Motion Preservation in the Neck
The term “motion preservation” for the treatment of neck (cervical spine) disorders includes non-surgical, traditional surgical, and new surgical technology and implants. Motion preservation allows treatment of spinal conditions due to aging and disc degeneration without spinal immobilization from either brace or surgical fusion. By preserving motion, we hope to achieve more natural function, speed recovery, allow earlier return to work, and prevent degeneration in spinal levels above and below the area treated.
Non-Surgical Treatment
Most people with neck and arm pain, whether their symptoms follow minor injuries or develop slowly, have no risk to vital functions. Therefore, non-operative therapy is the mainstay of neck conditions. Fifty percent of volunteers over age 50 with no neck pain will show abnormalities on routine MRI scanning. Therefore, any neck symptoms must be carefully compared to MRI and X-ray findings to make sure they agree.
Physical therapy appears to be helpful in controlling certain symptoms. It is usually helpful to continue physical therapy exercises at home even after pain improves. In addition, re-arranging the workplace to make it more ergonomic may contribute to long-term pain relief. X-ray-guided injections may help with the treatment or diagnosis of arm pain due to neck conditions.
New Surgical Techniques and Implants
The primary motion-preserving neck surgery is disc replacement. A movable, artificial disc is placed in the space between neck vertebrae instead of a solid bone graft and a plate. Pressure on nerves is relieved, just as in traditional fusion surgery.
Results of disc replacement include quicker recovery, fewer swallowing problems, and earlier return to work, compared to other options. The FDA is currently reviewing a new generation of artificial disc implants and results are very promising. Studies from Europe indicate that we may soon see FDA approval of this treatment for a wider variety of medical conditions.
Conventional Surgical Approaches
Keyhole Foraminotomy
This procedure can be performed through a 1-centimeter incision. The pressure on the affected nerve is relieved from the back and the disc itself is preserved. In carefully selected patients, relief of arm pain is rapid, predictable, and similar to an anterior cervical fusion. However, there is the risk of return of the nerve compression and pain. This procedure may decrease arm pain, but not neck pain. Recovery is quick and there are no additional limitations after wound healing.
“Open-Door” Decompression without Fusion
“Open-Door” Decompression from the back is designed for the treatment of multi-level compression of the spinal cord. In the “Open-Door” technique, a hinge is created in the elements in the back of the spine on one side while the other side is opened, similar to a door, decompressing the nerve tissue. No fusion is required, preserving motion.
Fusion Surgery
Fusion surgery of the neck can be accomplished through a short incision in the front of the neck, which results in a scar. The disc and the offending bone spurs are removed and fusion is achieved with bone graft and a plate. It takes 8 to 12 weeks for the bone to heal. Smaller plates are becoming available, which will allow disc replacement adjacent to a fusion.
Summary
A patient’s diagnosis, symptoms (arm pain, neck pain, weakness), and expectations will help decide the appropriate treatment. For example, an NFL player with one diseased disc can return to play only with fusion surgery. For other patients, mobility may be more crucial than stability. A physician with experience in the entire treatment spectrum may tailor the treatment plan to the patient.
To learn more about motion-preservation treatments and how they can benefit you, contact us to discuss treatment options or make an appointment.