Degenerative disorders of the cervical spine have become increasingly common, with most cervical disc degeneration problems being common with ageing.
The majority of people may have few and non-disabling symptoms throughout the course of their disorder. However there is a significant amount of patients who may develop persistent and disabling symptoms. In general the symptoms include neck pain, stiffness and radiculopathy with pain referred along one or both upper extremities and finally myelopathy which is caused by pressure on the cervical spinal cord and may affect balance, gait, mobility and lower limb function as well as bladder dysfunction.
Back to the Article indexSymptoms associated with cervical disc herniation may develop insidiously or acutely in the affected patient. The spectrum of symptoms includes neck pain, occipital pain, shoulder girdle pain and specific upper extremity symptoms such as pain, sensory disturbances and weakness. Complete neurological examination is mandatory and usually offers sufficient information to arrive at a preliminary diagnosis.
Surgery is usually indicated in the patient with significant and disabling symptoms which fail to respond to adequate conservative treatment and those with significant neurological symptoms and signs. Certainly myelopathy is almost always an indication for surgery. Pre-operative diagnostic work up must include appropriate imaging of which MRI and CT scanning remain invaluable.
Surgery for cervical disc herniation is very straightforward and commonly practised.
Back to the Article indexCervical spondylosis is defined as degeneration of the intervertebral cervical discs. It is a common and ubiquitous process and the resultant spectrum of this degenerative disorder can range from relatively asymptomatic manifestations to more severe problems such as compression of the nerve roots and the spinal cord. Cervical radiculopathy is an extra-dural compression of the nerve root resulting in some degree of pain, sensory loss and motor weakness in the distribution of the cervical nerve root.
The most frequently encountered indication for surgery in cervical spondylotic radiculopathy and myelopathy is neural compression. The midline compression of the spinal cord from an osteophyte results in myelopathy and the lateral spurs at the affected level cause radiculopathy.
Back to the Article indexThe cervical spine is involved in up to 25% of patients with polyarticular rheumatoid arthritis. When significant instability exists in the upper cervical spine in the rheumatoid patient it becomes an emergent indication for surgical stabilisation. Surgery is also indicated in the patient with severe pain resistant to conservative measures including immobilisation and the presence of myelopathy is an absolute indication for surgery as the outcome is unfavourable in such patients if myelopathy has not been detected and or allowed to progress.
Surgery for the unstable rheumatoid upper cervical spine is usually in the form of stabilisation from the skull to the cervical spine including as many affected areas as necessary. There are currently many instrumentation systems available to perform this procedure.
Back to the Article indexCervical spine injuries are quite common with high energy motor vehicle accidents therefore screening of the cervical spine by appropriate imaging is standard protocol in patients with poly-trauma. Indications for surgery in these patients are relatively straightforward and surgery is performed to stabilise an unstable cervical spine which prevents injury to the spinal cord in the unstable cervical spine. Often the unstable or dislocated cervical spine may need to be managed initially by skull traction to restore the alignment of the cervical spine after which surgery can be performed safely.
Surgery in cervical spine injury is again relatively straightforward and of course involves quite close collaboration with the anaesthetic team to ensure safety during intubation and positioning. Often fibre-optic intubation may be necessary and skull traction may need to be continued intra-operatively to prevent instability and cord compression during surgery.
Surgery can be performed anteriorly or posteriorly depending on the individual type of trauma and almost always necessitates the use of instrumentation and fusion to stabilise the cervical spine permanently at the level of trauma and instability. Instrumentation systems include stand alone cages, plating systems and posterior lateral mass instrumentation devices.
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