What is cervical spondylosis?

Cervical spondylosis is age related wear and tear of the neck bones and discs. It is said to affect most people by the age of 60, but commonly we even see youngsters with this problem. This results in degeneration of the disc in the neck as well as bony overgrowth. These are responsible for the symptoms which patients experience in cervical spondylosis.

What are the symptoms of cervical spondylosis?

The most common complaint of patients with cervical spondylosis is neck, upper back or shoulder pain. Sometimes, they may also have pain at the back of the head or vertigo. When bone overgrowth or disc starts compressing neural structures, it can cause severe symptoms like radiculopathy or myelopathy.

What causes cervical spondylosis?

There is no definite cause of cervical spondylosis, but generally people are affected by it due to their own genetic or body predisposition. Many people are not aware that smoking can contribute to cervical spondylosis. Lifting very heavy weights on the head, sudden jerk to the neck, lack of exercises and whiplash injuries can also contribute to cervical spondylosis. In the majority of people, there is not one specific cause for cervical spondylosis.

What is Cervical Radiculopathy

When a nerve root is pressed because of a slip disc or osteophytes in the neck, this condition is called cervical radiculopathy. These patients may complain of pain, tingling and numbness going down one of their arms. Rarely, they may also develop weakness of one arm. It is most common at C5-6 and C6-7 levels. If one is getting symptoms of nerve compression, then one must definitely meet a spinal surgeon. It can be easily diagnosed with Cervical Spine MRI.

What is the treatment of Cervical Radiculopathy?

Majority of these patients improve in 3-6 weeks with the help of simple rest, medicines, physiotherapy and exercises. But, if symptoms persist for > 6 weeks or if major weakness has developed in one of the arms, then you may need decompression of the involved nerve. This is usually done by performing an Anterior Cervical Discectomy and Fusion (ACDF) or an Anterior Cervical Disc Replacement (ACDR).

What is Cervical Myelopathy?

Instead of an isolated nerve, when the entire spinal cord is pressed from a slip disc, osteophyte (bony overgrowth) or ligamentous overgrowth; this condition is referred to as Cervical Myelopathy. This is a serious condition, which needs to be recognized and addressed as early as possible. Otherwise, it can result in irreversible paralysis.

These patients may complain of tingling or numbness in their hands. They may have difficulty with their balance (can be tested by trying to walk along a straight line. They may find it difficult to perform fine motor activities with their hands (like buttoning their shirt, messaging on a mobile or typing on a computer).  Rarely, they may report an electrical sensation going down their body on movement of their neck. They may even report a change in their ability to control their urine or motion.

If a patient is experiencing these symptoms, he should immediately see a spine specialist. As this is an irreversible and progressive condition, the treatment for this condition is always surgical. Depending on whether the compression is from front of the neck or behind the neck, decompression can either be done from the front (ACDF or ACDR) or from behind (Cervical Laminectomy with or without fusion or Cervical Laminoplasty).

When is Cervical Spine Surgery needed? What is anterior cervical spine surgery or ACDF?

Cervical spine surgery is mostly needed with a slip disc in the neck that starts pressing upon a nerve resulting in radiculopathy or on the spinal cord resulting in myelopathy. Such patients may need an Anterior cervical discectomy and fusion (ACDF), or cervical corpectomy or cervical laminectomy or cervical laminoplasty or cervical disc replacement (ACDR).

Both these surgeries are done from the front of the neck. The initial steps until the decompression  and discectomy (taking out the disc) are the same. In ACDF, the space left behind is filled with bone graft and a plate is applied for stabilization. The goal of the surgery is creation of bone in the space left behind after taking out the disc.

What is cervical disc replacement?

a slight advantage over fusion but is more expensive. All cases may not be suitable for Disc Replacement and the decision should best be left to your Spine surgeon.

What to expect from your cervical spine surgery in India?

The incision size is about 2-3 cm. The typical hospital stay for ACDF or ACDR is 2-3 days. You can expect to walk the next day after surgery. You will be pretty much independent by the time of discharge. Most patients are able to travel back to their country in about 10-14 days after their spinal fusion surgery. You can expect to join back work in 3-4 weeks.

What is the success rate after cervical spine surgery?

The success rate for anterior cervical discectomy and fusion as well as cervical disc replacement is 99%. The approximate cost of a single level ACDF surgery at the best hospitals in India is approx. 6000 USD using American Implants.

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