What Are the Indications for Neck Surgery?

When a patient has neck surgery, the results are typically much better than for surgery of the low back. The reason is that the indications for surgery in the cervical spine are much better defined than they are for the lumbar region.

Allow me to explain why. A few decades ago, studies were done looking at neck surgery for patients who had neck pain that was not radiating into the arms. This is called axial neck pain and was due to arthritis in the joints of the neck. The results showed that outcomes for neck surgery for this reason were fairly poor. Patients did not get substantially better, and there was a high incidence of patients needing further surgery within a few years. So surgeons stopped doing it.

Due to this, the indications for neck surgery have been fairly well defined. Here is a list of 4 indications for neck surgery.

1. Fracture with instability. Patients who are involved in a car accident or a trauma may end up with broken bones in their neck and an unstable spinal column. These individuals need surgery in their cervical spine to prevent a spinal cord injury from occurring. One interesting reason for neck surgery is if the patient has no evidence of fracture on the imaging studies, but significant instability on the dynamic x-rays.

2. Herniated disc with radiculopathy- just because a patient has a herniated disc in their cervical spine with radiculopathy does not mean surgery is absolutely necessary. The term radiculopathy refers to when the herniated disc is pushing on a nerve root and causing pain down the arm in the sensory distribution of that nerve. If a person has muscle weakness from the nerves being pinched, that is more of an indication for surgery than simply having pain.

If a person tries conservative treatments for over 6 weeks and the pain is not getting better, surgery can be considered. The results of surgery for a pinched nerve in the neck are very good at over 90 to 95% success rates. If a person does have motor weakness as mentioned, it should not be watched for a very long time as if it doesn't get better even if they technically perfect surgery is performed the motor weakness may not improve if there was too long of a wait before doing the surgery.

3. Spinal stenosis- this is a problem that comes on from arthritis causing bony overgrowth along with soft tissue overgrowth. These can result in multiple cervical nerve roots being pinched. Because of this, a person may have significant pain going down one or both arms. Surgery for spinal stenosis is a quality of life decision, and is not mandatory. If the pain is treated nonoperatively and it simply is not getting better, as an elective decision then a decompression to free up the pinched nerves may help substantially.

4. Spinal cord compression- a person's cervical spinal cord may be compressed for a number of reasons. There may be a tumor in the area that's pushing on spinal cord. Also, the person may have a disorder called cervical myelopathy which may be a result of a large disc herniation that is calcified and is pushing on the spinal cord itself. The spinal cord can react against this and start to shrink. It is a good idea when the shrinking begins to happen to go ahead and have a decompression surgery as waiting too long may not reverse the resulting problem.

Neck surgery for these conditions often has a great outcome. The fact that neck surgery for pain that stays in the neck due to arthritis has been out of favor for a long time once again is the reason that the surgeries tend to do much better.