Bone & Joint
August 29, 2018

Motion-preserving spinal surgeries can offer better recovery

by Asian man plays the violin

A spine surgeon explains these techniques and their advantages over spinal fusion surgeries.

 

Problems with the spine and spinal cord in the neck are unfortunately quite common. For many people, relief comes from surgery.

Some neck surgeries involve fusing vertebrae – attaching two or more of the bones forming the spine to each other to fix a structural problem and decrease pain.

However, fusion reduces range of motion, and that in turn can create long-term side effects.

“When we stiffen the spine with screws and rods, it puts more strain on the spine and discs above and below” that hardware, explained Byron Stephens, M.D., a Vanderbilt Spine Center specialist at Vanderbilt Bone & Joint.

Motion-preserving surgery, however, does not artificially stiffen the spine. This makes it a good treatment particularly for older patients – those in their 60s and older, even into their 80s, Stephens said – because it comes with a shorter recovery period than fusion surgery and it allows full range of motion after recovery.

Stephens explains two common types of motion-preserving surgeries that can resolve problems in the neck:

Cervical disc replacement

A disc replacement means removing a damaged or diseased cartilage disc from between two vertebrae. These discs are supposed to provide cushioning between the bony vertebrae, but when they wear down or slip out of position (for example, with a herniated disc), the bones can rub against each other, causing pain; or compress the spinal cord, which can create muscle dysfunction and balance problems.

A cervical disc replacement involves removing the cartilage disc and replacing it with an artificial one made of metal or plastic. Not everyone is a candidate for this type of surgery, Stephens said, but for those who are, it can potentially reduce the risk of needing more surgery in the future.

Cervical laminoplasty

This type of surgery relieves compression on the spinal cord in the neck. An incision is made in the back of the neck. The surgery effectively makes the spinal canal bigger by creating a “hinge” in the lamina, the bone forming the back of a vertebra. The surgeon hinges open the lamina and inserts a tiny screw, bone graft or metal spacer to prop open the lamina, much like a door stop prevents a door from swinging closed. The vertebrae are not fused together, so the patient avoids the long-term effects of fusion surgery.

In contrast, a cervical laminectomy – removal of the lamina – requires fusing vertebrae together.

For people eligible for cervical laminoplasty, “It’s a great surgery,” Stephens said. “Its advantages over laminectomy (with) fusion are that it has faster recovery, it’s a quick surgery, they spend less time in the hospital and there is no need to heal a fusion.” Often there is not even a need to wear a neck brace after surgery, he said.

Conditions treatable with motion-preserving surgeries

Problems that motion-preserving surgery can solve include degenerative conditions that put pressure on the spinal cord or on the spinal nerve roots. Those causes can include arthritis, bone spurs, tumors, fractures, cervical myelopathy, cervical stenosis (narrowing of the spinal canal in the neck) and more.

Symptoms that can indicate the need for these surgeries vary, but in the case of a compressed spinal cord in the neck, a sign could be that motor control in the hands is off. A pinched nerve in the neck is usually shooting pain down the arm or arms into the hands. Sciatica pain originates in the lower back and is not treated with disc replacement or laminoplasty surgeries, Stephens said.

Sometimes patients need physical therapy after cervical disc replacement or a cervical laminoplasty, Stephens said, but that’s not always the case.

Man paddles a canoe on a lake

If you are dealing with an injury, facing surgery or coping with chronic pain, Vanderbilt Orthopaedics offers a full spectrum of care. Our specialists work with you from evaluation and “prehab” through physical therapy and, if needed, surgery. We’ll help you get back to doing the things you love, pain-free. To make an appointment, call 615-936-7846.

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