FAQ Category: Cervical Spine

It could though not enough research has been done to provide convincing evidence one way or the other to say for sure. Of the studies published, there was a recent one comparing three different types of implants: the Bryan disc, the Mobi-C, and the ProDisc-C.

These three were chosen because they are different in how they are made (material) and how they work (motion system). The Bryan disc is made of titanium and polyurethane. Polyurethane is a resilient, flexible, and durable manufactured material that can be stretched, smashed, or scratched, and remain fairly indestructible.

The Mobi-C implant is composed of titanium and polyethylene (plastic component). And the ProDisc is cobalt chrome and polyethylene. On a continuum of motion provided by each artificial disc, at one end, there’s the Bryan disc, which provides the most movement with the least constraint. At the other end, is the ProDisc device with the least motion. The Mobi-C falls somewhere in between.

X-rays were used to look for heterotopic ossification (HO) during the follow-up period after the joint implants were put into place. The length of time between surgery and the development of HO was also recorded.

The overall results showed there was more bone formation than expected and that the type of implant did make a difference. In a group of 170 patients treated in Korea, 40 per cent developed heterotopic ossification.

Occurrence rate was highest in the ProDisc-C group and lowest in the Bryan disc group. And it was serious enough to reduce the life of the implant to an average of only 27 months (less than two and a half years). More study is needed in this area to sort out who develops heterotopic ossification, why, and what can be done to prevent it and protect the implanted discs.

ACDF is one of the most common surgical spine procedures in the U.S. In this procedure, the surgeon makes an incision in the anterior (front) of the neck, performs a discectomy (removes the disc) and fuses the two vertebrae together. A fusion simply means that two bones grow together.

Usually, when two vertebrae are fused together, a small piece of bone called a bone graft is inserted between the two vertebrae where the disc has been removed. This bone graft serves to both separate the vertebrae and to stimulate the two bones to grow together – or fuse. The fusion procedure usually involves the use of hardware, such as screws, plates, or cages to keep the bones from moving.

In a recent study, national trends in anterior cervical decompression and fusion (ACDF) were reported. Using data collected by the Centers for Disease Control and Prevention (CDC) as part of the National Hospital Discharge Survey, the following trends were observed:

Anterior cervical decompression and fusion (ACDF) is one of the most common surgical spine procedures in the U.S. It is the favored treatment for degenerative disc disease so common in aging adults. Results remain good-to-excellent with fewer complications than ever before.

The fusion procedure is fairly easy to perform, patients recover quickly, and studies show good results overall. To evaluate the performance of this procedure, surgeons ask: Is the procedure having the intended effect? Are the outcomes successful? Who can benefit and are there other people out there who could really use this treatment? Is it safe and effective for all age groups, both sexes (male and female), and for each diagnosis for which it was used?

Researchers keeping track of data on outcomes report that the technique has been so successful that the types of patients who can have the surgery has expanded. Better technology, improved surgical techniques. and safer anesthesia means that patients with other health problems can have this surgery.

That’s compared with 15 years ago when diabetes, obesity, high blood pressure, heart disease or other condition would have meant no surgery. Not only that, but it looks like better medications has gained improvements in pain control. Postoperative physical therapy has speeded up recovery and reduced the length of hospital stay.

If the surgeon has deemed the procedure necessary and safe, then it’s likely that your mother is a good candidate with a low risk profile.

The debate about neck collars has been going on for decades. Some surgeons never have their patients use them — even to stabilize the neck after a fusion procedure. Others use them to provide support and security for the patient but don’t consider them really necessary. And when asked in a survey at least half of the surgeons fell somewhere in between those two opinions.

The debate continues beyond just whether or not to use collars. The next question is then: soft or rigid? Studies have clearly shown that soft collars don’t restrict motion at the end ranges. That means if the person really wants to turn the head all the way to one side or the other (or fully flex or extend the neck), the collar doesn’t prevent it. Tests show that rigid collars don’t fully restrict motion either.

In fact, many patients still have up to half their normal motion even when inside a rigid neck brace. And given the fact that rigid neck collars can be hot, cause skin rashes and sores, and restrict swallowing and breathing, they can be difficult to get used to. If they don’t really do any more than a soft collar, why bother using them?

A recent study from Yale University School of Medicine showed that bracing after neck surgery just isn’t needed. Not only are many neck fusions held together internally with hardware like metal plates and screws but people seem able to regulate their own motion.

