As we age, the material between the vertebras called disc material also ages and loses water content. This process makes it harder for the area to function as a shock absorber of the spine. Wear and tear of everyday life can result in the changing of the shape of the disc and the disc rubbing up against the nerve nearby. This causes neck pain, shoulder blade pain and radiation of the pain into the upper and sometimes lower arm. Severe cases can cause pain into the hand itself along with numbness and muscle weakness in the arm.
Cervical Artificial Disc Replacement
When cervical disc symptoms have not responded well to non-surgical measures like traction and steroids, Dr. Brennan may offer surgery on the affected disc level. This surgery may involve fusion or the more recently FDA approved cervical Artificial Disc Replacement or ADR. The fusions are discussed below. In ADR surgery, Dr. Brennan removes the disc completely and restores the normal dimensions of the cervical spine by installing a permanent stainless steel cervical disc replacement. Admittedly, there is nothing better than your own disc for retaining normal motion but Dr. Brennan feels that the Prestige TM Artificial Cervical Disc by Medtronic is the best product out there with years of research to make sure patients have the best outcome possible. The procedure is done in the hospital, frequently same day surgery, and many patients return to normal activities very soon while preserving the motion segment in their neck for as long as possible. Please see the video animation regarding the Prestige TM disc on this page.
The bone in the cervical spine has the same properties as bone anywhere in the body. When it is compressed over time with repeated actions such as daily wear and tear, the bone in the vertebra can develop “spurs” or osteophytes. These spurs are actually calcium buildup in response to the pressure on the bone. Over time narrowing can develop inside the tunnels where the nerve roots exit the spine. Such narrowing can cause pressure on the nerve roots. If severe, it may also limit the spinal canal itself and cause pressure on the spinal cord leading to leg symptoms like weakness, urinary problems and numbness.
Dr. Brennan believes in trying everything to avoid surgery and cervical traction is one of the methods patients can use to reduce their symptoms of a pinched nerve in the neck. These kits can be found at many local medical supply stores and some pharmacies. They cost about $25-35 and can be effective if used properly. If Dr. Brennan has reviewed the MRI and feels it’s safe to proceed, he usually recommends no more than 10 pounds of weight and 30 minutes of traction twice a day. Most patients can manage to fit this into their daily schedule and this is done sitting down in a chair with the apparatus attached to a door in the house. Dr. Brennan has noticed that approximately half of the patients that have come to see him have been able to avoid surgery with this simple and effective treatment plan.
Cervical Epidural Steroid Injection
This procedure has been used for many years to reduce the pain of pinched cervical nerves. Dr. Brennan can prescribe this treatment, if needed, and arrange for this procedure at an outpatient surgery center. Many patients feel relief by the time they get home and repeating the procedure depends on how long the first procedure was able to relieve pain. Relief of only a few days or a week means surgical intervention may be necessary to obtain long lasting symptom relief.
Cervical Nerve Root Decompression
It is very common to develop bone spurs in the cervical spine as we age. The spurs are due partly to our DNA and partly from everyday wear and tear on the spine. When these bone spurs develop in the area where the nerve root is trying to exit the spine, pinching on the nerve can result in neck pain, shoulder blade pain and numbness radiating down the arm. Dr. Brennan can use minimally invasive techniques to open up the affected nerve tunnel. During these surgeries, by using a mini-drill, Dr. Brennan can drill away the bone covering the nerve and give it space to return to normal size. Patients usually notice relief of pain initially, then numbness and later, improvement in weakness. Patients are cautioned that waiting to undergo surgery may cause the development of weakness in the associated muscles. On the first assessment, if Dr. Brennan feels there is slight weakness, a trial of non-surgical treatment may be appropriate but if there is no improvement quickly, Dr. Brennan will most likely recommend surgery. The surgery to relieve compressed nerves can range in time from 30 minutes to a few hours depending on the problem severity. Dr. Brennan’s minimally invasive techniques reduce post op pain and speed return to work or recreation.
Long considered the gold standard in cervical disc surgery, the anterior cervical discectomy and fusion (ACDF) may soon find it’s match with the artificial disc replacement, but each patient has unique and special needs. Many patients prefer the ACDF as the procedure strives to eliminate the segment in the spine as a motion segment and therefore reduce motion based pain. This surgery usually takes about an hour per level of the spine treated and after removal of the disc material, a bone plug is placed in the space and a titanium plate is then placed over the top to lock everything together. The plate is the size of a postage stamp. Patients are usually out of work from 2 weeks to 4 weeks but many feel like returning sooner. Like all fusion operations, the fusion of the segment may take 6 to 12 months to show completed fusion on an x-ray.