Surgical Options

Simply stated, patients with constant symptoms who did not improve and cannot function with normal activity are usually surgical candidates. It is estimated that approximately 2.2% on non-institutionalized adults will develop some form of neck pain [1]. That would be approximately 4 – 6 million people per year in the United States. Most symptoms improve with conservative care since less than 200,000 patients undergo some form of cervical surgery. The majority of patients referred to our office have failed conservative measures and because of the lack of improvement, are referred for surgical consideration.

An Anterior Cervical Fusion (ACF) operation is the traditional and more common treatment option for surgery of the cervical spine. There are over 100,000 anterior cervical spine operations per year in the United States making it one of the most common spine procedures. The goal of the surgery is to reduce any compression on the nerves or spinal cord. The usual site of compression is the disc space and that is the part we remove to access the cervical spine.

During an ACF, a horizontal incision is made on the front of the neck in a skin crease. There is a natural dissection plane allowing easy access to the anterior cervical spine and minimizing muscle trauma. The level is verified with an X-Ray and then the disc is removed utilizing an operating microscope. Once the disc is removed, the cervical nerves or spinal cord are decompressed allowing them to improve towards normal function. Because the disc was removed, either a fusion device or disc replacement device needs to fill the void of the removed disc space. One or the other is inserted into the disc space to complete the operation. After the placement of the device, the incision is closed with dissolvable sutures on the skin and covered with a small dressing.

Patients can be candidates for one-level and two-level disc replacement surgery. Disc Replacement is FDA-approved for one-level or two-level surgery. In disc replacement surgery, a replacement of the disc is performed rather than a fusion surgery. Candidates should have evidence of disc degeneration with neck pain and/or cervical radiculopathy. The overall procedure is similar to a fusion operation except the devices differ. Patients with instability, evidence of a subluxation or disc height of less than 3-mm may not qualify for disc replacement surgery.

For one-level surgery, treatment option with either fusion versus disc replacement shows equivocal results. Most patients are concerned with subsequent surgery after their initial spinal surgery hoping that disc replacement will allow them to avoid an additional procedure. Study results evaluating one-level anterior cervical fusion versus one-level anterior disc replacement show that there is minimal difference in further surgery when comparing the two treatment options (Reference: Schroeder G. et al. 2021 Position Statement From the International Society for the Advancement of Spine Surgery on Cervical and Lumbar Disc Replacement. International J of Spine Surg. Vol. 15, No. 1, 2021, pp. 37-46.).

For two-level surgery, the only approved disc is from Biomet Mobi-C. In clinical studies, there was no difference at 4 years after surgery, however, there was an improvement in pain scores and decrease in secondary surgery at 7 years (Reference: Schroeder G. et al. 2021 Position Statement From the International Society for the Advancement of Spine Surgery on Cervical and Lumbar Disc Replacement. International J of Spine Surg. Vol. 15, No. 1, 2021, pp. 37-46.).

If you need surgery, your procedure will be performed by Drs. Abrahams & Neubardt, both a Neurosurgeon and Orthopedic Surgeon. Dr. Abrahams will perform the decompression on the nerves and spinal cord whereas Dr. Neubardt will place either the fusion or disc replacement device.

Selecting a Date

Once you decide to proceed with surgery, our surgical coordinator will work with you to select a date at one of our hospitals, Northern Westchester Hospital or White Plains Hospital. Our coordinator will then work with your physicians to set up your pre-surgical clearance for your procedure. This includes your Internist but may include other Providers such as your Cardiologist, etc. You can always contact the team using our proprietary messaging system and access is given to you after your consultation.

Day of Surgery

The hospital will call you the day before surgery to let you know what time to come to the hospital. Please be sure to bring your MRI or CT Images to the hospital the day of surgery. When you get to the hospital, the surgical team will see you and review your surgery and symptoms. Surgery will not proceed until the team speaks with you and mark the site of the incision for verification purposes. The surgery is done in the hospital. Most patients who undergo 1-level or 2-level surgery are discharged the same day; patients undergoing a 3-level procedure usually stay overnight.

Surgical Procedure

The incision is on the front of the neck off to the left side usually only 1 ½ inches in length. Surgery is usually completed within 1 to 2 hours. After surgery, you are taken to the recovery room as you wake up from surgery and pain is controlled with medication. Once pain is controlled, you are transferred to the Same Day Surgery area and mobilized in preparation for discharge to home.

Discharge Instructions

• If you are feeling well, you will be discharged home. You must have someone with you to leave the hospital and you cannot get a ride on your own or use a taxi service.
• Pain medications will be called into your pharmacy so you can pick them up on the way home. You should only use the medications if necessary and convert to Tylenol as soon as possible.
• We will see you in the office a week after surgery to check on your incision and progress. You should call the office on the way home to set up your appointment.
• Leave the bandage on for 48 hours and then remove. Once you remove the bandage, you will see Steri-Strips and those you should leave on. We will remove the Steri-Strips when you come to your first postoperative visit.
• You can begin driving after 48 hours.
• We will discuss returning to work on your first postoperative visit.
• Physical Therapy usually starts after 4 weeks to allow you time to heal. If you have weakness before surgery, we start therapy sooner. If you had only preoperative pain only, you will not need therapy at all.

Follow Up After Surgery

We usually see patients at 1 week, 1 month, 3 months and 1 year after surgery evaluating you each time with an X-Ray done in the office.