The two common reasons for needing elective cervical surgery are because of
- pressure on the nerves as they leave the spine - Radiculopathy
- pressure on the spinal cord - Myelopathy
Radiculopathy – Pain that radiates from the spine proximally, extending outwards with numbness and paraesthesia along the dermatome.
Myelopathy – Weakness/stiffness and clumsiness of both the upper and lower limbs with variable impairment of sensations below the level of the compression of the spinal cord. (Pain is not a big feature)
How does one decide what surgery is required for the cervical spine problem?
- When the nerve is being compressed by a bony spur from in front - we approach from the front.
- Anterior cervical discectomy and fusion
- Anterior cervical discectomy and arthrodesis
- Anterior cervical corpectomy and fusion
- If the compression is from the front for more than 2 vertebral levels the tendency is to relieve pressure by operating from the back.
- If there is a suggestion of excessive degeneration or instability, a fusion is usually done.