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Cervical Spine MRI Degenerative Disc Disease with Cord Compression | This requires surgical intervention as early modalities of nonsteroidal anti inflammatory drugs, physical therapy, bracing, traction and injections are long past their efficacy. If the impingement is localized to one or two levels in the spine, an anterior cervical discectomy and fusion may be done. In this case, an incision is made in the anterior neck area and the muscles, trachea, esophagus and blood vessels are retracted safely. The involved disc is then removed and the posterior osteophytes are decompressed. Bone graft from the bone bank is usually added for fusion and an anterior plate is placed on the spine to help with stability as the fusion heals. This can be done at several levels and sometimes the entire vertebral body or part of it is removed to allow adequate decompression of the spinal canal and cord.
If the degeneration and osteophytes pattern of the neck is sufficiently involving multiple levels the decompression, surgery may be done from the rear or posterior. One of the problems with multilevel anterior decompressions and fusion is that as the length of fusion increases the success for fusion decreases. Also with a stiffer neck the likelihood that there will be residual pain and dysfunction increases. To prevent this, a posterior laminoplasty is performed. In this procedure the posterior muscles are removed and small openings in the posterior cervical laminae or bony shingles which protect the cord in the back are made.
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Cervical Spine 4 Level Anterior Fusion with Plate |
Carefully under microscopic technique the laminae are then hinged open like a door allowing the cord precious extra millimeters of space. Bone graft or metal plates are often placed along the opening to maintain their open position. Depending on overall cervical stability metallic plates and screws or a rod and screw construction are placed, often with bone graft sometimes taken from the pelvis to form a fusion. More recently, a laminoplasty is done without fusion or metal to allow maximum mobility of the spine which seems to help in pain relief from multiple levels fusions which limit neck motion.
These procedures can be enormously rewarding for patient and surgeon in that individuals whom can barely walk due to myelopathy, often leave the hospital or return for post op visits walking normally. Normally a soft neck brace is worn for several weeks and lifting restrictions are placed until healing is occurring.
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