Understanding Cervical Neck Surgery

Understanding Cervical Neck Surgery

by Ravi Ramachandran, M.D.

Cervical neck surgery is often a last resort when patients have cervical radiculopathy from a herniated disc. There are different types of cervical neck surgery to know and understand.

A 50-year-old male came to my office with burning pain and numbness in his right arm. We tried nonoperative techniques first but in the end he underwent a cervical discectomy and fusion. This relieved his symptoms and he did quite well. He came to the office well-informed prior to the surgery with questions about different options.

What are the options in cervical neck surgery and what should you know? Here are 5 points to take home about various types of cervical neck surgery.

Anterior and posterior pathology. Anterior refers to the front of the neck. Posterior refers to the back of the neck. In the cervical spine the spinal cord occupies the spinal canal. When things begin to degenerate or break down, nerves can become pinched. This can result in inflammation and pain and numbness in the arms. As a spine surgeon I am trained to treat where the pathology, or problem, is located. If the issue is predominately anterior, I will recommend to treat from the front of the neck. If the pathology is posterior, then a posterior approach is appropriate.

Anterior fusion versus disc replacement. Anterior procedures are done through an incision in the front of the neck. This is where a disc herniation or bone spur known as a osteophyte are addressed. The most common is known as an anterior cervical discectomy and fusion. The acronym is an ACDF. The success rate with an ACDF is high particularly for arm and hand symptoms. A cervical disc replacement is a newer technique which attempts to not fuse a spinal segment. Both an ACDF and cervical disc replacement are equivalent in success for patients with single level disc pathology.Anterior corpectomy. Corpectomy is a type of cervical neck surgery where a bone is removed. This is utilized when an entire bone is pressing on the spinal cord as is seen incervical myelopathy. Corpectomy is also used when there is a significant bend or kyphosis in the neck which can stretch the spinal cord. Other conditions include infection and tumor which fortunately are rare.

Posterior procedures. When the pathology in the cervical spine is throughout the spine or in the back of the neck, a posterior approach may be appropriate. This includes cervical laminectomy, laminectomy and fusion and laminoplasty. A smaller technique for a compressed nerve is known as a key hole foraminotomy. This is where a small opening is made from the back of the neck to relieve pressure on the nerve from a herniated disc or bone spur.Combined posterior and anterior approaches. In some selected cases it may be necessary to perform surgery from both the anterior and posterior part of the spine. This is often for significant deformities of the neck, trauma or patients who are risk for failure with a single approach.This is a brief introduction to some various techniques with cervical neck surgery. As you can see, this is a more complicated discussion. Good rapport with your physician and a thoughtful discussion of possible options is key. This should occur in the office face to face.

If you still have questions or concerns it is always appropriate to get other opinions about your condition. In the correct patient cervical neck surgery can provide meaningful improvement in quality of life.


Ravi Ramachandran M.D. - Spine Surgeon in Sacramento, CA