When is neck surgery appropriate?

If neck pain and other symptoms aren’t improving with massages, physical therapy and over-the-counter pain relievers, you may wonder if surgery is the obvious next step.

And while surgery might sometimes be necessary, neck pain is not always the only clue that something could be wrong. Dr. Patrick Sugrue, a neurosurgeon at Advocate Health Care, says numbness, tingling, weakness, difficulty with coordination and trouble with balance can also be warning signs of a spinal health condition or injury.

Common conditions that impact the neck

Several cervical spine conditions can cause neck pain and other potentially concerning symptoms, including:

• Herniated disc – Discs are found between each vertebra in the spine. When one slips out of alignment, it’s known as a herniated disc. The slipped disc can put pressure on nearby nerves, resulting in arm pain, numbness or tingling.
• Degenerated disc – It’s natural for discs to deteriorate with age. Some factors can expedite this process, including wear and tear from certain repetitive movements, genetic predispositions, obesity, smoking and injury. Disc deterioration leaves less cushioning between spinal vertebrae, leading to inflammation, nerve irritation and neck pain.
• Spinal stenosis – This condition occurs when the spinal canal is compressed. The spinal canal is a fluid-filled space that protects your spinal cord and surrounding nerves. When this space becomes too small, it can cause nerve pain and spinal cord irritation.

“To diagnose these conditions, your doctor will review your symptoms, medical history and imaging,” Dr. Sugrue says. “Surgery is not a first-line treatment. Instead, your doctor will have you try non-operational treatments first. If these treatments fail, then surgery using the least invasive and most effective technique possible is considered when appropriate.”

What surgeries are there for neck pain?

If you do need neck surgery, there are fortunately many available surgical options:

• Laminectomy or laminoplasty – The surgery involves removing part of the spinal bone, called the lamina, to create more space in the spinal canal. This helps decompress the nerves and spine.
• Cervical disc replacement – The damaged cervical disc is surgically removed and replaced with an artificial disc. This helps preserve range of motion.
• Anterior cervical discectomy and fusion – Surgery is performed from the front of the neck to remove the damaged disc. Stabilization devices, such as plates, screws and “cages,” are surgically placed to stabilize the neck and restore alignment.
• Posterior cervical decompression and fusion – Surgery is performed from the back of the neck to remove the lamina, the arched bones that protect the spinal cord. Rods and screws are placed to stabilize the neck and restore alignment.

“Many people experience quick improvement with their symptoms after surgery; however, it’s important to remember that it takes time for nerves to heal,” Dr. Sugrue explains. “So, it may not be immediate relief. The aim is always to choose a procedure or treatment that matches a patient’s needs and goals.”

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