Is Neck Fusion Surgery Necessary?
Symptoms associated with neck pain can alarm anyone. These include pain in the neck and arm, numbness, tingling, and weakness. You may notice pain after an injury, excessive activity, or it may even be pain that you notice developing over time. No matter how the pain starts, people can usually identify that they are having a neck issue easily.
Most people will just ignore neck pain while assuming it is just from wear and tear. However, once someone starts experiencing arm pain, they begin to worry that the issue is more serious than they previously thought. Once the arm pain starts, people begin assuming that they are suffering from some sort of disc issue and they begin to investigate alternatives to surgery, such as Total Disc Arthroplasty.
What is causing my neck and arm pain?
The neck is made up of several separate bones called the vertebrae and the shock absorbers in between the vertebrae called the discs. The vertebrae help support the weight of the body while the discs help to absorb the shocks in the spine. Every vertebra is connected to the ones above it and below by soft tissue, muscle, and ligaments. The discs in between each vertebra allow for light movement of the spine. When any of these structures are damaged pain may occur.
Most neck injuries are the result of injuries to the ligaments and muscles of the neck, normally designated as a sprain or strain. Usually, strains and sprains will heal on their own, although you may need manipulation or physical therapy. For people suffering from a cervical or neck sprain, anti-inflammatory medication may also help with pain management.
While most neck injuries are diagnosed as strains or sprains, they may be caused by more serious damage. Some more serious injuries that will require medical management include:
- Fractures of the vertebrae
- Cervical disc strain
- Cervical disc disruptions
- Cervical disc herniations
Cervical disc issues can sometimes be overlooked because of muscular pain and missed on x-rays. They also may not cause any neck pain at all. The tell-tale sign of a serious disc injury is when you develop pain, tingling, numbness, or weakness in the arm. This occurs when the disc is pressing on the nerve that runs from the spinal cord into the arm. Irritation of this nerve is what can cause nonstop pain that runs down the arm, hand, and fingers. It may also cause weakness and a loss of grip.
These symptoms are categorized as radiculopathy or being caused by the pinching of a nerve in the spine. Radiculopathy usually causes a noticeably different pain from muscle pain. Most of the time people who suffer from this can tell how different it is from muscular pain right away.
What are the different kinds of neck injuries?
Different types of neck injuries are categorized based on the force that physically caused the injury. These are also known as mechanisms of injury and they all can cause disc and vertebrae trauma. The mechanisms of injury surrounding the neck include:
- Axial injury - This is when the force comes down through the top of the head into the neck. Common injuries include tackling in football or having something fall on top of the head.
- Hyperextension injury - This type of injury occurs when there is a forceful extension of the neck. This injury occurs, oftentimes, during car accidents but may also happen during falls and sports. Other terms include “whiplash” or flexion-extension.
- Torsion injury - This is when the rotation of the head and neck causes a twisting injury. Common injuries occur from falls.
Are these injuries the only causes of disc trauma?
Sudden injuries are not the only way that you can suffer from a disc injury. Injuries can also show up after years of use and repetitive trauma. Some prolonged repetitive doings that can cause trauma include:
- Vibration exposure - prolonged exposure to vibrations from heavy equipment like helicopters or construction equipment can cause a disc injury over time.
- Repetitive collisions - recurring head and neck collisions can cause damage and disc deterioration over time. This includes things like construction work, motorsports, and football.
- Light activities - even exposure to jobs and hobbies that keep your neck in a certain position too long can cause damage. Including things like working at a computer every day for years.
How does a bulging or herniated disc occur?
As the tough fibers that make up the outer layer of the disc get damaged from prolonged exposure or injury, the soft inner nucleus of the disc pushes out and up against the spinal cord. This can continue to worsen as the nucleus protrudes further out of the disc and against the nerves and spinal cord, causing intense pain. This may also lead to arm pain, numbness, and tingling.
Some milder cases of herniated discs may get better with the use of anti-inflammatory medications, injection therapy, or back support. However, if the herniated disc is pushing up against the nerve root you may need surgical treatment. This is especially true if the pressure from the herniation is causing weakness because this may mean that you need urgent surgery to avoid permanent damage or paralysis.
Damaged cervical disc treatment
The theory when it comes to treating a herniated disc is simple. If you remove the herniated disc and decompress the nerves and spinal cord, then the pain will stop. In fact, some people find immediate arm pain relief when the disc is removed. The disc removal is called a discectomy.
After a discectomy there is nothing to keep the two vertebrae apart so something must be done to keep them from collapsing onto each other and causing pain. The traditional way of stabilizing the disc area is called a cervical fusion. This is when the surgeon puts bone or some other kind of synthetic material into the gap between the vertebrae. They then lock it into place with screws and a plate to keep everything in place. As the surgery site heals, bone will begin to grow across the gap and fuse the two vertebrae together. This procedure (anterior cervical discectomy and fusion) has a high success rate, and most of the time people do not need any further treatment.
However, there are two main concerns with ACDF. First off, if the fusion of the bone does not occur correctly it may be frail, and an additional surgery may be needed to get a better fusion. Second, after the fusion has occurred successfully, the fused segment will never be able to move again. This can lead to extra stress and degeneration at the levels around the first surgery site. This can lead to more surgeries in the future.
Are there alternatives to neck fusion surgery?
Yes, an alternative to neck fusion surgery does exist. It is called Total Disc Arthroplasty or Disc Replacement Surgery and it has been available through clinical trials for more than 15 years in the US.
During this procedure, your disc is removed and then replaced with a device that will still allow movement. This relieves pain while allowing important motion to return. There are lower risks associated with this than there are with ACDF, and studies have shown that there is less risk for degeneration to the areas around the site. With Disc Replacement Surgery you will experience:
- A quicker return to activity
- No healing fusion site means little to no time in a brace
- Light activity is encouraged quickly after surgery
- Certain pain medications that can interfere with a fusion can be used immediately since there is no fusion
- No bone graft and no bone graft pain
In some cases, disc replacement surgery is not recommended and ACDF may be required. ACDF is normally the best option when the motion has already been lost, the space in between the vertebrae is too narrow, or the patient has a history of neck fractures or infection.
Schedule an appointment to talk to Dr. Siegal today about your pain and treatment options.
If you are having symptoms of neck and arm pain that just will not go away, it may be time to visit Dr. Siegal at Key Clinics. He will be able to diagnose your pain and talk about treatment options. He will also be able to determine if Disc Replacement is good for you. You may not need a fusion.
