Month: December 2013

Is Minimally Invasive Spine Surgery Performed on the Neck?

Yes, minimally invasive spine surgery is an option for those with damage to the cervical spine (neck), as well as to those with injuries lower in the back. Patients with chronic neck pain who are not helped by conservative treatment may benefit from surgical treatment. Patients should consider surgery if they fail to improve with conservative therapy, have severe pain, weakness, cervical myelopathy, spinal cord dysfunction, spinal cord compression, and spinal cord swelling on an MRI scan. A discectomy is done to remove the disc compressing the nerves and spinal cord. The disc can be removed from through the front or back of the neck.

Most discs are removed through the front of the neck.  After the disc is removed a bone plug is inserted into the cleaned out disc space to hold the vertebrae apart. The vertebrae are then secured together with metal plates and screws.  Over time the two vertebrae and bone plug will fuse together.

New cervical neck endoscopes are being designed to remove the disc herniation without fusion and instrumentation. An endoscope is a micro video camera the size of a pencil which can be inserted through an incision the size of a fingernail. The camera then projects the images onto a video screen so the surgeon can easily visualize the disc compression.  Tiny instruments are inserted through the camera to decompress the nerve, which quickly provides relief from pain and suffering.

Cervical discs can be removed through the back of the neck.  The lamina in the rear of the spine is found and partially removed, exposing the disc that is pinching the nerve. The disc is then carefully removed.

New minimally invasive techniques allow this surgery to be done through a small tube inserted between the neck muscles, which decreases the muscle damage and weakness caused by muscle retraction. The disc and pinched nerve are found with the microscope and decompressed. The patient usually recovers quickly and without complication.

What is Spinal Stenosis?

Spinal stenosis is narrowing of the spinal canal.  This may be inherited, that is you were born with a small canal, or acquired, the spinal canal became smaller over time from degeneration, that is bulging discs, bone spurs and thickened ligaments.

As people age, the neck begins to “wear out”.  This begins with the drying out and collapse of the cervical discs.  This collapsed disc changes the forces across the spine and results in abnormal motion.  To stop this motion the body strengthens the neck by thickening the spinal ligaments and stabilizing the mobile joints with bone spurs.  This is especially seen behind the vertebral bodies, around the facet joints located at the side of the spine and in the ligamentum flavum (yellow ligament) at the back of the spinal canal.   These changes lead to decrease in the size of the spinal canal and may result in spinal cord compression.

Spinal stenosis may cause spinal cord injury and dysfunction called myelopathy. This may be due to compression, abnormal spinal motion or poor blood supply.   Myelopathy commonly presents in older people with neck pain, clumsy hands and difficulty walking.   This may be associated with pain, numbness, tingling, weakness, coordination problems (doing up buttons, fastening bra and eating), arm and leg stiffness, and bladder and bowel dysfunction.   People must rush to the bathroom to prevent incontinence.   Head movements may cause electrical shocks to shoot down their spine.   At times people may show slow decline in mobility:  from a cane to walker to wheelchair.  Very rarely, spinal stenosis can cause paralysis.