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
Review of the conditionCharacteristics of cervical stenosis Radiculopathy commonly presents as arm pain, numbness and tingling
down the arm, occasional weakness in specific muscle groups (depending
on which nerve root is affected), and neck pain. Certain neck positions
can aggravate the patient's symptoms.
Myelopathy
can present as changes in walking patterns, clumsy hand coordination, in severe
cases, bowel and bladder changes. Reflexes can be exaggerated with myelopathy.
Myelopathy
and radiculopathy can occur at the same time and the patient can have a
combination of these symptoms. Types Spinal
stenosis can be caused trauma or injury, by bony growths, or can be inherited and
degenerative.
Vertebral
discs are the doughnut-shaped, shock-absorbing structures that sit between each
vertebrae. An injury or trauma often herniates a disc, causing part of it to protrude
from between two vertebrae and into the spinal canal. Depending on the location
and extent of herniation, the patient can have radiculopathy, myelopathy, or
both. In the same way, degenerative disc disease – the wearing down of the
discs
Spinal
stenosis also can be a result of advanced arthritis in the neck or upper back.
Bone-spur formation can place pressure on the spinal cord and/or its nerve
roots. Similarly, tumors can emerge around the spinal canal, putting pressure
on the cord.
Congenitally,
cervical stenosis presents as a naturally narrower spinal canal. This
condition can make a person more prone to experience radiculopathy,
especially if the narrowing progresses throughout life. Similar conditions The
presence of certain neurological patterns and cervical stenosis highly suggests
that the patient’s symptoms are coming from the cervical spine. However, other neurological conditions can
mimic these symptoms. For example, if a nerve is compressed in the arm, rather
than the neck, this can mimic symptoms of cervical stenosis.
Occasionally,
an electromyography (EMG) test can help differentiate the source of symptoms.
In addition to other potential sites of nerve compression, certain metabolic
conditions such as multiple sclerosis can mimic symptoms of cervical stenosis.Incidence and risk factors Recent studies
estimate cervical stenosis to be as common as 5 percent of the general population,
nearly 7 percent of people 50 or older, and 9 percent of population 70 or
older. It is unknown what rate of patients with cervical stenosis experience
symptoms or do not experience symptoms.
Diagnosis Radiculopathy
and myelopathy are diagnosed with physical exam. A variety of physical exam
tests examining muscle groups, the distribution of numbness and tingling, and
the quality of reflexes allows the physician to identify which nerves are
affected.
X-rays
and magnetic resonance imaging (MRI) serve to confirm diagnoses and provide
more detailed information to help determine the appropriate surgery.
Occasionally, in a clinically challenging patient, an electromyography (EMG)
and nerve-conduction testing are done to isolate the area of nerve injury.Medications
Radiculopathy
(nerve root compression) can be successfully treated with anti-inflammatory
medication such as ibuprofen or Naproxen, which are sold over the counter at
drugstores and groceries. These medications decrease the inflammation and can
relieve the patient’s symptoms.
If these
medications fail, a steroid injection around the affected nerve can be
performed. The steroid injection delivers a higher concentration of
anti-inflammatory medication directly around the affected nerve.
Myelopathy
(spinal cord compression) generally does not respond to anti-inflammatory
medication as well as radiculopathy.
It is
important that the patient be aware of the possible side effects of these
medications, including stomach irritation, kidney problems and bleeding. If the
patient has a history of difficulty with these medications, other treatment
options should be considered.
For each medication, patients should learn
possible interactions with other drugs, the recommended dosage, and the cost.Exercises In
general, exercises do not relieve myelopathy (spinal cord compression). Therapy
can provide some relief for radiculopathy. Traction exercises can help relieve
stenosis affecting nerve roots. These exercises can provide enough relief until
the radiculopathy has resolved.
Possible benefits of anterior cervical decompression and fusion (acdf) With
anterior cervical decompression and fusion, the surgeon removes the offending
disc(s) and/or vertebral bodies, and the spine and its nerve roots are
decompressed in the front. This part of the procedure directly takes pressure
off of the spinal cord and its nerve roots.
After the
decompression, a bone graft is placed to replace the removed tissue. This bone
graft partially fuses the cervical spine and stabilizes the neck. The bone may
be taken from the patient’s own pelvis (autograft) or from the tissue bank
(allograft –cadaver bone). Cadaver bone has been shown to have excellent
healing rates and avoids a second incision in the patient at the hip.
In
addition to the bone graft, a small titanium plate is placed at the vertebral
levels above and below the affected vertebra to give additional stability to
the fusion after placement of the bone graft.
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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