Anterior Cervical Discectomy, Decompression and Fusion for the Treatment of Pain, Weakness, Numbness and Tingling in the Neck and Arm caused by Radiculopathy or Myelopathy.
Last updated Tuesday, January 15, 2008
Considering surgeryWhat kinds of surgery are recommended for cervical stenosis?
The
cervical stenosis can be approached from the anterior (front) or from the posterior
(back) of the patient. The decision to approach the spine from the front is
dependent upon many factors, including:
- how many levels of discs and vertebrae are involved
- the overall alignment of the cervical spine
- the presence of radiculopathy, myelopathy, or both
- the presence of neck pain
- the extent of arthritis, and more
The
surgeon weighs these factors and the results of a full diagnostic workup, and
recommends the surgical approach and procedure. Who should consider anterior cervical decompression and fusion (acdf) for cervical stenosis and in what cases?
Generally
patients with symptomatic myelopathy are appropriately treated with surgery to
prevent progression of their condition. Patients with very mild myelopathy can
be observed.
Patients
with radiculopathy can initially be treated nonsurgically. Anti-inflammatory
medication, therapy, and steroid injections can treat radiculopathy. If these
treatments fail and symptoms persist, surgical intervention is generally
recommended.
What happens if nothing is done for cervical stenosis (best case/worst case scenarios)? Radiculopathy
often can resolve with non-operative treatments. If radiculopathy does not
improve with non-surgical approaches, it is reasonable to examine surgery as an
option. Myelopathy, in general, does not improve without surgery. With
myelopathy, the surgeon’s goal is to prevent progression of the condition and
further neurological damage. Although patients can recover neurological
function after a surgical procedure for myelopathy, the recovery rate is
variable. A patient usually can recognize as neurological deficits progress: walking
becomes more difficult; increasing weakness and burning sensation or tingling
in arms and legs; and more problems with fine motor control of their hands. In
severe cases, bladder and bowel problems emerge.What options exist for surgery for cervical stenosis? The
cervical spine may be approached from the front or the back of the neck. If
approached in the front, an anterior decompression and fusion is usually
performed. If approached from the back, a number of options exist. The decision
to recommend one surgical procedure over another depends on many factors already
discussed.
A
decompression from the back can be performed with or without a fusion. The
question of whether fusion is appropriate should be addressed directly with
your doctor. When performed by an experienced surgeon, how effective is anterior cervical decompression and fusion (acdf) for cervical stenosis likely to be and how long will the benefit last? In
the hands of an experienced surgeon, decompression and fusion surgery is usually
very effective in relieving symptoms of nerve root compression, and in
preventing progression of nerve damage from spinal cord involvement. After the
patient has healed from the fusion procedure, the positive effects of surgery
level can last decades.How urgent is anterior cervical decompression and fusion (acdf) for cervical stenosis?
Anterior
cervical decompression and fusion for radiculopathy is not generally emergent.
A trial of initial non-operative treatment is usually appropriate.
To
treat myelopathy, the surgery is more urgent, however not emergent unless is a
progressive neurologic deficit exists. At times, particularly in traumatic
settings, surgical intervention is warranted on an emergent basis. Generally,
it is recommended that patients with symptoms of myelopathy be treated sooner
rather than later to prevent further neurological damage.What are the most frequent and most serious risks of anterior cervical decompression and fusion (acdf) for cervical stenosis? How common are they? Any
surgical procedure carries a certain amount of risk. These risks include, but
are not limited to, infection, bleeding, nerve injury, and swallowing
difficulty.
With this
procedure, the fusion may not heal properly and a second surgery may need to be
performed. There are also risks of anesthesia. Although risks exist to the
procedure, the complication rate is low. Generally, patients do not require a
blood transfusion, as blood loss for these surgeries is very low. If risks occur during or after anterior cervical decompression and fusion (acdf) for cervical stenosis how are they managed? In
the rare event of a complication, measures can be taken to counter them. If an
infection emerges in the early postoperative period, a surgical cleansing of
the wound can be performed. If there is a nonunion, or if the bone graft does
not fuse and the patient has symptoms because of this nonunion, a fusion can be
performed posteriorly, or the fusion can be revised from the front.Surgery for Cervical Stenosis at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 (outside the Seattle area: 800-440-3280) to make an appointment.
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