FAQ Category: Cervical Spine

This isn’t done routinely yet. It takes a special set of operating rooms to offer outpatient surgeries.

According to researchers in this area, patients must be selected very carefully for this kind of outpatient surgery. It must be the first spinal surgery for the patient. Only one or two levels can be done.

Fusion must be in the mid- to lower cervical spine. This includes C45, C56, and C67. The patient must not have any signs of pressure on the spinal cord. There must be help at home for them when they leave the surgery center.

When following these guidelines, a recent study shows the results were very good. There were very few problems. None of the patients had to be admitted to the hospital afterwards.

You may be able to have this surgery as an outpatient. It may depend on where you live and/or the status of the orthopedic community. Check with your local surgery centers and find out if it’s already being offered in your area.

Core stability comes from the coordination of function within the soft tissues of the spine, pelvis, and hips. The goal of core stability is to increase stiffness in the spine to protect it. Core strength allows the spine to withstand movement and force and thus prevent back injury.

The abdominal muscles are a key part of the “core” … but they aren’t the only muscles involved.

Recent studies have shown that it’s possible to increase the pressure within the abdominal area without using the abdominal muscles. You can do this by contracting the diaphragm and the pelvic floor muscles at the same time. The effect is to increase pressure within the abdomen. This in turn increases trunk stiffness.

Abdominal muscle training is still important. It’s never too late to improve muscle tone and strength…even after the muscles have been cut during a C-section. It will take at least six to eight weeks of consistent exercise and using correct postures.

Pain with movement usually points to a joint, muscular, or other soft tissue problem. Muscle weakness can present as a burning sensation or pain. This occurs in less than 15 seconds.

Pain that comes on after five or 10 minutes of activity may be more serious. For example, adults with a history of heart disease may report upper back, neck, or jaw pain with overhead positions of the arm. If this is coming from blocked coronary arteries, there may be shortness of breath or sweating.

If the problem persists, see a medical doctor.

This isn’t as strange as you might think. Nerves to the structures of the neck and shoulder overlap. Pain signals from the shoulder may be sent to the neck causing this confusion. This phenomena is called referred pain.

One condition in particular may be at fault. This is called shoulder impingement. Doctors at Stonybrook University School of Medicine in New York reported on this problem in 34 neck pain patients. One of the most telltale signs is neck pain with the shoulder motion you describe.

Neck pain from shoulder impingement is treatable. See your doctor soon for an exam.

Steroids can be injected into the epidural space of the neck. This is called dural puncture. The epidural space is inside the spinal canal but outside the spinal cord.

Headache after injection into the epidural space is called a spinal headache. There are no known reports for dural puncture in the cervical spine. Many reports for the low back area (lumbar spine) are available. Rates of spinal headache from lumbar puncture vary from as low as 7.5 percent to as high as 75 percent.

The first study of epidural steroid injection for the neck was recently published. Headache is the second most common problem with this procedure. In a group of 157 patients, 16 reported having a headache that went away within 24 hours.

Treatment for spondylolysis varies from doctor to doctor and region to region.
It’s best to find out what your doctor’s protocol is for this problem. Some doctors start patients on rest for two to four weeks and then use a brace. The brace may be prescribed only if
the patient has back pain after that.

Exercises are progressed over the first six weeks. Football practice wouldn’t be
advised until the patient is pain free and at the end of the prescribed exercise program. The doctor may ask the athlete to wear the brace for the first eight to 12 weeks of sports practice.

When the athlete is pain free during the sports activity, then it can be weaned away over several weeks.

Simply put, the hole in his spinal canal isn’t large enough for the size of his spinal cord. There is pressure on the spinal cord because of it.

To break this down for you, myelopathy is the medical term for any change in the spinal cord. It could be caused by a variety of different conditions. Congenital tells us that he’s had the stenosis or narrowing of the spinal canal since birth.

This condition is treatable. Antiinflammatories and physical therapy can help manage symptoms if it causes neck, shoulder, or arm pain. Changes in sensation and muscle weakness are signs that the condition is more serious. Surgery may be the next step to enlarge the opening and take the pressure off the cord.

For a long time, surgery was only done on the neck from the back or posterior approach. This causes some problems with wound drainage and infection. There is also the risk of cutting the spinal cord, the nerve roots, or the lining around the spinal cord. The result could be permanent nerve damage or paralysis.

Using the posterior approach, the doctor often cuts through the bone and removes part (or all) of the facet joint. When more than 50 percent of the joint is removed, the spine can become unstable.

More recently, opening the spine from the front or anterior approach has gained in favor. The doctor can avoid the spinal cord with this method. However, there are blood vessels and soft tissues to work around. Too much pull or an accidental cut can lead to serious injury.

A recent study from Thomas Jefferson University in Philadelphia reviewed the cases of 19 patients who had a posterior surgery. They found that this method is both safe and effective when the cause of the problem is disc herniation to the side.

Cases of wrong body parts being removed do happen, although these are extremely rare. Medical staff has strict steps to follow to prevent this from happening. These events are always tragic and the news media reports them broadly.

In the case of spine surgery, doctors use imaging to show the correct part before going ahead with the operation. Once the spine is cut open, special X-rays or imaging machines are used in the operating room. The doctor can see right away if the location is correct. There is also an operating microscope used during the operation to give the doctor a clear view inside the area.

The spine is divided into three distinct units. The neck is called the cervical spine. Removing one or more discs between the bones of the cervical spine is called a discectomy.

The disc can be removed from the front (anterior) or back (posterior) of the neck. The preferred method is to do an anterior cervical discectomy. The doctor makes a cut or incision at the front of the neck and pulls apart the muscles and bones. A special tool is used to remove the disc.