Your surgeon is quite right that a collar isn’t necessary. Sometimes the added support provides the psychologic security needed to relax and begin moving again. At that point, a soft collar on a temporary basis will probably provide all of the extra support and proprioceptive input needed for daily tasks.

Neck pain that travels down the arm can be caused by several problems. Angina and heart attacks can sometimes present this way — especially on the left side. But arthritis with bone spurs, disc herniations, and even postural issues (head forward and shoulders slumped) can create similar symptoms.

In the case of nerve compression, irritation, or impingement, the neck pain going down the arm is referred to as cervical radiculopathy. A change in neck and arm position (such as wearing a neck collar) can shift the structures that are pressing on the nerve enough to alleviate the pain.

You might get the same effect by standing up straighter and lifting your shoulders slightly. In fact, if wearing a collar and/or changing your position relieves your symptoms, then you might be a good candidate for chiropractic and/or physical therapy care.

Stretching tight muscles, correcting posture, and realigning the joints is a more permanent solution to the problem than wearing a neck brace. Sometimes there are muscle imbalances that need to be addressed as well. Usually a short series of appointments with a home program of stretching, postural exercises, and strengthening may provide a permanent solution to your problem.

It’s been just slightly more than 10 years since the first cervical disc replacements were done on a group of patients in England. These first generation implants had design problems that have since been improved.

Whether to have a cervical spine fusion or disc replacement may depend on several factors. Your diagnosis is important. Currently, there is a limited use for the disc replacements. If you have any spinal deformity, subluxation (partial dislocation) of the vertebra, or issues with alignment, then disc replacement is not usually an option.

Anyone with osteoporosis, a previous history of spinal infection, or spinal instability from trauma isn’t usually a good candidate for cervical disc replacement either. Other problems that can put you out of the running for disc replacement include spinal tumors, allergy to metal, lupus, rheumatoid arthritis, or congenital spinal stenosis (narrowing of the spinal canal).

Your age might be a factor. With limited data on how well these implants wear and for how long (durability), surgeons may be reluctant to use them in younger patients. But no one knows for sure because there aren’t any studies out yet comparing the rates of success, wear rates, or durability of implants based on age.

Rates of success with spinal fusion rank in the 90th percentile. This means nine out of 10 patients report a good-to-excellent outcome. Surgeons are reluctant to give up that kind of success for a procedure that has had known problems in the past.

Your best bet would be to see your surgeon for an evaluation and recommended treatment plan. Each patient has individual risk factors and issues that must be taken into consideration when making this decision. Your surgeon is the best one to advise you.

Swallowing problems and sometimes difficulty breathing can be a problem after cervical (neck) fusion. Having multiple levels fused increases the risk of complications. The amount of spine exposed during the operation and the length of time it takes to do the procedure may be two factors in the development of this particular problem.

Smokers tend to be at increased risk for dysphagia (difficulty swallowing). Long-term heavy smoking has an effect on the tiny blood vessels in the body and makes it difficult for the body to heal. The dysphagia may be temporary and gradually go away.

But it sounds like you’ve had this problem for more than just a few weeks. It’s the sort of thing you should have your surgeon check on. A follow-up visit is advised. Many patients see the surgeon for a post-operative check but don’t mention any problems like difficulty swallowing.

Many people forget to mention it or just figure they have to put up with it. The surgeon won’t know if you don’t tell him or her. There may be something that can be done to alleviate the discomfort and restore your ability to eat regular food again. Don’t wait much longer to get an appointment and find out what are your options.

In a laminectomy, a portion of the vertebral bone (the lamina) is removed to take pressure off the spinal cord. Usually this is done because a disc is protruding and pressing on the nerve structures. Removing the bone around the bulging or herniated disc takes the pressure off the cord and spinal nerves in that area.

When a laminectomy is done at multiple levels without a fusion to stabilize the spine, the bones can collapse like in your situation. Instead of a nice curve in the neck (called lordosis), the bones line up either too straight or curved in the opposite direction (called kyphosis).

The risk of pressure on the spinal cord or spinal nerve roots and possible paralysis is too great to just leave the patient with this postlaminectomy kyphosis. That’s why a fusion has been recommended. The problem of postlaminectomy cervical kyphosis is a complex one and treatment can be challenging.

