What kind of cervical spondylosis requires surgical treatment?
1.In milder cases, MRI or CT shows that the nerve or crestal medullary compression is not serious, conservative treatment is ineffective or the reduction is not obvious, and the symptoms gradually progress or even suddenly worsen as time lengthens.
2, the more severe symptoms, MRI or CT shows that the nerve or crestal medullary compression is more serious (the appearance of crestal medullary degeneration), such as the emergence of walking difficulties, hand and foot strength loss, urinary and fecal effort, muscle atrophy, etc., should be considered for surgical treatment.
3, engaged in fine work and driving workers, with higher requirements for hand and foot control and responsiveness/safety, such as a master driver with dizziness and hand weakness affecting driving safety.
Is osteophyte within the scope of surgery?
Cervical spondylosis is a group of diseases including: cervical disc herniation, ossification of the posterior longitudinal ligament, osteophytes, cervical spinal stenosis, etc. Osteophytes that exist to compress nerves should be surgically given for removal, otherwise it is difficult to improve the symptoms. However, because some patients have osteophytes growing in front of the nerve or cremaster, and the adhesions are serious, resection is very risky, such as using a biting forceps under the naked eye to bite off the osteophytes, which is risky and inadequate for resection. In contrast, neurosurgery now uses ultrasonic bone knife under the microscope to grind away the osteophytes with complete excision, adequate nerve decompression, and significant improvement in symptoms.
If diagnosed with surgery, can massage, hot compresses, cupping and other methods still be used?
1.Cervical spondylosis massage and cupping have great risks. The nerves and crestal medulla of the neck itself are in a state of compression, and massage or cupping may aggravate the compression of the nerves and crestal medulla, resulting in sudden aggravation of symptoms, such as increased pain in the neck and shoulder, weakness or even paralysis of the arms and legs, and incontinence of urine and stool, etc. Every year, we encounter such unfortunate patients in outpatient clinics.
2, hot compresses and extraction can be carried out to promote blood circulation and dilute inflammatory factors to achieve short-term improvement of symptoms, but only to treat the symptoms but not the root cause, the symptoms are repeated and difficult to cure.
What are the dangers of not operating when it is time to operate?
1, the crestal medulla is very “delicate” and “precious”, each person has only one crestal medulla, once the damage occurs, it is difficult to repair and regenerate. When cervical spondylosis patients should be operated, most of them are in the semi-injured or compensatory stage of the crestal medulla, and once they break through the “degree that the crestal medulla can bear”, it will cause irreversible damage, and at this time, even if they are treated with surgery, the efficacy will be very poor, and they may even become permanently incontinent or wheelchair-bound.
2, with the extension of time, the body will appear other protective changes, such as increased osteophytes, calcification or ossification of the intervertebral discs, etc., bringing difficulties to the subsequent surgical treatment, and the risk increases accordingly.
Is it true that the earlier the surgery, the better the result?
The prevalence of cervical spondylosis is high, including many physicians who have it, and from a physician’s perspective it may be more objective to consider.
1, relatively mild cervical spondylosis, where the symptoms are not obvious, can be treated conservatively, such as bed rest, medication-assisted treatment, etc.
2, the symptoms gradually aggravate or are heavier at the beginning, and MRI or CT performance is also heavier, it is still recommended that the earlier the surgery the better, the earlier the nerve and crestal medullary compression is lifted, the better the effect.
3. The older people tolerate the blow of surgery less well as they get older, for example, the safety and recovery effect of surgery at the age of 70 is worse than that at the age of 60, and at the age of 80 is worse than that at the age of 70, and very often the conditions and opportunities to do surgery are lost because of other physical indicators failing to meet the surgical requirements even if they want to do surgery because they are too old combined with more other diseases.
Is there an age limit for cervical spine surgery?
According to the current development of surgical technology, age is not an absolute restriction (contraindication) for cervical spine surgery, but as mentioned above, in many cases, the conditions and opportunities for surgery are lost because other physical indicators do not meet the requirements for surgery due to the combination of other diseases at an advanced age.
What conditions are contraindications to surgery?
1.Poor general condition, difficult to tolerate surgery.
2.Not accepting or understanding surgical treatment.
3.Do not operate blindly if the cervical spine disease is mild and can improve the symptoms through conservative treatment.
What are the procedures of cervical spine surgery? What kind of cases are they suitable for?
To summarize, there are anterior cervical surgery (from the front of the neck) and posterior cervical surgery (from the back of the neck)
1. anterior cervical surgery most commonly includes: artificial disc replacement, intervertebral fusion
2, posterior cervical surgery most commonly includes: single/dual door surgery, laminoplasty, laminectomy + screw fixation fusion.
How to choose the surgical approach? In what cases should the anterior-posterior approach be combined?
1, single-segment or short-segment cervical disc herniation, the anterior cervical approach can mostly solve the disease, especially neurosurgery has greater advantages in microscopic technology, wide field of vision, operation under direct vision, complete nerve protection, less trauma, and good results.
2.For multi-segment (more than 3 segments) cervical disc herniation, cervical spinal stenosis, hypertrophy of the ligamentum flavum, ossification of the posterior longitudinal ligament, etc., posterior surgery can be chosen.
