What is Neck Surgery?
Neck surgery is a generic term for a surgical procedure designed to alleviate or relieve neck pain when conservative measures such as rest, physical rehabilitation, medications, and steroid injections have been unsuccessful.
The neck bears the weight of the head, allows a significant amount of movement, and is less protected than the other parts of the spine. All of these factors can make the neck more susceptible to injury or other painful disorders. Common neck pain may occur from muscle strain or tension experienced in everyday activities including poor posture, prolonged use of a computer, and sleeping in an uncomfortable position.
Neck pain may also occur as the result of injury to the soft tissues (muscles, ligaments, or nerves) or prolonged “wear and tear”. Traumatic accidents or falls and contact sports can cause severe neck injuries, causing pain in the neck. Neck pain can also come from infections, tumors, or congenital abnormalities of the vertebrae.
Anatomy of the Neck
The neck is part of the spine. The spine is made up of 33 small bones called vertebrae and is known as the spinal column or vertebral column. It can be divided into 5 parts: cervical, thoracic, lumbar, sacral, and coccygeal. The cervical spine comprises the first 7 vertebrae (C1 to C7), which support the neck and the head. The vertebrae are protected by spongy vertebral discs that sit between them and are further supported by ligaments.
Indications for Neck Surgery
When pain and symptoms fail to improve with non-surgical treatment measures such as activity modification, pain medication, non-steroidal anti-inflammatory drugs, muscle relaxants, physical therapy, or spinal injections, then neck surgery procedures are employed.
Neck surgery is generally indicated for the following reasons:
- To mitigate pain caused by nerve root impingement as a result of bone spurs or material from a herniated or ruptured disk - a condition known as cervical radiculopathy
- To prevent adjoining vertebrae from rubbing against each other due to degenerative disk disease, which generates neck pain from pinched nerves
- To eliminate pressure on the spinal cord caused by bone spurs, a condition known as spinal stenosis (narrowing of the spinal canal)
Preparation for Neck Surgery
You will have a preoperative assessment session before surgery. During your assessment, you must inform your doctor about any health conditions you may have such as diabetes or bleeding disorders, and about any medications that you may be taking, such as blood thinners, over-the-counter medications, or supplements.
- You may be asked to stop taking certain medicines for several days before the procedure.
- Complete nicotine cessation prior to any surgery is strongly advised as nicotine interferes with skin, muscle, and bone healing.
- You should not consume any solids or liquids at least 8 hours before the surgery.
- Your doctor will explain the surgical procedure, its risks, and benefits, and answer all your surgery-related queries before the procedure.
- Blood tests, X-rays or other imaging tests may also be ordered to assess your medical condition.
Types of Neck Surgery
There are various types of neck surgery, depending on the condition to be treated. Some neck surgeries are listed below:
- Cervical laminectomy: This procedure is undertaken to alleviate pressure on the spinal cord or the nerve roots. The spinal cord is covered and protected by laminae, which are bony plates on the backside of the vertebrae. Pressure on the spinal cord and nerves are reduced by removing the laminae. Also, during this procedure, sections of bone spurs and herniated disk can be removed through the opening in the vertebrae.
- Cervical laminoplasty: This procedure is used to assist people with spinal stenosis by making more space for the spinal cord within the spinal canal. During this procedure, the spine is exposed by making an incision on the back of the neck and the vertebral laminae are reconstructed to enlarge the spinal canal creating more room.
- Anterior cervical discectomy: This is regarded as the most common surgical procedure performed to mitigate neck pain caused by a nerve-pinching herniated disk. During this procedure, the spine is exposed by making an incision in the front of the neck right next to the windpipe. Through that incision, bone spurs or herniated discs that may be causing pain are removed. Then, a piece of bone (either your own or a bone graft from a donor) or other material is used to refill the space left between the vertebrae, fusing the adjacent vertebrae.
- Cervical spinal fusion: During this procedure, two vertebrae that are rubbing against each other are fused as the disk between them has worn out or herniated. A metal implant or bone graft is used to fuse the vertebrae, which ultimately grows together into one bone.
- Posterior microdiscectomy: This approach is employed to treat a large soft disk herniation located on the side of the spinal cord and is performed by making a vertical incision in the posterior of your neck. A high-speed burr is utilized to detach some of the facet joints to identify the nerve root under it. The nerve root is gently moved aside to make room for the surgeon to remove the disk herniation.
Postoperative Care
After the surgery, you may have to stay in the hospital for up to a week based on the type of neck surgery involved. You will have to wear a neck brace or protective equipment to aid in healing and to support the neck. Complete recovery may take 5 weeks or more. You will be instructed on avoiding heavy lifting or exertion for several months. You will be given an exercise regimen to strengthen your neck muscles and improve neck function. It is normal to feel some pain and discomfort in the neck area; medications will be provided for comfort. You will also be given instructions on activity modifications, diet, wound and dressing care, bathing, and driving.
Risks and Complications
Neck surgery is a relatively safe procedure however, as with any surgery, there are risks and complications that could occur, such as:
- Damage to the spinal cord or nerves
- Infection at the site of surgery
- Failure of the fusion of vertebrae
- Damage to veins and arteries
- Bone graft displacement
- Seepage of cerebrospinal fluid (CSF)
- Persistent pain or stiffness
- Hematoma or bleeding at the site of surgery
- Displacement of plates or screws