Overgrown or damaged cartilage and bone spurs are also removed. The doctor uses a cutting tool called a curette or a high-speed drill for this. Many doctors fuse the neck after discectomy. Only the sections where the discs are removed get fused. Bone chips or a special cage is used to hold the cervical spine in its natural position. This gives the neck the support and structure it needs to function.

Removing the disk between two bones of the spine is not uncommon. Men and women do return to work (RTW), usually sometime between one to three months after the operation. The timing of RTW depends on many factors. These include the patient’s age, type of job, and method of surgery. Problems after the operation such as infection can slow recovery.

Many patients who have this operation report decreased pain, improved sensation, and increased strength afterwards. One study in Switzerland followed patients for at least one year. Some patients stayed in the study for almost three years. Three-fourths returned to work on a full-time basis one month after surgery. A smaller number did not return to work at all.

Aging or injury can cause damage to the discs between the bones of the spine. If the disc presses out of its space, it’s called herniation. The protruding disc can put pressure on the spinal nerves, causing many problems.

Taking the disc out (discectomy)can relieve painful symptoms and restore strength and function. Some studies even show improved mental capacity after this operation. Most likely, this occurs as a result of decreased pain.

Changes in sensation and motor function can occur with a disc herniation. The arms and hands may become numb or weak. Swallowing can be difficult. Loss of bladder function is even possible when the disc in the neck area protrudes and presses against the spinal cord.

Removing the disc doesn’t always return the patient to normal function. There may be part or complete recovery. Discectomy will keep the patient from getting worse.

Since the mid-1990s surgeons have been using mesh cages filled with bone chips to replace collapsing bones. These cages offer immediate support. However, they aren’t without some problems.

Studies of patients receiving titanium cages show a high complication rate. As many as one-third of all patients have trouble after the operation. In some cases, the cages move or the screws loosen. There can be wound infection, nerve damage, or serious blood loss. Paralysis or even death can occur.

Some patients complain that they can feel the plate that holds the cages in place. Others have injuries to the esophagus or vocal cords. Doctors report that various problems are more likely to occur when more than two levels of bone are removed. Removing only part of the vertebra is another cause of problems.

Researchers will continue to look for ways to improve this operation or find another method of treatment.

The ending “-ectomy” always refers to removing something. A corpectomy is the removal of bones in the neck or cervical spine. Doctors may remove only one vertebra, but often more than one must be taken out.

Aging, trauma, and diseases such as arthritis cause damage to the discs and bone in the cervical spine. The bones can slip and put pressure on the spinal cord causing serious problems. When all other treatment has failed, removing the bone may be the next best step.

In the English language, “dowager” refers to an elderly woman. The term Dowager’s hump describes an increased curve in the upper back. The change in the position of the bones causes a bump or hump to form along the back of the neck. The correct medical term for this condition is kyphosis.

Kyphosis occurs when aging and weak bones collapse along the front border of the spine. The vertebral bones take on a wedge or pie shape causing the spine to curve forward. This can happen to men or women.

The most common goal of a bone fusion is to relieve pain. Bone fusion will also help hold the spine upright and steady. When motion is eliminated, the body starts to absorb some of the bone spurs that have formed.

With the bones lined up correctly, pressure is taken off the nerves and the disc spaces are kept open. This is more comfortable and helps prolong the life of the nearby structures.

Many patients are turning to alternative treatment for a wide variety of problems. This approach has become very popular for neck and back pain, as well as other conditions such as cancer.

The three most common forms of alternative care for neck and back pain include chiropractic, massage, and relaxation. Patients report that these methods are “very helpful.”

Be prepared to pay out-of-pocket if your insurance company doesn’t cover these types of services. Other alternatives include prayer or spiritual healing by others, biofeedback, hypnosis, imagery, and herbs.

The doctor will use the X-rays to assess for success of the surgery. Even if you’re feeling good, the graft may not be holding. When bone is taken from one site and donated to another, problems can occur. The graft may fragment or break into tiny pieces. It may collapse causing settling of the bones.

X-rays after cervical spine fusion can show how well the graft is holding up, literally. The doctor will look for loss of bone height, narrowed disc spaces, or fractures in the bone graft. If a metal plate was also used to hold the spine, then X-rays are reviewed for loose screws, cracked plates, or other problems.

Finding problems early can prevent a worse result later. Don’t skimp on this follow-up visit. Follow your doctor’s advice closely for the best result.

Cervical refers to your neck. Radiculopathy means any disease that involves a spinal nerve. These nerves come out of the spinal cord as it passes from the skull to the low back area. A cervical radiculopathy (CR) then refers to any problem with the spinal nerves in the neck area.

This is most often caused by damage to the disc material between the bones. It the disc pushes out of its space, it puts pressure on the spinal cord and/or the spinal nerves. Other causes of CR include tumors or bone spurs from arthritis.

CR usually causes neck and upper arm pain. There may be other symptoms such as weakness, numbness, and tingling. When the spinal nerves leave the spinal cord in the neck area, they travel down the arm to the wrist and hand. These same symptoms in the wrist and hand may signal carpal tunnel syndrome (CTS).

CTS can occur as a result of cervical radiculopathy. It can be caused by something affecting the nerve just in the wrist area. CTS can also occur as a result of a systemic problem such as diabetes, gout, or thyroid diseases.

The physical therapist will do a variety of tests to measure your strength, range of motion, reflexes, and sensation. Some additional tests may help pinpoint the location of the problem. These findings guide the therapist in choosing the right treatment for each patient.

Treatment may include neck traction, ultrasound, and nerve, joint, and soft tissue mobilization. Exercises to stretch and strengthen the neck and arms may be added later. The therapist will also look at your posture at home, work, during sleep, and other activities. A program to improve your posture is likely.