Many people don’t realize that pain and numbness in the hands and arms can be caused by conditions in the neck. If you’ve tried medications, physical therapy, maybe even alternative therapies, and your pain or numbness persists over weeks or months — and threatens to keep you from enjoying life — surgery may be an option.
Once you’ve decided on surgery to relieve pain, your next decision is: What kind of neck surgery? There are many options, and the best one for you depends on many factors, including the cause of your pain, and your goals for surgery.
Two of the most common options are fusion surgery and cervical artificial disc replacement surgery. While both are common and effective, there are significant differences between the two.
Neck fusion surgery
Anterior cervical discectomy and fusion (ACDF) is a type of neck surgery that involves removing a damaged disc to relieve pressure on the spinal cord or nerve root. A cervical plate then is placed on the vertebra to provide stability. During surgery, a bone graft or other implant is placed in the space left by the removal of the disc to prevent disc space collapse and provide stability. For most people, fusion surgery permanently eliminates pain as well as numbness and tingling.
Cervical spine fusion surgery is a good option for patients who have:
- Degenerative disc disease
- Herniated disc
- Cervical stenosis
- Unstable or weak spine
This procedure can be used for people with disease in one or multiple vertebrae. While the procedure relieves pain even when multiple vertebrae are involved, there is some evidence that it is more beneficial when used with one level. In all cases, some impairment of movement is likely, which has traditionally been considered a drawback to the procedure.
The risks of this surgery are relatively low when performed by an experienced neuro spine surgeon. The most common complication is short-term difficulty swallowing, a condition called dysphagia. This typically resolves in a few days or weeks. Other risks include the procedure not relieving symptoms or in a small percentage of patients, vertebra not fusing. These risks are low, particularly in patients who have been carefully selected. At Neurosurgery One, we only recommend spine surgery if there is good medical evidence that the procedure will benefit you. We also take into account other factors, such as your overall health and your lifestyle habits, including whether you smoke, have diabetes, or have weak bones. (If you have osteoporosis or another condition contributing to lack of bone strength, we can refer you to our Bone Health Clinic prior to surgery.)
Artificial disc replacement
Cervical disc arthroplasty (CDA) is a newer technique that involves removing the damaged or degenerated cervical disc and replacing it with an artificial disc.
A disc replacement device typically is composed of two metallic surfaces. One of those is attached to the upper vertebra, and the other to the lower vertebra where the disc has been removed. These metal implants can slide on each other or can be separated by a piece of medical-grade plastic.
One advantage of this leading-edge procedure is that the design of the implant device allows patients to retain motion in the affected area.
Candidates for cervical disc replacement surgery, like those for fusion surgery, include:
- Patients who have had ongoing neck pain for a long time
- Patients whose neck pain hasn’t been relieved by physical therapy or medication
- Patients with pain, numbness, tingling, or weakness involving the arm or hand
The procedure is best for those with only one or two damaged vertebrae. Patients who have osteoporosis are not good candidates for disc replacement surgery.
For those patients who are good candidates, cervical disc replacement surgery may be a good alternative to fusion surgery. This technology allows me to accomplish surgical pain relief while preserving the patient’s mobility.
In addition, studies indicate that because artificial disc replacement eliminates the need for additional surgery. And, many patients like the fact that they probably won’t have to wear a neck brace or collar after artificial disc replacement surgery.