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Cervical Spine Surgery
Cervical Spine Surgery is required when there is an abnormality in the neck like a herniated or degenerative disc or injury that causes compression in the spine. Since cervical spinal cord injuries are the most severe of all spinal injuries, it may affect one or both sides of the body. Therefore, early treatment is imperative to its prognosis.
Cervical spine involves the first seven vertebral levels of the spinal column in the body. They are the very top bones which form the neck region. It consists of the bones, muscles, joints and ligaments.
Surgical treatment of Cervical disorder involves Anterior Cervical Discectomy and Fusion (ACDF) where the damaged disc is removed and a bone graft inserted to act as a bridge between two vertebrae so that spinal fusion can occur and form a solid piece of bone. The bone graft and vertebrae are firmly fixed in place with metal screws and plates.
Bone grafts can come from different sources such as:
- Autograft Bone – bone cells taken from your own hip bones
- Allograft Bone – bone cells taken from a bone bank where people have agreed to donate their bones after they die
- Bone Graft Substitute – artificial bones made of plastic, ceramic and bioresorbable compounds
Other surgical options include Anterior Cervical Discectomy without Fusion, Posterior Approach or a Combined approach.
Causes of Cervical Spine Disorders
- Degenerative disc– a gradual degeneration of the disc between the vertebrae due to aging
- Herniated or slipped disc– when the disc breaks open or bulges out due to injury or trauma to the neck
- Spinal Stenosis– a condition when the spaces in the spine becomes narrow and the bones and other parts begin to press the spinal cord and nerves
- Rheumatoid arthritis– an auto-immune system wherein the immune system attacks the healthy joints, tissues and muscles causing inflammation mostly in the neck
- Cervical Spondylosis– abnormal degeneration of the cartilages and bones in the neck region
Symptoms of Cervical Spine Disorders
- Stiffness of the neck
- Neck pain
- Loss of neck function
- Burning, tingling or numbness in the neck
- Neck pain radiating to arms and shoulders
Diagnosis and Tests
- Physical examination of the cervical spine
- Electromyography (EMG)
- MRI Scan
- CT Scan
- Bone assessment
- Blood tests
- A thorough examination of your cervical spine by the doctor.
- Diagnostic tests should be done as suggested.
- Inform your doctor of all your medical history along with current medication and allergies.
- The doctor will review the tests and discuss the best solution with you.
- You will be asked to stop certain medications such as blood thinners, herbal supplements etc if you currently do.
- You will be asked to stop smoking, chewing of tobacco etc if you do as nicotine prevents bone growth with a higher risk for fusion failure along with slower wound healing.
- You will also be asked to stop drinking alcohol a week before surgery and 2 weeks after surgery as it can cause bleeding problems.
- You will be asked to fast 8 – 12 hours before surgery.
- Any medications given should be taken with small sips of water.
- You will be given general anaesthesia, so this will make you fall asleep and you will not feel any pain.
- The surgery will take at least an hour.
- If an Autograft is to be done, your hip area will be prepared for a graft along with preparing your neck.
- An incision is made either on the left or right side of your neck.
- The muscles, organs and tissues in the neck are moved aside to have a clear view of the bony vertebrae and disc.
- With a fluoroscope, the surgeon locates the damaged disc and the areas around it are separated.
- The surgeon then makes a cut and removes the damaged disc along with the ligament and any disc material that presses the spinal nerves.
- Bone spurs pressing the nerve roots are removed and drilling is made to make more room for the nerves to exit the spinal canal.
- The open disc space is prepared for a bone graft fusion reinforced with metal plates and screws.
- An X-Ray will be done to verify the position of the graft, plates and screws.
- After checking, the surgeon places the muscles and organs back to their place.
- The incision is closed and dressing is applied.
- You will stay in the hospital for at least a night depending on your recovery and complications.
- If you had an autograft, you will feel more pain in your hip area than your neck.
- Pain medications will be administered to you.
- Drink lots of water as pain medication can result in constipation.
- You will also experience hoarseness, sore throat or difficulty in swallowing, but this will heal in 1 to 4 weeks.
- You may be able to shower 1 to 4 days after surgery.
- Hot tubs, tub baths or swimming in a pool are not allowed until you are allowed to.
- Walking a short distance initially is encouraged and a physical therapist may be recommended to help you with exercises.
- You may need to wear a cervical collar or brace.
- You may avoid sitting for long periods of time.
- You will need to avoid bending your head forward or backward.
- Do not lift anything heavier than 5 pounds.
- Follow up will be scheduled 2 weeks after surgery where examinations will be done to review recovery.
Risks and Complications
As with any surgery, Cervical spine surgery is not without risks. Some complications that could occur are:
- Failure of bone fusion
- Nerve damage
- Hardware fracture
- Migration of bone graft
- Transitional syndrome
- Difficulty swallowing
- Hoarseness of voice
Factors affecting the cost of Cervical Spine Surgery
The cost price may vary depending on certain factors like:
- Your medical condition
- Type of bone graft
- Type of surgery
- Location of the hospital
- Choice of hospital
- Cost of diagnostic tests
- Surgeon’s fee
- Medical treatment
- Duration of hospital stay