Cervical spondylosis and slip disc

Cervical spondylosis is a process of wear and tear of the discs between our neck bones. Due to this wear and tear, the water content in the disc decreases. As a result of this, the normal load bearing capacity of the disc is compromised resulting in neck pain. Mostly, cervical spondylosis is caused by your own tendency or genetic make-up but a small contribution may be because of smoking and minor or major injuries. Most cases of cervical spondylosis cause only neck pain. But some patients may develop nerve or spinal cord compression from a slip disc or osteophytes (bony overgrowth).

Most cases of cervical spondylosis cause only neck pain. But some patients may develop nerve or spinal cord compression from a slip disc or osteophytes (bony overgrowth).

Cervical Myelopathy

 

Instead of an isolated nerve, when the entire spinal cord is pressed from a slip disc, osteophyte (bony overgrowth) or ligamentous overgrowth; this condition is referred to as Cervical Myelopathy. This is a serious condition, which needs to be recognized and addressed as early as possible. Otherwise, it can result in irreversible paralysis.

These patients may complain of tingling or numbness in their hands. They may have difficulty with their balance (can be tested by trying to walk along a straight line. They may find it difficult to perform fine motor activities with their hands (like buttoning their shirt, messaging on a mobile or typing on a computer). Rarely, they may report an electrical sensation going down their body on movement of their neck. They may even report a change in their ability to control their urine or motion.

As this is an irreversible and progressive condition, the treatment for this condition is always surgical. Depending on whether the compression is from front of the neck or behind the neck, decompression can either be done from the front (ACDF or ACDR) or from behind (Cervical Laminectomy with or without fusion or Cervical Laminoplasty).

What to expect from an anterior cervical operation (ACDF or ACDR)?

The incision size is about 3-5 cm. We generally don’t use any external stitches and the scar usually gets hidden in the neck skin folds. The typical hospital stay for an ACDF or ACDR is 3-4 days. You can expect to walk the very next day after surgery. You will be pretty much independent by the time of discharge. Usually, no collar will be needed after surgery. You can expect to join back work at 4-6 weeks. The success rate for an anterior cervical operation is in the high nineties with a very small complication rate of 1-2 percent.

 

 

Cervical Radiculopathy

 

When a nerve root is pressed because of a slip disc or osteophytes in the neck, this condition is called cervical radiculopathy. These patients may complain of pain, tingling and numbness going down one of their arms. Rarely, they may also develop weakness of one arm.

Most of these patients improve in 3-6 weeks with the help of some medicines. But, if symptoms persist for > 6 weeks or if major weakness has developed in one of the arms, then you may need decompression of the involved nerve. This is usually done by performing an Anterior Cervical Discectomy and Fusion (ACDF) or an Anterior Cervical Disc Replacement (ACDR).

 

Both these surgeries are done from the front of the neck. The initial steps until the decompression  and discectomy (taking out the disc) are the same. In ACDF, the space left behind is filled with bone graft and a plate is applied for stabilization. The goal of the surgery is creation of bone in the space left behind after taking out the disc. In ACDR, the disc that is removed is replaced by an artificial disc made of metal. The goal here is to preserve the motion between the two bones. Preserving motion has a slight advantage over fusion but is significantly more expensive. All cases may not be suitable for Disc Replacement and the decision should best be left to your Spine surgeon.