3. In comparison, anterior surgery requires high technical requirements, without the assistance of microscope, microscopic technology protection, and microscopic instruments, the probability of damage to blood vessels/nerves caused by surgery is high, and even the probability of postoperative aggravation and paralysis is high. In contrast, the posterior approach is relatively safe and simple to perform.
What are the advantages and limitations of the anterior approach?
1. Advantages: direct access to the diseased disc from the normal muscle, blood vessel and nerve tissue gap, less trauma, resolves the compression of the disc on the crestal medulla, deals with osteophytes and ossification, and rarely destroys the stability of the cervical spine.
2. Limitations: for multi-segmental ossification and stenosis lesions, cervical spondylosis caused by hypertrophy of the ligamentum flavum, etc., the operation is more time-consuming and the risk of trauma increases.
What are the advantages and limitations of posterior approach?
1. Advantages: high surgical safety, simple operation, and the ability to deal with spinal stenosis caused by multi-segmental lesions.
2. Limitations: It destroys the integrity of the muscles, has an impact on stability, cannot fundamentally remove the herniated disc and bone spur, and only indirectly relieves the compression of the nerve and crestal medulla. The postoperative effect is improved to a certain extent, but sometimes it is difficult to prevent the progress of the herniated disc and bone spur.
How to choose bone graft material?
1.Autogenous bone: part of the iliac bone is removed from oneself and given as bone graft, with the advantages of low cost, no rejection and good fusion effect.
2.Artificial bone: artificial material, the advantage is that you don’t need to make an incision to take your own bone, reduce trauma, and the rejection of some high quality artificial bone is also very low at present, and the fusion rate is also very high.
What is the case for cervical artificial disc replacement?
For younger patients, generally under the age of 70, who have high requirements for cervical spine mobility, who have insignificant osteophytes or whose bone spurs or osteophytes can be taken care of intraoperatively (microscopic combined with ultrasonic bone knife can better handle this), and whose families can afford this cost.
What is minimally invasive treatment for cervical spondylosis?
1. Microscopic surgery is minimally invasive, and whether it is minimally invasive or not depends mainly on the extent of the disease. Minimally invasive is definitely not minimally invasive in terms of small incisions, but small damage to muscles, small damage to bones and joints, and especially minimal damage to nerves and crestal marrow, because the skin of the incision can grow again, muscles can grow again, and bones can grow again, but nerves and crestal marrow cannot grow again.
2. With the development of microscope and endoscope, the current pursuit is to achieve the most minimally invasive trauma, including nerve and crestal medulla, muscle, and even incision, etc.
How to choose the endoscopically assisted and microscopically assisted crestal surgery technique?
1, at present, the “gold standard” of surgery for cervical and lumbar spondylosis at home and abroad is microscope-assisted surgery, more than 80% of foreign countries are neurosurgeons operating under the microscope, but the current situation in China: only neurosurgeons operate with a microscope, but a large number of patients are distributed in orthopedics.
2, endoscopic-assisted crestal surgery technology has been developed for a shorter period of time and is a new minimally invasive method, but it is difficult to replace the microscope at present, for reasons including short-term efficacy but long-term recurrent symptoms, unsatisfactory postoperative improvement (not up to expectations), high recurrence rate, cost is not lower than the microscope and other disadvantages.
Why do I see more shoulder pain after cervical spine surgery?
1, strain and injury of the nerve root during surgery.
2, inappropriate size of the endophyte, resulting in a state of nerve tension.
3.The endophyte takes longer to adapt.
What should I do if the bone marrow of the cervical spine is edematous after cervical spine surgery and the compression of the nerve causes unconsciousness below the waist?
1. Violent surgical operations, especially blind operations without microscopic assistance, can easily cause crestal marrow injury, sometimes the injury is transient, but sometimes it is permanent. Hyperbaric oxygen, systemic rehabilitation or even nerve repair can be considered.
2. Inadequate surgical decompression and compression of the crestal medulla by residual discs or bone spurs. If MRI or CT is determined, another surgery is needed to release the compression.
3, microscope assistance is the gold standard for the treatment of cervical spondylosis, but microscope training requires more than 5-7 years of training to be in place, and the status quo in China is: neurosurgeons for microscope training and orthopedics without microscope training.
What symptoms appear after surgery, should be reviewed and seek medical attention as soon as possible?
1. The reappearance of the original symptoms, which gradually worsen.
2.New symptoms appear and affect life.
Why do symptoms of cervical spondylosis such as dizziness and hand numbness still appear after surgery?
1.The preoperative symptoms were too long and the nerve damage was too heavy to recover.
2, no microscope was used during surgery, the bone spurs and protruding discs were not handled properly, decompression was not sufficient, and residual bone spurs or discs compressed the nerves.
Do I need to take out the built-in objects implanted in the anterior cervical spine surgery? Which ones can be removed and for how long?
Artificial discs and fusion devices do not need to be removed and are similar to a “prosthesis”, such as a pacemaker. However, if it is displaced or damaged, the implant will need to be replaced or the procedure changed.