Cervical

Your cervical spine or c-spine starts at the shoulder blades and ends at the base of the skull. While the c-spine is a very small area, an injury to this area can be traumatic.

Herniated Cervical Disc

The most common injury in the spine is a herniated or slipped disc. Despite its widespread familiarity, many people do not understand what this injury entails.

Let's talk about the vertebrae or back bones. Each vertebra is stacked one on top of the next, and in between each is a soft cushion called an intervertebral disc. Each vertebra supports the one above it, with the top bone supporting the head.

The disc is a compound of a central jelly-like component and an outer, thick cartilaginous component.

Vertebral Disc
If you get a tear in the outer thick part, then that jelly-like center can be released, putting pressure on the nerve which originates in that vertebra. Typically, it is pressure on a single nerve, because one particular nerve originates or begins at each vertebra. It can also irritate the nerve chemically, which is why you experience severe pain right away. As that chemical irritation washes out, the pain can ease up.

Some factors that can cause a herniated disc are:

With a herniated disc, typically pain radiates into the branches of one of the nerve roots and extends through the lower cervical region into the arm and usually the fingers. In addition to tingling fingers, you may experience weakness in one arm, a burning pain in the neck or even bowel or bladder problems.

Treatment options include a regimen of anti-inflammatory medication, such as ibuprofen. If over the counter treatment is not effective, then oral steroids and epidurals may be prescribed. If that doesn't work, your doctor may begin to talk about surgery.

Surgery for a herniated disc is very common. The standard procedure is called a microdiscectomy. After a small incision is made, the surgeon removes just the herniated part of the disc and any of the loose material - usually done with or without a microscope. Some surgeons do this procedure arthroscopically, using a laparoscope and even smaller incisions. Ask your doctor about the pros and cons of each method.

Many of the procedures can be done as outpatient surgery or with an overnight stay in the hospital. When you awake from surgery you may feel back pain due to the surgery itself, however, most patients experience significant pain relief as soon as they wake up from the operation. Following surgery, most patients will be up and around within a few weeks.

Cervical Spinal Fusion

Spinal fusion joins one or more segments of vertebra to eliminate motion and associated pain. Fusion creates space for otherwise compressed nerves and prevents spinal deformities later in life.


Cervical Spine Fusion
Spinal instability and herniated discs are two common reasons to perform a spinal fusion. In the case of herniated discs, a cervical discectomy, in which the disc is removed and replaced with graft material, may be performed in the same operation as the fusion.

Spinal fusion may be performed using bone grafts. Bone grafts from the patient (autograft) or from a bone bank (allograft) are the two primary choices.

With an autograft, bone is harvested from the patient's hip bone. Despite the second incision required in this operation, historically, the results have been good. Chances for complications or nonunion of the graft are affected by obesity, size of the graft, nutrition and whether the patient is a smoker or not.

In an allograft, the bone graft material, often combined with metal hardware, works to allow the patient's own bone to grow over time. Allograft bone does not heal as efficiently as autograft bone. Therefore the risk of nonunion is greater for allograft surgery.

Opinion differs among surgeons regarding how many segments to include in the fusion. Some surgeons only fuse two segments to treat the primary complaint. Other surgeons may elect to fuse multiple segments to eliminate future problems, but there is a risk of diminished natural movement of the cervical spine.

Cervical Nonunion


Cervical Spine Nonunion
Cervical spinal fusion surgery for cervical radiculopathy, disc herniations, fractures and spinal instability sometimes results in pseudoarthrosis or nonunion. This means that despite the hardware or bone grafting materials used, the bones have not completely healed. Treatment of a nonunion can be surgical or non-surgical. Non-surgical treatment may avoid complications of repeat surgeries.

Electrical bone growth stimulation has been proven to help nonunions heal. Either implanted or external devices may be recommended.

Surgical treatment of cervical fusion nonunion uses additional bone graft material, either from the patient or from a bone bank. However re-operation for cervical fusion is risky, due to the need to reconstruct a partially healed reconstruction. Surgeons may use commercially available bone graft materials called DBM. These materials use allograft bone, combined with other materials, to enhance healing.

Anterior Cervical Corpectomy

In cases of severe spinal injury, in which there is risk of spinal cord injury or paralysis, surgeons may perform a corpectomy in which the entire vertebral body is removed. Removing this outside ring of the vertebra reduces compression on the spinal cord. Similar to discectomy, with a corpectomy a larger incision is made, discs are removed above and below the vertebra, and ligaments may be removed from the back to optimize exposure. A fusion is then performed to reconstruct the portion of the spine which was removed. A strut graft may assist the fusion. This is a larger graft made of solid bone, fastened into place using screws or plates. Alternatively, titanium cages can be used to reinforce the spine after corpectomy if they are FDA-cleared for that use.