As we age we develop ‘wear and tear’ changes throughout our bodies, and the spine is no exception. In fact, degenerative change in the spine is extremely common and affects most people at some stage in their life. In the lumbar spine this can cause low back pain or leg pains such as sciatica, and in the cervical spine this can cause neck pain (especially with movement) or arm pains when a nerve root is compressed, which we call cervical radiculopathy. When very bad the spinal cord can even become compressed within the central canal of the cervical spine, and as expected having spinal cord compression is a serious condition that frequently requires surgical correction.
Degenerative cervical spine change, or “cervical spondylosis”, is very easy to identify on x-rays (image above left). The normal uniform square block shape of the cervical vertebral body becomes compressed or flattened, the intervertebral discs can lose their height and their ability to shock absorb the bones either side, and new abnormal bone formation can occur at the margins of the vertebral bodies which we call osteophytes. In addition to neck pain these degenerative changes can also result in nerves being compressed as they make their passage from the spinal cord within the central canal into the arm through their exit channels, bony tunnels that we call foramen. When nerves become compressed within the foramen they can produce pain that frequently ‘shoots’ down into the arm and sometimes the hand, they can also produce pins and needles or numbness in the skin that the particular nerve root innervates, and they can also produce weakness in different muscles and joint movements in the arm. A CT and MRI scan can demonstrate nerve root and spinal cord compression in the cervical spine, and a Neurosurgeon can take a relevant history and perform a physical examination to help determine what identified degenerative change you have in your cervical spine may be producing your symptoms. Not infrequently a cortisone injection can be performed around the affected nerve root(s), and if successful this may alleviate some of your symptoms, but most likely any benefit will only be for a short period such as days or weeks.
Fortunately these degenerative changes can be corrected with cervical spine reconstructive fusion surgery. It requires open surgery, and all surgery carries a certain amount of risk, however in many people the expected benefits of surgery outweigh these risks and for many people most of their pre-operative symptoms are significantly improved or resolve completely. Surgery involves approaching the cervical spine anteriorly through an incision in the neck, removing the old degenerative disc and osteophytes, decompressing the spinal cord and the nerve roots on both sides, then reconstructing and restoring the disc space and height with a special implant that is locked into place and over time promotes fusion of the joint; this operation is called an Anterior Cervical Discectomy and Fusion, or ACDF for short. Although not the primary goal of surgery, resolution of neck pain is an added bonus in many patients. Comparing plain x-rays before (above left) and after (above right; same patient) clearly demonstrates the ability that surgery has to restore disc height and other normal anatomical attributes of the cervical spine. This patient for example had quite advanced degenerative change at two anatomical levels and underwent a C5/6 and C6/7 anterior cervical discectomy and fusion procedure, which resulted in resolution of her arm and hand pains and numbness and of her arm weakness, and with a significant improvement in her neck pain. She will have x-rays every 6 months until fusion has been demonstrated which should occur by around 12-18 months after surgery.
Although anterior cervical fusion surgery is a very good option in select individuals there are other ways to manage neck and arm pains, and a good surgeon will discuss non-operative alternative management strategies with you before committing you to surgery. Although surgery has certain benefits it also exposes you to risk, and you must be fully informed about your decision to proceed to surgery, which includes considering non-surgical alternatives. If you have been diagnosed with cervical spondylosis and would like to discuss your management options please make an appointment to see Dr Wells today.
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