Do I Have To Have My Neck Fused?

“My surgeon told me I had to get my neck fused?”.  This comment from patients is something we hear quite routinely from patients that come to see us for a second opinion.  Individuals with acute or chronic neck problems, that may or may not have symptoms which radiate down the arms are typical patients at AllSpine Laser and Surgery Center.  Classically, these patients have had symptoms for more than 2-3 months, and have tried a variety of non-surgical treatments such as physical therapy, chiropractor, medications, injections, and acupuncture.  Unfortunately, upwards of 20% of such patients fail conservative therapy and need surgical intervention.



Although surgery on the cervical spine (neck) has been done for decades, the various surgical options for cervical disc issues has blossomed over the past 5-10 years. The most common procedure performed in the United States for a ruptured disk in the neck is an anterior cervical discectomy and fusion (ACDF).  This involves a small incision in the front of the neck to approach the spine and remove the offending disc material off the spinal cord/nerves, and stabilize the spinal level with a variety of different implants/hardware.  The success rate for this surgery is above 90%, and up to two levels can be easily performed in an outpatient setting.  However, the ACDF is NOT the ONLY option, and your surgeon should advise you of this fact!

Depending on the severity of the disc herniation, as well as the extent of the underlying degenerative nature of the spine, a patient may be a candidate for a cervical artificial disc replacement (CADR), posterior cervical foraminotomy (PCF), or intradiscal laser decompression (IDLD).  Although these three procedures cover a broad surgical spectrum, they have ONE thing in COMMON: they ALL preserve the motion of the spine.  The CADR implants an artificial disc at the treated level, rather than fusing the segment. This results in preserved range of motion of the neck, despite removing the offending material off the spinal cord/nerves.  The PCF avoids any surgery from the front of the neck, and is performed through an inch incision in the back of the neck.  Using a series of dilating tubes, the surgeon exposes , through the inch incision, the joint in the back of the neck that is contributing to the compression of the nerve root (which causes the arm pain/numbness/weakness).  By removing this bone and any offending material off the nerve, the arm symptoms are resolved in >90% of cases.  The IDLD is a percutaneous (through a needle) procedure that places a needle into the center of the disc, followed by the laser fiber. Using a unique laser technique, the laser delivers a set amount of joules (energy) into the center of the disc which causes it to shrink away from the spinal cord/nerves.  All three of these procedures are routinely performed as an outpatient procedure at the AllSpine Laser and Surgery Center.

In contrast to the cervical fusion that is meant to stop movement at that segment, the CADR, PCF, and IDLD maintain motion at the treated level.  This translates into often quicker recovery, return to work, and less pain following surgery.  Although patients are unique, it needs to be stressed that surgical outcomes can vary between two individuals having the same exact surgery.  A lot of things come into play when we talk to patients about recovery and expectations.  If you find yourself in the situation where a spine surgeon says you need a fusion, call AllSpine and meet with one of our expert NeuroSpine surgeons today for an opinion!!

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