![]() This surgery is performed from the front of the neck in which the disc is removed and is replaced with cage along with autograft and the two vertebrae are fixed to each other with use of plate and screws. It is also performed in cases of fracture or dislocation of the spine. It is usually performed for degenerative disc disease of the neck along with disc herniation causing compression on the spinal cord or nerve roots. ANTERIOR CERVICAL DISCECTOMY AND FUSION (ACDF)ĪCDF is one of the most common surgical procedure performed over the cervical spine. The patients usually must wear a neck collar for a couple of weeks and there is a gradual recovery over a span of two to three months. This surgery allows retention of movements of the neck as oppose to laminectomy and fusion surgery in which there is some restriction of movements. This surgery is performed in patients who have narrowing of the spinal canal at multiple levels, especially from the back side. Window is made on the lamina of the cervical vertebrae and this window is held open with use of mini plates. This surgery is usually performed in stable spine. Laminoplasty is a motion sparing surgery that is performed over multiple levels on the back of the neck. The patients usually will have some restriction of movement after the surgery, especially if it is performed at multiple levels. ![]() The patients usually have to use a neck collar for a few weeks and there is a gradual recovery over a span of two to three months. This surgery is combined with fusion of the neck from the back using screws and rods. This procedure is usually done for patients who have compression of the spinal cord from the back or patients who have narrowing of the spinal canal at multiple levels. CERVICAL LAMINECTOMYĬervical laminectomy is the procedure of removal of the lamina or the bone on the back of the vertebrae of the neck. The recovery and rehabilitation from this surgery is faster and has good results. This surgery allows retention of movement between the vertebrae as there is no fusion involved. This surgery is done from the back of the neck in which a limited amount of bone is removed to form a window to decompress the nerve root and remove the bulging disc material. This is a minimal invasive procedure which is usually done in carefully selected patients to remove the pressure of the disc over the nerve root causing the pain. All cervical spine surgeries are performed under general anesthesia after endotracheal intubation. This surgery allows retention of the mobility between the vertebrae and results in preservation of the neck motion after the surgery. When indicated, patients may be a good candidate for cervical disc replacement in which the disc from the front of the vertebrae are removed and replaced with the artificial disc. Occasionally, the patient may be a good candidate for motion sparing surgery like Microdiscectomy or Laminoplasty. This is usually combined with fusion using screws and rods. ![]() Referral of high-risk patients to a neurologist or spine specialist may be indicated.Patients who have compression from the back of the vertebra may need surgery from the back in which the lamina is removed and the spinal cord and the nerve roots are decompressed. Computed tomography and magnetic resonance imaging can clearly define anatomy, but these studies are costly and have a high false-positive rate. ![]() In considering diagnostic tests, physicians should apply the principles outlined in an algorithm for the evaluation of low back pain prepared by the Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and Research). Physicians must look for “red flags”-key historical and clinical clues that increase the likelihood of a serious underlying disorder. The most important information in the assessment of a possible spinal cord emergency comes from the history and the clinical evaluation. The differential diagnosis includes spinal cord compression secondary to vertebral fracture or space-occupying lesion, spinal infection or abscess, vascular or hematologic damage, severe disc herniation and spinal stenosis. Spinal cord emergencies are uncommon, but injury must be recognized early so that the diagnosis can be quickly confirmed and treatment can be instituted to possibly prevent permanent loss of function. Physicians who work in primary care settings and emergency departments frequently evaluate patients with neck and back pain. ![]()
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