In cases where arm pain is caused by a cervical disc bulge or herniation or from degenerative changes producing osteophytic spurs (aka “bone spurs”), the pain is called cervical radiculopathy. Typically listening to the history and pattern of the pain allows the physician to determine where the problem is. After physical examination and radiographic studies (MRI, CT, myelogram with CT, and/or plain films), the area of concern is usually identified.
Another condition, called cervical myelopathy, may also be associated with neck and arm pain, numbness, or weakness. In cases where the disc herniation and/or osteophyte/spurs cause compression of the spinal cord, this is potentially a very serious condition due to the risk of spinal cord injury if left untreated.
Many patients improve with a nonoperative course of anti-inflammatory medication (non-steroidal or steroids), pain medication, injection trials (epidural steroids), and physical therapy. If nonsurgical treatment fails, or if the risks of nonoperative treatment exceed the risks of surgery, then surgery options are considered.
Anterior cervical discectomy and fusion involves an incision in the front of the neck. One or more cervical discs can be addressed by this approach. It is performed under general anesthesia and typically patients are able to go home within 6-24 hours after surgery. Once the disc is removed, the affected nerve root or spinal cord is decompressed and a spacer is placed in the position where the disc was removed. The spacers may be cadaveric allograft bone, autologous bone from the patients’ own hip, a synthetic (PEEK, carbon fiber), or a titanium cage. A plate with screws may be used on the adjacent vertebral bodies to provide some initial stability while the operative site heals. A cervical collar, or orthosis, may be used postoperatively for additional support during the early healing phase.
Anterior cervical corpectomy and fusion is a similar type procedure to the anterior cervical discectomy. It includes removal of the cervical disc from an anterior approach, as well as removal of part (partial) or the majority of the vertebral body (body=corpus) in between the involved discs. This may be done in cases where there are multi-level disc herniations or spurs and/or spinal cord compression. A spacer is then placed in the area where the discs and vertebral body were removed. A plate may also be placed on the front of the adjacent vertebral bodies for support. A cervical collar or orthosis may be used postoperatively during the early healing phase.
Both procedures have similar operative risks: infection; bleeding; spinal fluid leak; decreased range of motion secondary to removal of the discs and fusion; dysphagia (difficulty swallowing-typically transient); cosmetic scar (visible on the front of the neck); hoarseness or voice changes (typically transient); Horner’s syndrome; non-union/pseudarthrosis (failure of the bone graft space to incorporate with the adjacent vertebral bodies) and/or instrumentation loosening. If non-union occurs, the plate and screws may subsequently loosen and require revision or removal. Neurologic injury: injury to the nerve root and/or the spinal cord may also occur.
Both procedures have similar operative benefits with respect to reduction of arm pain and numbness, and potentially reduction of neck pain with good success rates ranging 85-95%.
Figure1. C6-7 Anterior Cervical Discetomy, Fusion and Plating
Figure 2. C4-5, C5-6 Anterior cervical Discetomy, C4-C6 Fusion and Plating
Figure3. C4-5, C5-6 Anterior Cervical Discetomy, C5 Corpectomy, C4-C6 Fusion with Cage and Plating
Article Source: Jamie Baisden, MD FACS on December 14, 2010.