Degenerative Conditions of the Neck
Slipped disc, prolapsed disc and bone spurs are degenerative conditions of the neck, where your spine structure deteriorates progressively. As one ages, these issues may cause neck pain and affect your daily activities such as balance and movement. Below are the neck pain treatment options offered by Dr Hee at the Pinnacle Orthopaedic Group.
Spinal Injections to Neck Pain
(Percutaneous Nerve Root Block, Facet Joint Block)
Spinal injections can be a useful tool in alleviating the pain in many degenerative conditions of the neck , and it can help speed up the recovery process. The spinal injections are performed under local anaesthesia or light sedation. The procedure involves you lying on a special operating table which allows x ray images to be taken of your spine. A fine needle will be inserted to the target area of interest to administer medications to help your nerves and/or spinal joints.
Percutaneous Disc Decompression Neck Pain Treatment
In situations where the back pain problem is due to a bulging disc irritating your nerves, percutaneous decompression of the disc may be helpful in alleviating your symptoms. The procedure, such as Nucleoplasty, aims to reduce the pressure on the nerves by using radiofrequency to cause a small volume reduction in the disc. You will be gently sedated for the procedure, and again, this is performed with the help of CT (computed tomography) images taken on your affected spine. You need to wear a soft neck collar for 4 weeks.
Anterior Discectomy and Fusion for Slipped Disc
Anterior cervical discectomy and fusion (Figure 1) is an operation performed on the front of the neck to relieve pressure on one or more nerve roots, or on the spinal cord. The term is derived from the words anterior (front), cervical (neck), and fusion (joining the vertebrae with a bone graft).
Anterior discectomy and fusion of the cervical spine is performed from the front of the neck. It was first described in the 1950s, and is one of the more common spinal operations performed nowadays. The aim is to relieve the nerve(s) and/or spinal cord from compression, thereby allowing improvement of the environment for the nerve(s) and/or spinal cord to recover. By relieving the compression, fresh blood supply will allow delivery of nutrients as well as excretion of waste products of the nervous structures. Fusion is commonly performed using a bone graft either from the patient’s own bone or other sources. The objective of fusion is to maintain the space for the nerve(s) in the spinal column, as well as stabilizing the affected segment of the spine.
In this surgery, we will dissect between the muscles of the neck to get to the cervical spine. The windpipe and food channel will be gently retracted away to allow access to the surgical area. The offending disc is correctly identified by x ray imaging, and the disc is removed with the aid of an operating microscope. At the end of the decompression, the nerve(s) and/or spinal cord are ascertained to be free from obstruction under the view of the microscope. The second part of the operation is fusion (mentioned earlier) and stabilization with a titanium plate and screws placed in front of the affected spinal segment. The use of the titanium plate allows more immediate stability to be attained, and thus the patient does not have to wear an external collar for prolonged period of time post-surgery.
Sometimes, the bony spurs pressing on the spinal cord maybe located behind the vertebral body, and the surgery recommended will not only involve removing the discs, but also the vertebral body (anterior cervical corpectomy).
Artificial Disc Replacement
Artificial replacement of the discs of the neck are good procedures in suitable candidates. In general, if you are under 60 years and the problem is due to a single disc of the neck, you maybe a suitable candidate for this surgery (Figure 2). The surgery will involve general anaesthesia, and you lying face up. Using x ray images real time, we will remove the disc from the front thoroughly so that the nerves are free, and subsequently insert an artificial disc into the original disc space. This device is made from a combination of metal (either titanium or cobalt/chromium) and plastic. Depending on the situation, you will most likely need to wear a soft neck collar for several weeks.
Posterior Decompression and Stabilization
Sometimes, the spine surgeon may recommend operating from behind the neck (posterior). This is usually indicated if the patient has multiple levels of nerve and spinal cord compression. The objective of performing the posterior surgery is to increase the space available for the nerves and spinal cord. This can be done via laminectomy, whereby the bones (lamina) covering the spinal cord are removed. Sometimes, the surgeon may also elect to stabilize the levels decompressed by placing titanium screws (Figure 3) at the back of the neck (fusion).
Laminoplasty (Figure 4) is another alternative to laminectomy, and it is also recommended when there is evidence of narrowing of the spinal canal at many levels. One prerequisite of performing this surgery is that the spine must not be crooked or in kyphosis, otherwise the nerve compression will still remain after surgery. This operation is performed from the back of the neck, after positioning the patient in the prone (face-down) position. The procedure, in simplicity, creates more space for the spinal cord by creating and opening a trap door in the laminae of the spine. The difference with laminectomy is that the laminae or bones at the back of the neck are preserved instead of removed, hence reducing the need for fusion. Nowadays, we have newer methods of securing the opened laminae via mini plates and screws, which do not span across the joints of the neck, thus preserving mobility of the neck.
Cervical foraminotomy is an operation to enlarge the space where a spinal nerve root exits the cervical spinal canal to relieve the symptoms of a “pinched nerve.” This is often done at the same time when the spine surgeon does laminectomy or laminoplasty. If done as an isolated procedure, it can be done via minimally invasive fashion.
Our orthopaedic doctor Adjunct A/Professor Hee Hwan Tak has much experience in surgeries to degenerative conditions of the neck. Contact us for a comprehensive consultation at Singapore Pinnacle Orthopaedic Group. Visit Dr Hee Hwan Tak’s Google+ page here.