Neck Surgery

Neck Pain :

Neck pain can be a crippling ailment for many patients. The cervical spinal region is the second most problematic area and is only beaten by the troublesome lumbar spine. There are a wide range of conditions which can cause cervical pain due to injury,disease or degeneration. Luckily, most structural painful neck conditions respond well to appropriate back pain treatments.

Neck Surgery :

Typically, surgeons use two surgical techniques for cervical spine surgery:
· Decompression, where they remove tissue pressing against a nerve structure
· Stabilization, where they work to limit motion between vertebrae

Cervical Decompression Surgery :

To remove the tissue that's pressing on a cervical nerve, your spine surgeon may perform one of the following types of surgery:

Facetectomy :

The joints in your spine are called facet joints; they're what help you move. However, facet joints can put pressure on a nerve. Ectomy means "removal of." So a facetectomy involves removing the facet joint to reduce that pressure.

Foraminotomy :

If part of the disc or a bone spur (osteophyte) is pressing on a nerve as it leaves the vertebra (through an exit called the foramen), a foraminotomy may be done. Otomy means "to make an opening." So a foraminotomy is making the opening of the foramen larger, so the nerve can exit without being compressed.

Laminectomy :

At the back of each vertebra, you have a bony plate that protects your spinal canal and spinal cord; it's called the lamina. It may be pressing on your spinal cord, so the surgeon may make more room for the cord by removing all or part of the lamina.

Pre Operative preparation: Patients are given a general anesthesia to put them to sleep during most spine surgeries. As you sleep, your breathing may be assisted with a ventilator. A ventilator is a device that controls and monitors the flow of air to the lungs.

Surgery : This surgery is usually done with the patient lying face down on the operating table. The surgeon makes an incision down the middle of the back of the neck. The skin and soft tissues are separated to expose the bones along the back of the spine. Some surgeons use a surgical microscope during the procedure to magnify the area they'll be working on.Surgeons have found that complete removal of the laminae loosens the facet joints that connect the back of the spine. This can cause the spine to tilt forward. To avoid this, a hinge can be formed by only cutting partially through the lamina on one side. A second cut is made all the way through the other lamina. This edge is then lifted away from the spinal cord, and the other edge acts like a hinge. The hinged side forms a bone union, which holds the opposite side open and keeps pressure off the spinal cord.

Small cutting instruments may be used to carefully remove soft tissues near the spinal cord. Then the surgeon takes out any small disc fragments and scrapes off nearby bone spurs. In this way, additional tension and pressure are taken off the spinal cord.The muscles and soft tissues are put back in place, and the skin is stitched together. Patients are usually placed in a neck brace after surgery to keep the neck positioned comfortably.

Discectomy :

If you have a bulging disc or a herniated disc it may be pressing on your nerves. In a discectomy the surgeon will remove all or part of the disc. The procedure . A small incision is made in the skin over the herniated disc and the muscles over the spine are pulled back from the bone. A small amount of bone may be removed so the surgeon can see the compressed nerve. The herniated disc and any loose pieces are removed until they are no longer pressing on the nerve, which was also adding to the compressing of the nerve.

Cervical Corpectomy :

Is performed through the front of the neck. Corpectomy means removal of the vertebral body, the major part of the cervical vertebra which looks like a building block. It is basically a long ACDF. Corpectomy is performed when two or more cervical discs need to be removed. For certain patients it is easier to remove two or more discs plus the intervening body or bodies. This is particularly true when there are osteophytes (bony spurs) behind the body and/or the disc space is narrow. By removing a cervical body there is a large area of exposure which is easier to work through rather than working down a narrow disc space.

Corpectomy :

Is done for much the same reasons as an ACDF but usually when there are two or more disc levels associated with bony spurs pressing on the spinal cord or, less often, for tumours of the cervical spine.

Procedure:

Once a space has been created in the spine this space has to be filled so that the spine doesn't collapse. Usually a bone graft is taken from the iliac crest (bony pelvis) but occasionally a hollow metal strut is used and then filled with either your own bone or plastic cement (acrylic). Acrylic tends to be used in tumour cases. Whatever spacer is used, the entire construct is reinforced with a long plate and screws. Occasionally for long anterior fusions, a fusion needs to be added as a separate operation through the back of the neck. The longer the fusion, the more likely it is that a posterior fusion needs to added. Generally a posterior fusion is done when three or more cervical bodies have to be removed, equivalent to four or more adjacent disc spaces.

Post Operative Care :

Is the same as for ACDF with the single important difference that you must not drive until you have solidly fused. This usually is at least three months. You may be a passenger in a car but you should not drive because forceful neck turns may undo your fusion. Depending on the strength of the construct, you may need to wear a brace for several weeks.

Stabilization Surgery :

Artificial Cervical Disc: This is a new—and very exciting—development in spine surgery. Recently, surgeons have begun implanting an artificial cervical disc after the discectomy. They're using this instead of fusion and spinal instrumentation. The advantage is that an artificial disc.enables a patient to retain normal neck movement after surgery. Previously, if the patient had two or more vertebrae fused, neck motion would be greatly reduced. Cervical discs still are a fairly new technology.

Procedure : Anterior cervical fusion, involves the use of instrumentation such as a metal plate or pins to help stabilize the neck. The surgery also involves fusion - when a piece of bone taken from either the patient's hip or a human cadaver is implanted into the disc space in order to fuse the vertebrae together. The purpose of the surgery is to limit movement in the spine and thereby reduce or eliminate pain.

Fusion and Spinal Instrumentation:

This kind of spine stabilization surgery has been common for many years. It can be done alone or at the same time as a decompression surgery. In spine stabilization, the surgeon creates an environment where the bones in your spine will fuse together over time (usually over several months or longer). The surgeon uses a bone graft (usually using bone from your own body) or a biological substance (which will stimulate bone growth). Your surgeon may use spinal instrumentation—wires, cables, screws, rods, and plates—to increase stability and help fuse the bones. The fusion will stop movement between the vertebrae, providing long-term stability.

Spinal Fusion and Instrumentation is undertaken when simple decompression of the nerves is inadequate due to the presence of spinal instability (abnormal motion). A fusion procedure links adjacent spinal vertebrae by promoting bone growth between them. Doing so eliminates the pain associated with abnormal motion between the vertebrae and prevents further injury to the nerves caused by compression and traction on the nerves produced by the abnormal motion.

To know more visit at http://www.spinesurgery-wecareindia.com

Email at info@wecareindia.com