Dr. Richard Obedian, M.D., F.A.A.O.S, understands that back and neck pain can impact a person’s quality of life. It can make it more difficult for people to complete daily tasks and participate in activities that they enjoy. As a board-certified orthopaedic surgeon specializing in spine surgery, he has treated patients suffering from a wide variety of conditions. Sometimes people experience problems due to normal wear and tear or degeneration, and other times it is due to injury. A common procedure for alleviating neck pain is cervical decompression.
Why the Spine is so Important
The spine is a main source of stability in the body. It is made up of 33 vertebrae divided into four main sections, explains Dr. Richard Obedian.
- Cervical Spine – Contains seven vertebrae that make up the neck. It starts at the base of the skull.
- Thoracic Spine – Contains 12 vertebrae that make up the upper portion of the back. The ribs attach here.
- Lumbar Spine – Contains five vertebrae that make up the lower portion of the back.
- Sacrum – Contains five vertebrae that are fused together and form part of the pelvis. Below the sacrum are four very small vertebrae that form the coccyx, or tailbone.
In between the vertebrae are intervertebral discs made of cartilage that help to absorb shock, cushion the spine, and facilitate movement. Sometimes these discs and vertebrae become damaged and cause pain and discomfort.
Why is cervical decompression performed?
The spinal cord passes through the center of the vertebrae along the entire length of the spine. Changes to the vertebrae, discs, and tissue, whether due to disease or injury, can cause the nerves to become compressed. These changes can also cause a narrowing of the spinal canal which puts pressure on the spinal cord. These conditions can result in neck pain and weakness or tingling in the arms and legs. Generally conservative treatment methods are tried first, notes Dr. Richard Obedian, but if they are not effective, surgery is another option.
Cervical decompression surgery is either performed through the front of the neck (anteriorly) or through the back of the neck (posteriorly). The surgeon will determine the type of procedure performed based on the individual patient’s condition. The goal is to reduce pressure on the nerves while still maintaining stability in the neck and vertebrae. Typically the tissue or disc that is causing the pressure is removed so that there is more room for the spinal cord and nerve tissue.
When undergoing posterior cervical decompression there are several types of procedures that the surgeon can choose from. It depends on where the compression occurs and what is causing it.
- Foraminotomy: the opening through which nerves pass through is enlarged.
- Laminotomy: the opening at the back of the vertebra is widened to provide more space for the spinal cord and nerves.
- Laminectomy: rather than making a larger hole in the lamina, either part or all of it is removed in order to reduce pressure on the spinal cord.
- Facetectomy: the joint that connects the vertebrae is removed.
- Laminoplasty: the lamina is surgically reshaped and hinged to allow for more room for the spinal cord to pass through.
In anterior cervical decompression, the following two procedures are common:
- Corpectomy: the parts of the vertebrae causing the narrowing of the spinal canal are removed.
- Microdiscectomy: a portion of the bone covering the nerve root, as well as any fragments of material under the root, are removed.
When portions of the bone and discs are removed it can cause instability in the spine, explains Dr. Richard Obedian. The way that it moves is altered. Because the discs provide support between the vertebrae, without them, the vertebrae could collapse or rub together. Following cervical decompression, cervical fusion is sometimes necessary.
Cervical fusion involves bonding segments of the bone together so that they no longer move independently and are a single unit. The surgeon may need to take bone from another part of the body and graft it onto the cervical vertebrae. They may also use a combination of other devices such as wires, cables, plates, screws, or rods. This helps to provide further stability and allow the bones to heal correctly. It keeps the vertebrae in the correct location with the proper amount of space between them.
Once the pressure on the spinal cord and nerves is relieved, patients often have a decrease in symptoms. Their pain is typically reduced and their mobility increases. The spinal cord and nerves are able to pass through the spinal canal without disruption. Though surgery cannot reverse the damage done to nerves, it can help to prevent further injury from occurring and provide symptom relief.
It can take several weeks for full recovery from surgery and requires gentle rehabilitation to return to safe, healthy movement. Patients can get back to doing the things they enjoy. Dr. Richard Obedian encourages people who are suffering from neck or back pain to talk to their physician about treatment options.