Should You Have Surgery for Cervical Radiculopathy?

Cervical radiculopathy can cause neck and arm pain, arm weakness, numbness, and/or electrical sensations down one arm. While surgery is sometimes an option, conservative treatments are often effective. So it is difficult to decide if and when you should consider talking to a healthcare provider about whether you could benefit from surgery.

Cervical radiculopathy is a condition in which one or more spinal nerve roots in the neck become irritated or compressed. It may be caused by a herniated disc, spinal arthritis or stenosis, or other conditions.

Neck Surgery for Radiculopathy Symptoms

Neck bones — Science Picture Co / Getty Images

Both passive and active non-surgical therapies may help reduce symptoms of cervical radiculopathy. Medication, physical therapy, and injections are often effective enough for people to avoid invasive procedures.

But surgery may be necessary when radiculopathy is accompanied by movement impairment or debilitating pain that doesn't improve with conservative management or when the neck is unstable.

The surgical procedures that are used to treat cervical radiculopathy are:

Anterior cervical decompression (ACD)
ACD with fusion (ACDF)
Posterior cervical laminoforaminotomy
Cervical disc arthroplasty

Disc Arthroplasty

Neck surgery — MedicImage / Universal Images Group / Getty Images

Disc arthroplasty is one of the many names given to spinal disc replacement surgery. During this surgery, a prosthesis designed to mimic the shape and function of a natural disc is inserted to replace the one that has worn out.

Disc replacements are used to treat cervical radiculopathy and discogenic pain. They're also used for revision surgery.

This procedure involves an anterior (front) surgical approach. The damaged disc is removed, and the area is cleaned out before the artificial one is put in.

Disc Arthroplasty vs. Common Neck Surgeries

There are several benefits to this type of surgery.

Motion preservation: Disc arthroplasty is also called "motion preservation spine surgery." Some cervical radiculopathy surgeries generally involve fusing the area, which removes the possibility of ever moving that area again after surgery. With an artificial disc, the motion is supposed to be preserved. But some motion through the bones of the neck may still be decreased.
Lower risk of degeneration: Adjacent segment degeneration (ASD) is degeneration of the discs above or below the surgical level. This type of surgery may be associated with a lower risk of ASD than other procedures.

A study on the long-term effects of disc arthroplasty found that at 7 and 10 years out from the procedure, the devices were still working and the outcome of arthroplasty was comparable to those of conventional ACDF procedure for radiculopathy symptoms, in the same time frame.

Another study found that disc arthroplasty shortened the time patients were in surgery, and also resulted in a better range of motion at the surgery site.

Anterior Cervical Discectomy With and Without Fusion

Spinal surgery hardware — BSIP/UIG / Getty Images

During ACD or ACDF surgery, the disc is removed to help relieve pressure on the spinal nerve root.

An anterior cervical discectomy is a procedure in which the surgeon cuts into the neck from the front to reach and remove damaged intervertebral disc material. During the procedure, the neck muscles are moved away to expose the trachea, esophagus, disc, and spinal bones.

The anterior approach provides the best opportunity to restore the natural neck curve, stabilize the spine, and predictably decompress the spinal nerve root.

Anterior Cervical Discectomy With Fusion

Anterior cervical decompression is done with and without fusion.

A 2017 study found the more levels being decompressed and fused, the greater the risk for postoperative neck and arm pain, as well as other problems.

The insertion of hardware (plates, cages, screws) may help your chances of a successful fusion, according to the authors. The authors also say that hardware may help decrease posture issues (kyphosis, in particular) as well as some types of bone graft complications.

Generally, when you have more than one level being fused, your surgeon will use an anterior plate.

Laminoforaminotomy for Cervical Radiculopathy Symptoms

Vertebra or spinal bone — MedicalRF.com / Getty Images

Posterior cervical laminoforaminotomy takes a posterior (back) approach.

The lamina is a part of the bony ring in the back of an individual vertebra.
The foramina are the openings In the spinal bones where the spinal nerve roots run.

During a posterior cervical laminoforaminotomy the surgeon enters through the back of the neck and cuts into the bone to make room for spinal nerves. The goal of the surgery is to allow unimpeded passage of nerves through the foramina. By removing bone material in the lamina and/or the foramina, the spine is decompressed.

Pros and Cons of Posterior Approach

With a posterior approach, fusion is generally not necessary and the surgeon can maintain good spinal balance and alignment.

The drawback is that the amount of decompression that can be done is limited. The common use for a posterior approach is to remove soft disc fragments that cause neuroforaminal spinal stenosis, a condition that can cause cervical radiculopathy.

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