Most patients with this type of problem would have a circumferential fusion — one that goes all the way around front to back. A circumferential approach requires two procedures: one from the front of the spine and one from behind (posterior). Efforts are being made to find alternate ways to treat this problem.

One surgeon in South Korea has used a hybrid technique. Instead of a fusion all the way around the spinal segments, the affected bone(s) and disc(s) are removed and fusion is done from the front of the spine (anterior approach). This approach eliminates the complications of spinal cord damage while still stabilizing the neck.

The surgeon uses screws or pins to help distract the bones and realign them. A metal plate and bone graft material are used to hold everything together in a more normal alignment. The long-term results are good with elimination of symptoms and maintenance of the improved cervical curve.

Disc replacement is a wonderful treatment option for the right patient. Lumbar (low back) disc arthroplasty (another name for replacement) has been around longer than cervical (neck) replacements. So there is more data from a larger number of studies on lumbar disc arthroplasty compared with cervical disc arthroplasty.

The uses for these implants are quite a bit different from one area of the spine to another. Neck pain from disc disease seems to respond better to surgery than low back pain does.

Complications from the surgeries are much lower with cervical spine fusion or arthroplasty when compared with the same procedures performed on the lumbar spine. Surgery is often done from the front of the spine in order to avoid trauma or damage to the spinal cord or spinal nerves. But the surgeon still has to deal with the large blood vessels when using the anterior (from the front) approach.

The complication rate linked with torn or punctured blood vessels during anterior spine surgery is much higher in the lumbar region compared with the cervical spine. In general, anterior cervical spine surgery is much less complex than anterior lumbar spine surgery.

Ease of implantation is only one of the many considerations with any device. Long-term durability, rate of adjacent level degeneration, cost, and post-operative recovery are other factors that impact results.

It’s natural to make comparisons between cervical and lumbar spine disc replacements. But the cervical disc arthroplasty is much newer on the scene with fewer studies to even look at. It will be some time before further comparisons of this type can be made and any real conclusions drawn.

Chronic pain is something that can be very difficult to treat, particularly if the cause of the pain was never pinpointed to begin with. If exercises, medications, and other physical techniques haven’t worked, some doctors recommend behavior management as a way to help control the pain. This is done not because the doctors think the pain is in your head, but because sometimes we – unknowingly – increase our pain by our actions.

Some people catastrophize their pain. This means, they feel that if they do anything to cause pain, it will be horrendously unbearable, so they do as little as possible to lower the risk of developing their pain. Other people begin to fear the pain, so they, too, limit their activities and how they do things so they don’t bring on the pain. However, sometimes these very actions do make pain worse.

By meeting with a therapist who is trained in working with people with chronic pain, you may be able to see if you are unwittingly making the pain worse, or you may learn coping techniques that make the pain feel less intense and bothersome.

When someone has been in pain for a long time, finding a way to help manage it can be quite a relief. And, since it was so difficult to find a helpful technique, once you’ve found it, you don’t want to let it go. That is completely understandable.

Have you spoken with your doctor about your concerns? It’s not common for a doctor to discharge you from a program with no follow-up. Usually, there are arrangements that can be made so you can either have follow-up visits, phone calls, or other resources available to you to help you learn how to manage on your own. Perhaps if you explain this to your doctor, she can reassure you about the steps that she takes when she feels a patient is ready to go it alone.

A cervical spine injury, an injury to the high upper back or neck, can easily happen in elderly people as the result of a fall. The seven vertebrae (bones) in the neck are delicate and the angle at which your mother hit her head was likely how and why this happened.

Why did she die? Without autopsy findings, it would not be possible to tell the cause of death, but in general, there are some reasons why someone may die as a result of breaking their neck. One cause would be the inability to breathe. If the injury was at or above the fifth vertebrae, or if swelling occurs and presses on that area, it can affect the ability to breathe. The other cause would be a sudden and severe drop in blood pressure, causing the body to go into shock.

Another issue to consider is although your mother may have seemed perfectly healthy, there could have been some health issues that were not diagnosed, that she didn’t know about. It could be that this contributed to the problem.

Christopher Reeve, the actor of Superman fame, did break his neck in a horse riding accident. His injury was severe enough to cause complete paralysis below the neck, including being unable to breathe without help. Many people, when they think of broken necks, think about his case or those of people who have died. However, this isn’t always the case.

