Anterior Cervical Discectomy and Fusion
An anterior cervical discectomy and fusion or ACDF is a very common procedure in spinal surgery. When the discs become tired in the cervical spine they bulge backwards. This causes compression of either small nerves coming off the side of the spinal cord or the cord itself. In either circumstance the patient can present with arm pain on one or both sides or issues with hand function or balance. Unlike in the lumbar spine, discectomy in the neck is generally performed via removal of the whole disc. This allows a full decompression of whatever structures are compressed. The anterior cervical discectomy is done via a small incision on the right side of the neck. The tissues are gently teased apart allow access to the front of the cervical spine. The surgery takes around an hour depending on complexity, and most patients go home the next day. In most case the arm pain has already settled. Fusion is brought about by placing a small spacer in the gap where the disc used to be. This allows the bone to splinted apart while they fuse over time.
Disc Replacement
When a cervical discectomy is performed, there may be some benefits in not fusing the bones together. One option is to use a small device that allows for continued movement. This is known as a cervical disc replacement. It is not suitable for everyone.
Corpectomy
This is a lumbar epidural, similar to the caudal epidural. This time the injection is placed directly around specific nerves. This makes it more selective and can thus be used as a diagnostic tool. It is very useful when two nerves are being pinched from a bony spur or disc bulge.
Laminectomy
When a spinal cord is compressed from wear and tear in the neck, it is most commonly caused by a bulging disc. Less commonly, it is possible for the bones and ligaments at the back of the neck to cause compression. When this happens, a small procedure is required in the back of the neck to remove this bone (lamina) and ligament. Generally just the ligament bone spurs are removed, very occasionally small screws are required to hold the bones in the correct position.
Foraminotomy
If the nerves coming off the spinal cord are compressed by small bony spurs at the back of the neck, it is sometimes possible to remove them, leaving the majority of the posterior bone (lamina) intact. This is most often done after the nerve is decompressed from the front of the neck with an ACDF.
