Patients with neck and/or arm pain should be evaluated for issues with the neck (cervical spine). The cervical spine is made up of 7 vertebrae. The spinal cord runs through the middle of the cervical spine. Individual nerve roots exit the spinal cord at each cervical level. Compression of either the spinal cord or the nerve roots can result in neck pain, arm pain, tingling, numbness, and/or weakness. This often occurs due to a disc herniation or stenosis (thickened ligament). Severe compression of the spinal cord can result in upper arm and leg weakness, poor hand grip, dropping objects from the hands, loss of fine motor skills in the hands, and/or loss of balance. This constellation of symptoms is often referred to as cervical myelopathy. Patients may also experience pain due to arthritic changes in the neck, resulting in facet hypertrophy or kyphotic alignment of the cervical spine.
Evaluation of neck/arm pain includes a clinical exam, cervical x-rays, MRI scan, and possibly a CT scan.
Surgical treatments for neck/arm pain are determined on an individual basis.
Anterior Cervical Discectomy & Fusion (ACDF)
ACDF stands for anterior cervical discectomy and fusion. It is a type of spinal fusion in the neck that decompresses the spinal cord and nerve roots and stabilizes the spine from an anterior approach. It is usually indicated for patients with intractable neck and arm pain with stenosis, disc herniation, compression of the spinal cord and/or instability of the spine.
At each affected disc space, he uses a series of tools to remove the disc between the two vertebral bodies. He then carefully decompresses the spinal cord and nerve roots, effectively removing any compressive material. The disc space is then filled with an appropriately sized bone graft and locked into place with screws.
Cervical Artificial Disc Replacement (ADR)
Cervical ADR stands for artificial disc replacement in the cervical spine. It is a motion preservation technique that allows for decompression of the spinal cord and nerve roots and maintains the natural movement of the neck. It is usually indicated for patients with intractable neck and arm pain with disc degeneration, stenosis or a disc herniation.
At each affected disc space, he uses a series of tools to remove the disc between the two vertebral bodies. He then carefully decompresses the spinal cord and nerve roots, effectively removing any compressive material, and prepares the vertebral endplates for the device. The artificial disc is then implanted into the disc space.
Posterior Cervical Decompression (Foraminotomy, Laminectomy, Laminoplasty)
Posterior Cervical Decompression refers to several techniques that decompress the spinal cord and cervical nerve roots from a posterior approach. Such techniques include cervical foraminotomy, cervical laminectomy, and cervical laminoplasty. These techniques are usually indicated for patients with intractable neck and arm pain with stenosis, disc herniation, and/or compression of the spinal cord.
A posterior cervical foraminotomy is the most minimally invasive technique, with the smallest exposure and disruption of the tissues. A foraminotomy opens the foramen (the channel where the nerve root exits) by shaving the edges of the bone to allow access for removing a disc herniation or osteophyte. It is usually indicated when symptoms are localized to a specific nerve root distribution.
A cervical laminectomy entails the removal of the lamina (the bone that covers the back of the spinal cord). It requires a more extensive exposure than a foraminotomy in order to adequately decompress the spinal cord. It is usually indicated when symptoms are consistent with significant compression of the spinal cord, such as arm and leg weakness, gait disturbance/balance issues, or loss of dexterity.
A cervical laminoplasty allows for decompression of the spinal cord without the complete removal of the lamina. The lamina is hinged open like a door, keeping its attachments intact and is especially useful in multilevel stenosis
Posterior Cervical Instrumentation and Fusion (PSF)
Cervical PSF stands for posterior instrumentation and fusion of the cervical spine. It is a type of spinal fusion that stabilizes the spine from a posterior approach. It is sometimes associated with a posterior cervical decompression, such as a cervical laminectomy or foraminotomy, to relieve stenosis or pressure on the spinal cord. It is usually indicated for patients with intractable neck and arm pain with stenosis, kyphosis, and/or instability of the spine.
The surgeon stabilizes the spine by placing screws into the bones at each level and locking the alignment in place with rods and locking nuts.