if the painful symptoms can be reduced, then the person can do more, so function improves, too. With decreased pain and increased function, it’s likely that your quality of life will also improve.

Many people obtain immediate relief from pain with acupuncture. Others notice a gradual improvement over a period of hours to days to weeks. A smaller number of patients report no change and stop the treatments.

For the best results, seek out someone who does acupuncture who has special training. Not all states require licensing or certification of training for this treatment. It’s best to ask what credentials the person has. Sterile technique is also important.

Studies show that improvement with physical therapy for neck pain patients may have more to do with the cause of your problem than the actual number or type of treatment sessions. For example, patients with trauma-induced pain (for example, car accidents) may take longer to recover compared to patients with pain of unknown cause.

Patients with pain AND decreased movement also require more treatment when compared with patients who have neck pain but full motion. You may simply have a different kind of problem from the other patients who have already been discharged.

If you have been in treatment for a month without seeing any progress, then there is some cause for concern. But if you are making steady gains with decreased pain and increased motion or function, then you may be right on target for your particular problem.

If you have questions or concerns, it’s always a good idea to bring them to your therapist. Your recovery will go faster and smoother if you have confidence in what you are doing and no doubts about your treatment.

Load-bearing disorder refers to pain from load on the joint. Lifting may not be the main factor. Sitting in one position for long periods of time is more likely the problem load.

It’s really true that motion is lotion. Joints stiffen up without regular, rhythmic movement. Muscles must contract and relax in order to move blood along and get rid of any toxins that build up from inactivity.

Nontraumatic neck pain can be classified as a load bearing disorder or a movement impairment disorder. The difference is based on what causes the painful symptoms: load or movement?

With load-bearing disorders, you are more likely to have pain but full motion when you do move your neck. With movement impairment, there’s pain and a loss of motion. According to a recent study on neck pain patients in Australia, you can expect a faster recovery with a load-bearing disorder compared to movement impairment disorder.

Cervical refers to the neck or cervical (upper part of the) spine. Spondy means bone. Spondylosis or spondylotic is used to describe a narrowing or closure of the spinal canal. Myelopathy is any condition that affects the spinal cord, and radiculopathy describes pain that goes from the neck down the arm.

Cervical spondylotic myelopathy is the most common cause of spinal cord problems in people age 55 and older. With aging, degenerative changes in the cervical spine can cause compression of the spinal cord. Symptoms often develop slowly and without a known cause. In other words, there’s no known trauma or injury. Patients report neck stiffness and pain, arm pain, numbness and weakness in the hands. Sometimes weakness of the legs and feet is also a problem.

An MRI is needed to diagnose the problem. The image shows narrowing of the spinal canal caused by bone spurs, herniated discs, and thickening of the spinal ligaments. The best treatment for this condition is still highly debated. Surgery to decompress the spinal cord and stabilize the spine is advised for some patients.

Spinal infection of this type is rare but occurs in patients with the types of risk factors you mentioned. Any kind of immune suppression is a risk factor. Once the person has any kind of infection, it can spread to the joints, especially the hip, knee, or spine.

A previous history of infection somewhere else in the body is often a trigger for spinal infection. It’s important to identify what kind of infection is present. Staph or strep infections are the most common.

Patients in good health can recover from infections of this type but the more typical response is for the infection to spread along the spine. Neurologic damage from pressure on the spinal cord can leave the person with permanent weakness and paralysis.

Surgery is advised to drain the infection. Antibiotics are an important follow-up. If at all possible, it might be good for your uncle to hear his physician talk about the potential complications. Treatment results are better with early intervention. Usually early diagnosis and treatment are needed to stabilize the spine.