Death after breaking the neck occurs if injury affects the breathing, the body goes into shock, or some other illness or condition in the body contributes to the death. Many people do break their neck and don’t die or even have any long-lasting handicaps. This is due to where the break occurred in the neck, how severe it was, and – very importantly – what type of care they received, right from the moment the accident happened.

Patients who come to the emergency department with gunshot or bullet wounds are treated first for blood loss and shock. Once the bleeding is stopped and she is stabilized, surgery will probably be done. The first thing the surgeon does when a patient arrives with an injury of this kind is get a good history of what happened, how it happened, and when it happened.

Then a physical exam is performed including all sorts of special tests designed to figure out what got injured, where, and how bad is it. Nerve injuries are common with open wounds like this. The group of nerves in the neck and upper arm coming from the spinal cord and going all the way down to the hand is called the brachial plexus.

Imaging studies starting with an X-ray of the head, neck, spine, and upper arm may be followed up with CT scans, MRIs, and electrodiagnostic studies. There are even some specific tests that can be done to look for bone fractures and damage to the muscles, tendons, and nearby blood vessels. Injury to the blood vessels is common with some brachial plexus injuries.

Identifying specifics about injury to the brachial plexus help provide the prognosis and treatment plan. For example knowing that there is an avulsion injury (nerve is pulled right off the spinal cord) requires immediate surgery. A less severe injury with damage or stretch to the nerve but no rupture or tear to the nerve fibers has the potential for spontaneous recovery.

Surgical procedures to reconstruct nerves that have been damaged can include nerve transfers, muscle or tendon transfers, nerve grafting, and arthrodesis or fusion of the affected joint(s). The surgeon must work with both the sensory and the motor sides of nerve function. Without proper sensation, the patient can be at risk for other injuries or even burns because of a loss of sensation. Surgery isn’t the end of treatment. After surgery there can be weeks and months of rehab to restore arm and hand function.

No two injuries of this type are alike. The hospital and surgical teams will do everything they can to care for your coworker. Your friendship, support, and encouragement in the months ahead are going to be just as important.

Brachial plexus injuries refer to stretching, avulsion, or rupture of a group of nerves that come from the spinal cord in the neck. Avulsion tells us the nerve root is torn from the spinal cord where it attaches. Rupture refers to a complete tear across the nerve dividing it into two or more parts. Plexus refers to the entire group of nerves as they first start out with several main branches that divide to form a much larger number of nerve groups.

These nerves provide both sensation (pain, temperature, touch, vibration) and motor function (muscle contraction) for the entire upper extremity including the shoulder, arm, wrist, and hand. Brachial plexus injuries are usually caused by some type of trauma such as a car accident, fall onto an outstretched arm (especially if the head and face are turned away from that side), and stretching or pulling on the hand, wrist, or forearm. Gunshot wounds, knife lacerations, and other blunt open injuries are also likely causes of nerve avulsion or rupture.

No two brachial plexus injuries are alike. These can be very complex and difficult injuries to treat and reach recovery. It will help both you and your brother to find out where in the plexus the injury has occurred and how severely the nerve is damaged. This will give you some idea of what to expect, what kind of treatment is recommended, how long recovery will take, and the best way to offer him support during the treatment.

Surgery for the vertebrae in the neck, the bones, can be approached in different ways, depending on what needs to be done. Some procedures are best done from an anterior approach, from the front, while others are best from the posterior approach, from the back. The type of surgery the surgeon chooses to do depends on the actual problem, how best to fix it, any other physical problems the patient may have, and the procedure the surgeon is most comfortable with.

If someone is going to have surgery on the vertebrae (bones) in the neck, he or she should have a frank discussion with the surgeon regarding any possible complications. Any type of surgery, no matter how small, has risks of some sort – neck surgery is no different.

The types of complications that can happen will vary according to the type of surgery being done and how the surgeon approaches it. For example, if surgery is being done from an anterior approach, from the front, there is always a chance that body tissue in the throat, such as the esophagus may be nicked or damaged. When operating on the disk area and the vertebrae, there is always a chance of there being some nerve damage. Of course, there is also the general surgical complications that are possible, such as infection, bleeding, and pain, just to name a few.

It’s been 10 years since the first artificial disc was implanted in the cervical spine (neck). That event took place in Europe and quickly caught on in the United States. Now we have the four- and six-year results starting to trickle into the orthopedic literature.

