Surgery
Sometimes, patients may require surgery to relieve chronic neck pain and neck pain associated with cervical radiculopathy. No surgical procedure has been developed for mechanical pain.
One of the most popular surgical procedures for neck pain is anterior decompression. It is a valuable alternative in disc degeneration, in which intervertebral discs are damaged, the vertebrae are very close to each other, and the nerve roots are compressed against one another. In such cases, studies show that surgery is associated with more significant pain reductions than physical therapy, cervical collars, and other therapeutic options. It also improves muscle strength and sensory loss problems in these patients, with a long-term improvement of the symptoms. After one year, patients still experience pain reduction, but some studies suggest that symptoms may return after two years or more.
Decompression techniques include:
- Anterior cervical discectomy and fusion: This is perhaps the most common type of decompression surgery. It involves the removal of the damaged disc, which is performed through the front part of the neck. The neck’s stability is maintained through the cervical spinal fusion of the remaining vertebrae. There is also a possibility of doing the same procedure from the back of the neck. This is useful when doctors only need to remove a part of the disc, not the complete structure. In such cases, the remaining vertebrae should not go through fusion. Anterior approaches are better if the location of the disc herniation is in the midline and not on the sides.
- Cervical artificial disc replacement: This procedure is newer and involves a similar discectomy, but instead of fusion of cervical vertebrae, an artificial replacement disc will be located in place. The damaged disc can also be removed through the frontal part of the neck or back. After this type of surgery, patients describe more natural neck mobility. In case of severe spinal degeneration, it is better to go through fusion instead of artificial disc replacement.
- Posterior cervical laminectomy: This is another option, and it can be done instead of or along with discectomy. It involves the removal of the posterior aspect of the vertebra, which is known as the lamina. Laminectomy allows for better neck flexibility, especially when neck fusion is avoided. Still, neck fusion and laminectomy can be done in the same procedure without a problem.
- Posterior cervical laminoplasty: The procedure is almost the same and involves the same part of the vertebra. However, instead of cutting the lamina as a whole, only a part of the lamina is removed, or it can be restructured to increase the available space for the spinal canal.
- Posterior cervical foraminotomy: This procedure directly involves the foramen, the opening or hole through which nerves arise. Part of the foramen can be removed, or the structure can be changed depending on what is happening. If a bone spur irritates the nerve, it can be taken out. Also, if a herniated disc is causing problems, part of the disc can be removed.
- Anterior cervical corpectomy: This procedure is similar to a discectomy, as noted above, except that it also removes a vertebral body. Thus, an essential portion of the vertebra is gone, and the discs above and below are also gone after the procedure. A bone graft then takes the space, and the remaining bones are expected to fuse. This is only done when multiple levels of the spinal cord are affected by nerve compression.