Non-Surgical Options

Any patient with persistent and worsening symptoms greater than 4 – 6 weeks is a candidate for a cervical spine evaluation. Most patients undergo an MRI to develop a diagnosis with their clinical presentation. If the patient is diagnosed with Arthritis or Cervical Degeneration without any nerve root or spinal cord compression, then they are a good candidate for an initial course of physical therapy. Most Providers will send patients to therapy for 6 – 8 weeks and only continue if they improve after the initial course. If patients worsen, they may be referred to Pain Management or a surgeon.

Acupuncture is extremely helpful for someone with persistent muscle spasms without nerve root compression and without myelopathy. Constant neck pain can cause the muscles of the neck and shoulders to be in continued spasm. Acupuncture is helpful in this particular situation.

Patients who present with any sort of neurological deficit are candidates for surgery sooner than later. This includes severe weakness of their upper extremities from a pinched nerve or someone with progressive Cervical Stenosis causing cord compression. Any other patients with mild to moderate symptoms are evaluated based on any extent of any deficits, length of symptoms and overall function.

Most patients who undergo Anterior Cervical Surgery through a 1-level, 2-level, or 3-level surgery will not be required to wear a collar. At the outset of cervical fusion surgery and as early as 10 years ago, Spine Surgeons mandated those patients wear a collar. That is not the case anymore since fusion rates are higher, greater education on post-operative care, and better fusion technology. A small number of patients who are involved in a traumatic accident with or without cervical spine surgery may be required to wear a collar for instability, but this is the minority population (< 5%).[/et_pb_accordion_item][et_pb_accordion_item title="Are you taking bone from my hip if I have a cervical fusion?" _builder_version="4.27.4" _module_preset="default" global_colors_info="{}" theme_builder_area="post_content" open="off"]The vast majority of Spine Surgeons do not take bone from your hip. As technology for the procedure improved and allograft products became more available, the need for hip bone became less important. In fact, the part of the procedure to remove hip autograft hurt more than the actual anterior cervical surgery. In my practice, I only use bone harvested from the patient using the same incision.[/et_pb_accordion_item][et_pb_accordion_item title="Do I need to stay in bed after cervical surgery?" _builder_version="4.27.4" _module_preset="default" global_colors_info="{}" theme_builder_area="post_content" open="off"]Mobility is the key. Over the past 20 years, surgical recovery has gone through an enlightening period where immobility was previously thought the gold standard has now been converted to mobility as the gold standard. I frequently tell my patients to follow the ‘20 Minute Rule” of changing position every 20 minutes as mobility loosens muscles and improves pain.[/et_pb_accordion_item][et_pb_accordion_item title="Will I keep having more surgery after my first one?" _builder_version="4.27.4" _module_preset="default" global_colors_info="{}" theme_builder_area="post_content" open="off"]This is an excellent question. The risk of needing additional surgery after your first cervical spine surgery is approximately 4% over your lifetime risk. This means that 4 patients out of 100 surgical patients will need to come back for additional surgery most likely on the level above or below the initial surgical level.[/et_pb_accordion_item][et_pb_accordion_item title="Is Cervical Disk Replacement better than Cervical Fusion?" _builder_version="4.27.4" _module_preset="default" global_colors_info="{}" theme_builder_area="post_content" open="off"]

A research study evaluating the 10-year outcome of patients undergoing single-level cervical disc replacement versus anterior cervical discectomy and fusion in New York was recently published in the Journal of Neurosurgery – Spine (April 2023).

Although Anterior Cervical Diskectomy and Fusion (ACDF) is considered the gold standard for treatment of cervical disc disease that can cause radiculopathy or myelopathy, a number of studies have been conducted to show that cervical disc replacement (CDR) may have added benefits. Some of the benefits include increased range of motion and reduced risk of adjacent segment disease after surgery in the long term.  The study highlighted here reviewed data from the New York State Database to assess each procedure and its effectiveness over 10 years.

The authors reviewed a retrospective cohort from the Statewide Planning and Research Cooperative System using diagnosis and surgical codes for adult patients who underwent either ACDFP or CDR at one level. The study included a total of 7,450 patients where 6,615 underwent ACDF and 835 underwent CDR. The analysis showed no significant differences in the incidence of revision risk between the two study groups. The CDR cohort had a higher incidence of postoperative swallowing difficulty while those patients undergoing ACDF had a longer average hospital stay.

The study did not highlight long-term success in terms of adjacent segment disease, only revision risk and immediate complications. They noted the revision risk; revision risk is simply when a patient is taken back to the operating room in the short term after the initial surgery. The database most likely did not track adjacent segment disease because it was probably not a feature of the database.

Overall, this was an excellent study to support both procedures in terms of the success and outcomes. It did not focus on the main topic of hypermobility or adjacent segment disease. My worry as a surgeon is that patients can have increased neck pain after cervical disc replacement.