Most people who have a cervical implant have degenerative disc disease with neck and arm pain along with neurologic symptoms such as numbness, tingling, weakness, and even paralysis. The condition has not responded to conservative (nonoperative) treatment. That’s why surgery is considered next. And instead of having a neck fusion, which limits neck motion, disc replacement is now available for some patients.

Radiculopathy (nerve pain down the arm) or myelopathy (pressure on the spinal cord) are common with disc protrusion or herniation. Most of the patients getting a cervical disc replacement have single-level disc replacement. But it is possible to replace the discs with implants placed at two levels.

Early results reported are very positive after the first two years. X-rays are used to view the neck, discs, and motion at each involved level. The patients fill out valid and reliable surveys to indicate how well they are doing (motion, function, neck and arm pain or other neurologic symptoms).

As time goes by, the results have been tallied and reported. In one recent multicenter study, there was a high incidence of adverse events reported. This included things like pain in the neck and arm (shoulder to wrist), numbness and tingling in the arm, and hoarseness of the voice. A few odd events were reported such as low back pain and a soft tissue tumor in the neck. Those problems weren’t likely caused by the implant but all complications are being investigated. The real area of interest (used as a measure of success or failure of the implants) was the number of second surgeries (reoperations).

Any time the device migrated (moved or shifted), put pressure on the spinal cord, or had to be removed for any reason, it was counted as a failure. Once removed, the neck was fused rather than trying another disc replacement. Some patients had a second surgery but it wasn’t to remove the implant or correct problems related to the first procedure. These additional surgeries were to treat disc problems at other levels in the cervical spine. Overall, the number of second surgeries was low and the success rate reported as 93.9 per cent.

Comparing the results after six years with the early two-year outcomes, it looks like most patients were still doing well. Any reports of pain or discomfort at the end of two years were even better after six years. There were some changes in sensation noted around the end of the fourth year. No one was quite sure what that was all about or why it resolved over time, so it’s something they will continue to investigate in future studies.

As with any surgical procedure, there can be problems related to the anesthesia, infections, wound healing, and blood loss. For now, all indications are that artificial disc replacement for the cervical spine is safe and effective. These are preliminary findings until long-term results can be reported after 10, 15, and 20 years.

Artificial disc replacement for the cervical spine (neck) have been used for the last 10 years, so the first batch of long-term studies are just coming out. Researchers are looking at many things in these studies. For example, what are the potential problems? How often does the patient need another surgery? Does everyone keep good neck motion years later?

One of the possible adverse events that can occur with any implant is migration or movement of the device. Sometimes it’s just a minor shift or sinking into the bone. The patient may not even be aware of it until an X-ray is taken showing the changes. But a significant shift of the implant can put pressure on the spinal cord or nerve roots, resulting in neck and/or arm pain and neurologic symptoms. That’s when the surgeon may have to go in and remove the device and fuse the spine.

The few studies that are out show pretty good results overall for cervical spine artificial disc replacements. Although many patients have one problem or another, most of these are minor and don’t require a second surgery to correct. Significant symptoms (especially pain or paralysis) or loss of neck alignment would be addressed immediately.

You would not be in any danger of getting your neck stuck in some unusual position. Loss of motion may increase your neck stiffness or make it more difficult to flex, turn, or side bend your head. These are rare and unusual events that you aren’t likely to experience.

In the cervical spine, spondylolysis describes a cleft or place where the bone doesn’t meet in the middle. The area affected most often is where the upper or superior facet (spinal) joint meets the lower or inferior facet joint. When present on both sides of the vertebra, this defect results in a forward migration or movement of the superior (upper) vertebra.

Most people with a cervical spondylolysis defect don’t even know they have it until trauma occurs and they develop symptoms. Trauma-induced injury can either make the problem worse or just bring it to the attention of the physician when X-rays are taken and the lesion is observed at that time. They call this unexpected discovery an incidental finding.

The spondylolytic defect is clearly visible on X-rays. MRIs may or may not show changes in signal intensity indicating a force is being exerted against the spinal cord. Even though MRIs don’t show cord compression, the symptoms can be severe enough to schedule surgery to stabilize and fuse the spine.

What causes cervical spondylolysis? There is some evidence by the way the structures look that some people might be born with this problem. In some cases, the pedicle (supporting column of bone) is missing, so it’s clear that there’s a genetic defect. In other people with this problem, repetitive microtrauma might be the reason stress fractures occurred causing the bones to separate and form a cleft.