Cervical spine surgery

Abstract

Cervical spine disorders that require surgical intervention can include degenerative disorders causing radiculopathy or myelopathy, trauma, tumors, and infections. Radiculopathy can present as parasthesias or weakness in a specific root level(s). Myelopathy is a condition caused by spinal cord compression; once manifest clinically, the only treatment for this process is surgery to prevent further neurologic decline. Tumors or infections can present in the cervical spine as radiculopathy, myelopathy, or pain due to instability or pathologic fracture. The cervical spine can be accessed via anterior or posterior approaches; a combined anterior–posterior approach (360° approach) may be utilized when necessary. The choice of approach is largely dependent upon location of the pathology, history of previous surgery, body habitus, and patient comorbidities. The anterior approach allows exposure of the spine by mobilization of the trachea and esophagus to exploit the interval between these structures and the carotid sheath. The anterior approach allows performance of anterior cervical discectomy and fusion (ACDF) as well as vertebral corpectomy. Anterior cervical discectomy and fusion involves removing the pathologic disc material and then replacing this void with a spacer fashioned from autograft bone, allograft bone, or synthetic devices. This procedure is employed primarily in treating radiculopathy and multilevel (< 3 levels) cervical spondylitic myelopathy. Anterior cervical discectomy and fusion can also be used in the treatment of certain fractures (e.g., unstable facet fractures or floating lateral mass fractures) and for infections.