Spine Cervical

My doctor has recommended a fusion for me (my neck). After two years of rehab, my pain is better but the X-rays, CT scans, and MRIs show it's not stable. Now we are talking about all the different options. The surgeon prefers to use something called ACDF with bone graft and a metal plate. I'd like to get by without the metal. Is it possible?

Sometimes when there's bone or disc degeneration in the cervical spine (neck), fusion is needed to stabilize the area. Over the years, one procedure in particular has gained popularity because of its effectiveness: the anterior cervical discectomy and fusion (ACDF).




I have a chance to be part of a study using a dissolving plate to fuse my neck. I'm wondering what you think about these.

Bioabsorbable plates are fairly new to the spinal fusion scene. For a long time now, surgeons have used an approach called the anterior cervical discectomy and fusion (ACDF). Anterior refers to the location of the incision and the way surgeon enters the spine (front of the neck). Anterior fusion is performed through the front of the spine to avoid the spinal cord and spinal nerves. Cervical refers to the neck and discectomy is the removal of the disc from between two vertebrae.




A Possible Solution to the Problem of Metal Plates in Neck Fusion

Bioabsorbable plates are fairly new to the spinal fusion scene. For a long time now, surgeons have used an approach called the anterior cervical discectomy and fusion (ACDF). Anterior refers to the location of the incision and the way surgeon enters the spine (front of the neck). Anterior fusion is performed through the front of the spine to avoid the spinal cord and spinal nerves. Cervical refers to the neck and discectomy is the removal of the disc from between two vertebrae.




I had a CT-scan that confirmed my worst fears: a herniated disc in my neck. The surgeons are talking about fusion versus maybe trying a disc replacement. I'm going in for more tests to see which treatment might work best for me. How do these two operations stack up against one another? Would you recommend one over the other?

Painful symptoms from a herniated disc can limit function and really reduce quality of life. If the condition gets worse, patients can end up with irreversible neurologic damage. That's why surgery is recommended if conservative care doesn't result in any change in the clinical picture.




I was one of the first people in our area to have a disc replacement for a herniated disc that was pressing on my spinal cord. That was five years ago. So far, so good. They did warn me that anything could happen -- I could end up with the implant pressing on the cord or another disc going bad above or below the implant. I like to keep up on this technology, should I ever need another one. What's the latest?

The condition you were treated for is called myelopathy. Myelopathy refers to a narrowing of the spinal canal, the opening formed by the vertebral bodies when stacked on top of one another. The spinal cord travels through the open spinal canal. Anything that narrows this opening (e.g., disc protrusion, bone spurs, hardening of the spinal ligaments) can put pressure on the spinal cord and cause serious neurologic problems.




Pitfalls of Cervical Disc Replacement

The authors of this article on the treatment of cervical myelopathy originally presented the results of a study comparing disc removal and replacement versus spinal fusion for this condition back in November 2008. Now, they offer a detailed look at the surgical technique and pitfalls of cervical disc arthroplasty (disc replacement in the neck), along with an update on this procedure.




Can you help me understand a neck injury my husband got from a horseback riding accident? The surgeon says it's a moderately severe fracture of C34 and surgery is needed. They won't be able to tell until they do surgery how unstable it is. What makes a fracture moderately severe and/or unstable? I didn't really want to ask too many questions in front of my husband in case it's worse than we thought.

Your desire to protect your husband, the patient is very admirable. Given the stress of the accident and preparation for the upcoming surgery, a low key approach is often needed for the involved individual. But questions like this are appropriate and the information important to family members trying to plan ahead.




My 16-year-old son has a cervical spine fracture rated as a three on a score called the CSISS. Can you explain this to me? The surgeon showed us the X-rays and went over everything. I am a nurse, so I do understand anatomy but I'll admit I was in a state of shock at the time. Most of it went right by me.

The Cervical Spine Injury Severity Score (CSISS) is one of several different ways to classify the severity of cervical spine injuries in order to predict who might need surgery to stabilize the spine. The CSISS is favored by some surgeons because it's easy to use by the surgeon and proven to be reliable and valid (accurate in predicting who needs surgery). The CSISS is for patients with neck injuries involving the lower cervical spine (C3 to C7).




New Classification System Takes the Guesswork Out of Treatment Planning For Neck Injuries

There's a move on now in the medical community to find reliable, valid ways to classify a problem and then decide how to treat it. In this study, orthopedic surgeons from St. Louis University School of Medicine check out the Cervical Spine Injury Severity Score (CSISS) for its user friendliness and accuracy. The CSISS is for patients with neck injuries involving the lower cervical spine (C3 to C7). This is an area of common injury.




What does off-label use mean? My surgeon was telling me about using bone substitute for my spinal fusion and had me sign a paper saying I know it is an off-label use. At the time I thought I understood it, but when I tried to explain it to my brother, I got all fouled up.

Off-label use means the drug, implant, procedure, or device is not being used for what it was originally intended or tested for. The practice is not illegal -- doctors who discover a drug that works well for one application may see many other potential uses. But without proper testing for safety, the Food and Drug Administration cannot approve that drug for a secondary or off-label use.





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