neck Surgery

Neck surgery is a treatment measure that is especially used for non-healing neck prolapse. Neck surgery for neck prolapse is usually performed on anterior cervical discectomy with fixation, anterior cervical discectomy without fixation or posterior cervical discectomy.

When should neck prolapse be operated on?

If conservative treatment fails and the pain persists at the same strong level for more than 3 months or results in severe dysfunction, surgery may be necessary. The three types of neck prolapse surgery are anterior cervical discectomy with fixation, anterior cervical discectomy without fixation og posterior cervical discectomy. If you undergo such an operation, it is very important that you take the rehabilitation training seriously and do your best there - this to ensure the best possible result.

• Anterior cervical discectomy with fixation - Removal of the intervertebral disc, through surgery from the front of the neck, with subsequent physical fixation with titanium plate or similar. In English, this procedure is called 'anterior cervical discectomy and fusion'. A large retrospective study (Fountas et al, 2007)¹ showed that the mortality risk for such a surgical procedure was 0.1% (1 in 1015 patients died during such an operation). The complication rate was 19.3% (196 out of 1015 patients had complications during or after the operation) - the most common complication was dysphagia, ie difficulty swallowing. This accounted for 9.5% of the complications). A study of 71 patients showed that 82% experienced symptomatic relief (Yue et al, 2005)².

• Anterior cervical discectomy without fixation - Removal of the intervertebral disc, through surgery from the front of the neck, but without subsequent physical fixation in the operated area. Known as 'anterior cervical discectomy without fusion' in English. A study with 291 operations (Maurice-Williams et al, 1996)³ referred to symptomatic improvement in 94.5% of operated patients, deterioration in 3% og mortality risk of 1.5% (4 of 291 patients died).

• Rear cervical discectomy - In contrast to anterior cervical discectomy, one goes through posterior structures here. A recent study (Yang et al, 2014)⁴ compared the two interventions and came to the following conclusion:

"In our study, the clinical outcomes between the 2 approaches did not differ significantly. However, posterior full-endoscopiccervical discectomy may be preferable when considering the volume of disc removal, length of hospital stay, and the postoperative radiographical changes. As an efficacious supplement to traditional open surgery, FECD is a reliable alternative treatment of CIVDH and its optimal approach remains open to discussion. »

 

The clinical results were not very different, and the study suggested that posterior discectomy may be preferable to the two. But it is generally said that posterior discectomy is more risky, as you have to pass several blood vessels and thus risk bleeding. The debate over the best surgical method is ongoing.

Sources:
[1] Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, Lee GP, Robinson JS Jr. Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976). 2007 Oct 1; 32 (21): 2310-7.

[2] Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study. Spine (Phila Pa 1976). 2005 Oct 1; 30 (19): 2138-44.

[3] Maurice-Williams RS, Dorward NL. Extended anterior cervical discectomy without fusion: a simple and sufficient operation for most cases of cervical degenerative disease. Br J Neurosurg. 1996 Jun; 10 (3): 261-6.

[4] Yang JS, Chu L, Chen L, Chen F, Ke ZY, Deng ZL. Anterior or posterior approach of full-endoscopic cervical discectomy for cervical intervertebral disc herniation? A comparative cohort study. Spine (Phila Pa 1976). 2014 Oct 1; 39 (21): 1743-50.

Thanks to our friends in Nakkeprolaps.no for that they would share this article with us.