Multiple Cervical Discectomy For Cervical MyelopathyIn the aging cervical spine (neck) or in cases of degeneration from trauma, pressure on the spinal cord can occur. This condition is called cervical myelopathy. Surgery is often needed to decompress the spinal cord and spinal nerves. The natural curve of the neck called lordosis can be restored.
Removal of the discs and fusion of the spine may be needed to stabilize the spine. In this article two surgeons from the Department of Neurosurgery at the University of Utah School of Medicine describe the operation. They discuss who's the best patient for this procedure and when to do it. Complications from the operation are also presented.
First, the surgeon must decide whether to operate from the front of the spine (anterior approach) or from behind (posterior approach). This decision is usually based on the location of the problem. Are there bone spurs? Where are they located? What's the condition of the ligaments and joints? The alignment of the neck is also considered.
Multilevel cervical discectomy (removal of the disc) using the anterior approach is described here. Preparation and positioning of the patient are outlined. Location and technique for the incision are explained with diagrams. Each step of the operation is described and discussed.
The surgeon must be prepared for any problems that occur during or after the surgery. Injury to the soft tissues or nerves can lead to difficulty swallowing. In rare cases, permanent vocal cord damage can occur. There is always a risk that the bone fusion will fail. The graft may collapse, break, or just fail to fuse called nonunion.
The authors say they advise using the anterior approach when performing multiple cervical discectomy for the treatment of cervical myelopathy. It is more labor-intensive and takes longer, but it works well in taking the pressure off the spinal cord.
Virany H. Hillard, MD, and Ronald I. Apfelbaum, MD. Surgical Management of Cervical Myelopathy: Indications and Techniques for Multilevel Cervical Discectomy. In The Spine Journal. November/December 2006. Vol. 6. No. 6S. Pp. 242S-251S.
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