Neck Surgery for Cervical Radiculopathy

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Neck Surgery for Radiculopathy Symptoms

Neck surgery
Neck surgery. MedicImage/Universal Images Group/Getty Images

Neck Surgery for Radiculopathy Symptoms

Cervical radiculopathy may be a mouthful to say, but people who have this condition usually recognize it as pain and/or pins and needles that go down one arm.

If you've been to the doctor and the diagnosis is cervical radiculopathy, you likely also know that this condition is related to compression of one or more of your spinal nerve roots. Along with pain down one arm, you may also experience neck pain and/or weakness.

Do you need surgery?

The short answer is maybe, although according to Caridi, Pumberger and Hughes, in their 2011 review published entitled “Cervical Radiculopathy: A Review,” and  published in the journal of the Hospital for Special Surgery, most of the time, patients get better with the use of non-surgical therapies, both passive and active.

Caridi and his research associates say that surgery may be necessary when your radiculopathy is accompanied by motor deficits, debilitating pain that responds neither to non-surgical therapies, nor to the passing of time, or when your radiculopathy is disabling and your neck is also instable.

If any of these scenarios describe your experience, you may want to know about the types of surgeries commonly done.  Caridi, et. al. lists two main invasive procedures in use today.  A third, disc arthroplasty, is newer and not covered in this article.

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Anterior Cervical Discectomy with and without Fusion

Anterior Cervical Discectomy

The first, (and more commonly done) surgery for cervical radiculopathy is anterior cervical decompression, aka ACD.

An anterior cervical discectomy is a procedure in which the surgeon cuts into the neck from the front (in the throat area, to be exact) to reach and removed damaged intervertebral disc material. In an anterior cervical discectomy, the neck muscles are moved away to expose several structures, namely, the  trachea, esophagus, disc, and spinal bones.

Caridi et. al. say that in general, surgeons prefer the “anterior approach” because it provides them with the best opportunity to restore the natural neck curve (called cervical lordosis), to stabilize the spine and to predictably decompress the spinal nerve root.

Anterior Cervical Discectomy with Fusion

Anterior cervical decompression is done with and without fusion, but most surgeons prefer to fuse. That said, the "to fuse or not to fuse"decision for 1- or 2-level ACD surgeries is a controversial topic among spine specialists.

Caridi et. al. report that the use of plates increases fusion rates, decreases postoperative kyphosis and decreases certain problems with the bone graft and the instrumentation used in the surgery. They also say that using an “anterior plate” as it’s called for a surgery that covers more than two spinal segments (levels) is necessary for safety and success of this procedure.

Richardo Botelho, et. al., in their March 2012 review published in the Open Orthopedic Journal entitled, “The Choice of the Best Surgery After Single Level Anterior Cervical Spine Discectomy: A Systematic Review” found moderate evidence that there’s no significant difference between results gotten from an anterior cervical decompression surgery (ACD) and an anterior cervical decompression with fusion surgery (ACDF). The researchers also found limited evidence that patients who have the fusion along with the ACD surgery have better results than non-fused patients (ACD only).

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Laminoforaminotmy for Cervical Radiculopathy Symptoms

The next most common surgery for cervical radiculopathy takes a posterior (i.e., back) approach. It’s called the posterior cervical laminoforaminotomy.

Laminoforaminotmy for Cervical Radiculopathy Symptoms

Before you run away from this scary-looking term, let’s break it apart to understand what the procedure is about. As we’ve already discussed, posterior refers to an approach from the back, and cervical refers to your neck. The suffix –otomy means to cut into but not necessarily remove.

The terms “lamino” and “foramino” refer to areas of the spinal bone and/or column.

The lamina is a part of the bony ring in back of an individual vertebra. The lamina extends behind the transverse process on one side of the vertebra, to the base (on the same side) of the spinous process in back.

The term foramin means hole, and when talking about the spine, it refers to the holes on either side of the spinal column at every level that are made by pairs of neighboring, stacked (1 upper and 1 lower) vertebrae.

The foramen house the spinal nerve root, and the lamina is the part of the individual bone that forms the roof and floor of the foramin.

Putting it back together again, the term posterior cervical laminoforaminotomy is a procedure in which the surgeon enters through the back of the neck to cut into, but not necessarily remove one, two or both of these areas of the spine – the lamina at the back part of an individual bone, and one or more of the holes at the side.

This procedure is done to make room for nerves. The goal of the surgery is to allow the passage of nerves through the foramin to occur unimpeded. By removing bone material in the lamina and/or the foramin, the spine is said to be “decompressed.”

Posterior Approach to Neck Surgery - The Benefits

The benefits to using a posterior approach are that fusion is generally not necessary and that the surgeon can maintain good spinal balance and alignment.

The drawback is that the amount of decompression that can be done in a surgery like this is limited. Consequently, according to Calibri, et. al. the best use for a posterior approach may be to remove soft disc fragments that cause neuroforaminal spinal stenosis (a condition that can and does cause cervical radiculopathy).

When it comes down to it, the choice of surgery has more to do with your surgeon's preferred technique and the ability to maintain spinal alignment and balance during and after the procedure, Caridi, et. al. say.

Other types of Neck Injuries:

Sources

Botelho, Richardo, V., et. al. The Choice of the Best Surgery After Single Level Anterior Cervical Spine Discectomy: A Systematic Review. Open Orthop J. March 2012. Accessed Jan 2016.

Caridi, John M., M.D., Pumberger, Matthias, M.D., Hughes, Alexander, P., M.D. Cervical Radiculopathy: A Review. Hospital for Special Surgery. Sept. 2011. Accessed Jan 2016.

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