The cervical intervertebral disk is made up of a fibrous outer ring called the annulus and a gelatinous inner portion called the nucleus. The disk acts as a cushion between the vertebral bodies. When herniation occurs, the nucleus pushes through the annulus of the disk producing pressure on the nerve root, and/or spinal cord.

Nearly all patients complain of arm pain in the distribution of one or more nerve roots. Most have neck pain as well. Frequently, patients can be treated conservatively with success. However, when their ability to perform normal day to day functions is degraded for a substantial period of time (4-6 weeks) or in the presence of severe unrelenting pain or progressing neurological deficit, anterior cervical microdiskectomy with fusion is a highly effective treatment.

During microdiskectomy, the intervertebral disk and offending fragment are removed through a small, two to three inch incision in the crease of the neck. A dowel bone graft (from cadaver bone) or an intervertebral cage is inserted snuggly between the vertebral bodies to bring about a "fusion" or welding together of the two vertebral bodies. Other synthetic materials can be used to promote fusion as well. In many cases a plate is screwed into place to secure the bone graft. With success rates of around 70-80%, patients are able to return to work and full activity in an average of about 1-4 months. We have been performing anterior cervical diskectomy with interbody fusion on an outpatient basis for many years. It is well tolerated and preferred by patients over even a short hospital stay.

Your doctor will provide details of the procedure that is right for you as well as the benefits and risks. He will also provide instructions for your care before and after the procedure.

The spinal cord and nerve roots in the neck are surrounded and protected by the cervical vertebrae. These bones have an opening called the spinal canal through which the spinal cord passes. Ligaments and blood vessels are also present in the spinal canal. The nerve roots start at the spinal cord and pass through an opening between the vertebrae called the intervertebral foramen (or neural foramen). From there, they extend to other parts of the body.

Spinal stenosis is a condition where there is narrowing of the spinal canal and often the neural foramen that causes compression of the spinal cord and/or nerve roots. This narrowing is caused by numerous factors including bone spurs, degeneration of the intervertebral disks and facet joints, and thickening of the ligaments. Among the symptoms spinal stenosis can produce are pain and/or numbness in the arms, clumsiness of the hands, and gait disturbances.

Laminoplasty is a procedure intended to relieve pressure on the spinal cord while maintaining the stabilizing effects of the posterior elements of the vertebrae.

The laminoplasty procedure involves "hinging" one side of the posterior elements of the spine and cutting the other side to form a "door." As seen in the illustrations here, the door is then opened and held in place with wedges. By relieving pressure on the spinal cord it is the goal of laminoplasty to stop the progression of damage to the spinal cord and allow for as much recovery of function as possible.

Spinal stenosis is a condition where there is narrowing of the spinal canal and often the neural foramen that causes compression of the spinal cord and/or nerve roots. This narrowing is caused by numerous factors including bone spurs, degeneration of the intervertebral disks and facet joints, and thickening of the ligaments. Among the symptoms spinal stenosis can produce are pain and/or numbness in the arms, clumsiness of the hands, and gait disturbances.

Cervical laminectomy is a procedure to treat spinal stenosis. The back of the spinal canal is removed by cutting the lamina to provide more space for the spinal cord and nerve roots. By relieving pressure on the spinal cord it is the goal of cervical laminectomy to stop the progression of damage to the spinal cord and allow for as much recovery of function as possible. Your doctor will provide details of the procedure that is right for you as well as the benefits and risks. He will also provide instructions for your care before and after the procedure.

Anterior cervical diskectomy and fusion (ACDF) remains the gold standard procedure for the surgical treatment of cervical disk herniation and cervical spondylosis that produce intractable neck and or radicular arm pain that is unresponsive to conservative methods of treatment. It is also used in cases of cervical disk herniations and cervical spondylosis causing nerve root and spinal cord compression that result in radiculopathies and myelopathies with motor and sensory deficits. The use of the operating microscope has resulted in a safer and more complete decompression of the spinal canal and exiting nerve roots. High speed pneumatic drills and the development of fine microsurgical drilling technique, for example, skull base egg shell drilling, have advanced the art of removing the offending anterior compressive osteophytes and herniated disk from the dura and nerve roots. In the majority of cases, osteophytes must first be drilled out and removed before the disk herniation can be adequately identified and removed. The decompression has become wider and more complete with the development of this microsurgical technique. We attribute a large part of the success of this procedure to the proper decompression of the dura and nerve roots. The reported success rate for relief of pain is around 78% for ACDF (1). The procedure takes 1-1.5 hrs to perform for a single level and in the majority of cases, patients go home the same day.

Given the high rate of success for this procedure, why is there interest in a revolutionary change from fusion to artificial disk replacement? The answer lies in the “fusion” aspect of the procedure. Pseudoarthrosis, or the failure of the bone to fuse with the adjacent vertebral body, can occur following the ACDF procedure. This can cause foraminal stenosis and recurrence of symptoms. Another reason for interest in artificial disk replacement is something called adjacent segment disk disease. Following ACDF, once fusion takes place there is no movement in the joint. The joint can no longer do what it was originally intended to do, that is, to perform its share of work as a member of the array of joints that allow a full range of motion in the neck. The fusion of one level is felt to create greater stress on the remaining “movable” joints leading to their early failure. Both of these problems can result in the need for another operation.

Preserving motion while still achieving the necessary important decompression of the offending disk, theoretically can greatly reduce healing time (especially in smokers) and reduce the need for re-operation by avoiding pseudoarthrosis and reducing the effect of adjacent segment disk disease. Preserving motion of the operated disk segment may also improve the success of pain relief by restoring the segment to it’s more natural function of motion and reduce the excess strain on the other segments of the cervical spine.

Reference: 1. Silvers HR, Lewis PJ, Suddaby LS, Asch HL, Clabeaux DE, Blumenson, LE: Day Surgery For Cervical Microdiscectomy: Is It Safe And Effective? J Of Spinal Disorders 9:287-293, 1996.