Cervical Disc prolapse

Herniation(prolapse) describes an abnormality of the intervertebral disc that is also known as a “slipped,” “ruptured” or “bulging” disc. This process occurs when the inner part (nucleus pulposus) of the intervertebral disc bulges out. It usually happens through the outer, more fibrous layer that surround the disc (annulus fibrosis).

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Cervical Stenosis

The narrowing of the spinal canal is called spinal stenosis. This can happen as a result of the degeneration of spine and subsequent hypertrophy of the facet joints, spinal ligaments, bony end plates, and the intervertebral discs.

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Cervical Tumours

Tumours may be Primary or secondary. It may be extradural,Intradural extramedullary or Intramedullary tumours.

The most common are bony tumours, meningioms, schwanommas, ependymomas, Astrocytomas

Cervical Trauma-

Post traumatic conditions like locked facets, perched facets, listhesis can happen which will compress the spinal cord.

All these conditions causes variable symptoms depending of level and degree of compression and involvement of spinal cord and exiting nerve roots.

Symptoms may vary from

  • Neck pain
  • Pain radiating to upper limbs and back
  • Weakness of upper limbs and lower limbs
  • Bowel and bladder complaints
  • Sensory abnormality like numbness,tingling sensations
  • Vertigo
  • Headache
  • Thinning of muscles
  • Investigations usually done
  • MRI Cervical Spine
  • X ray cervical spine

Treatment –

Mainly depends on patients symptoms and examination signs and severity of nerve and spinal cord compression due to various etiologies described above.

Surgical Procedures performed

Anterio cervical Discectomy and Fusion(ACDF)

When a disc herniates or begins to degenerate and collapse, there is less room for the nerve roots (and sometimes the spinal cord) to function, which can be a source of chronic pain, tingling, numbness, and/or weakness radiating from the neck into the arm. Clearing away the damaged disc and inserting an implant aims to relieve pressure on any compressed nerves to give them space to heal and function normally. If the spinal cord was previously compressed, relieving pressure on it may help resolve or prevent progression of other symptoms, such as trouble with coordination, walking, and/or bladder or bowel control.

The surgery has 2 parts:

  • Anterior cervical discectomy. The surgery is approached through the anterior, or front, of the cervical spine (neck). The disc is then removed from between two vertebral bones.
  • Fusion. A fusion surgery is done at the same time as the discectomy operation in order to stabilize the cervical segment. A fusion involves placing bone graft and/or implants where the disc originally was in order to provide stability and strength to the area.

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  • While an ACDF is the most commonly performed operation for treatment of cervical disc pathology, a newer procedure, called a cervical artificial disc replacement, is also available.

Artificial Cervical Disc Replacement

The key goals of cervical artificial disc replacement surgery are to relieve nerve compression while also maintaining motion at the repaired spinal level.

By replacing the damaged disc with an artificial disc, natural biomechanics can be more closely retained throughout the cervical spine when the neck moves.

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Cervical Posterior Foraminotomy

A cervical foraminotomy is an operation done from the back of the neck to relieve pressure on one or more spinal nerves. It involves carefully removing a small portion of bone and joint which overlie the spinal nerve, as well as any soft tissue which may also be causing compression

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Anterior Cervical Corpectomy

Anterior cervical corpectomy and fusion (ACCF) is a treatment option for degenerative cervical pathologies with spinal cord compression and traumatic subaxial cercical injuries. The cervical spine is accessed by an anterior approach. After discectomy, the middle part of the vertebral body is resected. The defect is filled with a graft/implant to maintain height and stability followed by anterior plating.

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Cervical Laminoplasty

Cervical laminoplasty is a non-fusion, decompression procedure for cervical spondylotic myelopathy . It is most commonly indicated for patients with multiple level stenosis who have preserved lordotic alignment and minimal to no axial neck pain related to spondylosis. Expansion of the laminar arch can allow for direct and indirect decompression of the spinal canal.

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