Degenerative cervical myelopathy is usually due to spinal stenosis. Its incidence is increasing as the world's population ages.
We talk about his diagnosis, his treatment and innovations (Dynamic Magnetic Resonance Imaging, Smartphone App, minimally invasive surgery…).
Dr. François LECHANOINE
Senior Consultant Neurosurgeon, Specialist in minimally invasive endoscopic brain, spinal, and pediatric surgery at the NeuroNEC International Center in San Marino, which coordinates surgical activity between San Marino, Milan, Naples, and France.
Secretariat: open from Monday to Friday from 09:30 to 13:00 and from 15:00 to 18:00
348 916 3317
The cervical or cervical vertebrae arthrodesis It is a surgical procedure that allows you to join the bones of the uppermost part of the spineIt is particularly indicated when the patient suffers from cervical disc herniation, myelopathy, cervical stenosis, cervical spondylosis, tumors, infections, trauma e deformations of various nature.
Since the intervention is performed in general anesthesia, in the hours preceding the test the patient must carefully follow the fasting instructions.
The neurosurgeon, according to the problem to be treated, the conformation of the spine, the area of the cervical spine and the possible instability, chooses the most suitable approach for the patient: anterior or posterior or, more rarely, combined (both). Surgery generally consists of a phase of decompression of the nervous system and another phase of vertebral fixation (arthrodesis) and possible deformation correction. The long-term goal is that the union of the bones is stable.
Cervical arthrodesis can then be performed via the anterior route, so from the front side of the neck, and via the backBoth, after all, have equal pros and cons: while anterior cervical arthrodesis allows the neurosurgeon to effectively monitor radicular (cervical nerves) and spinal cord compression and leads to a quicker and more comfortable recovery, posterior arthrodesis, although requiring a slightly longer hospital stay, involves fewer risks for viscera, blood vessels, and the recurrent laryngeal nerve.
Furthermore, to monitor bladder and nerve function, a catheter and electrodes can be applied to the patient.
The neurosurgeon makes a horizontal or longitudinal incision on the neck and proceeds with a discectomy (removal of a cervical disc). Once the discectomy has been performed, the cervical canal and lateral foramina are opened, removing any osteophytes (arthrosis beaks) and any herniated or protruding disc, allowing the spinal cord and cervical nerves to be freed. It is then possible to insert industrial plants made of titanium or non-metallic materials, such as cages, plates, plate-cages fixed with screws.
As an alternative to the introduction of implants, it is therefore possible to take material, generally from the iliac crest or from some vertebral elements (spinous processes and laminae), and perform a bone graftAnother solution involves using synthetic materials.
During the operation, which generally lasts 30 to 90 minutes for a single-level arthrodesis, it is possible to intervene on multiple vertebrae.
The neurosurgeon makes a longitudinal incision at the back of the neck, detaches and moves the muscles that support the head and generally proceeds to perform a laminectomy (removal of the back of the cervical vertebrae), allowing the posterior half of the cervical canal to be opened and thus the spinal cord to be freed.
The arthrodesis phase consists of screwing the posterior part of the vertebrae and joining them by connecting the screws with titanium rods, previously shaped according to the surgeon's choice.
The procedure generally lasts from 60 minutes to 4 hours depending on the number of vertebrae being operated on.
Explanatory video on anterior cervical discectomy and arthrodesis (in English)
Explanatory video on posterior cervical laminectomy and arthrodesis (in English)
Immediately after the operation, the patient must remain in bed for a few hours for observation and can then get up without any problems. In the following days, they will be carefully monitored. monitor neurological status and wound healing, to avoid possible infections. A postoperative X-ray or CT scan will be performed.
Given the nature of the two cervical arthrodesis approaches, anterior or posterior, possible complications vary depending on the choiceAfter an anterior cervical arthrodesis, complications may include damage to the arteries, damage to the esophagus, dysphonia (voice disturbance), dysphagia (swallowing disturbance)… It should also be remembered that metal implants can be subject to breakage or misalignment and in the long term the patient may develop an “adjacent segment”, a wear of the adjacent segments.
As mentioned, cervical arthrodesis and convalescence also have different relationships. depending on the technique used: the anterior approach requires a shorter hospital stay and recovery times are quicker, unlike what happens with the posterior approach, which can result in more intense post-operative pain. After cervical arthrodesis surgery, the rehabilitation may require the patient to wear a support device, such as a cervical collar, for a few days. In other cases, a rest and attention to do not move your neck suddenly.
It is important to respect the deliveries that prohibit carrying loads or to exert stress on the cervical spine in flexion/extension.
Muscle rehabilitation physiotherapy is recommended after any spinal surgery, generally no sooner than 4-8 weeks.
