I. What kind of cervical spondylosis needs surgical treatment?
1.Cervical spondylosis of neurogenic type requires conservative treatment for more than 3 months to 6 months, and there are clear manifestations of nerve damage, as well as pain that seriously affects the patient’s work and life, and the patient has a strong need and desire for surgery.
2, spinal cord type cervical spondylosis, once clearly diagnosed, early surgery is appropriate.
In other words, for all cervical spondylosis (neurogenic cervical spondylosis, spinal cord cervical spondylosis, mixed cervical spondylosis), the premise of surgery is that there must be manifestations of nerve damage (such as: motor disorders, sensory disorders, changes in physiological and pathological reflexes, and changes in vegetative nerve function) and serious impact on the patient’s work and life before surgery is considered.
3, the so-called vertebral artery cervical spondylosis, sympathetic cervical spondylosis, now in the spine surgeons, these two cervical spondylosis in clinical practice is difficult to make a clear diagnosis and differential diagnosis, it is difficult to have a clear and effective surgical method, so these two diseases, do not consider surgical treatment.
Second, is osteophytes within the scope of surgery?
Osteomalacia is a manifestation of normal aging of the human body, bone degeneration, then hyperplasia occurs, surgery is not to remove the osteomalacia, osteomalacia, it is also impossible to reverse, otherwise the world would really have the meat of the monk to eat, but also really can live forever. Surgery is only to release the nerve compression, if there is an enlarged bone flab causing nerve compression, it will be removed.
Third, if I am diagnosed with surgery, can I still use massage, hot compresses, cupping and other methods?
For cervical spondylosis of the nerve root type, traction, massage, hot compress physiotherapy and drugs to relieve spasm and pain and reduce edema of the nerve root can be performed, but traction, massage and massage are contraindicated for cervical spondylosis of the spinal cord type.
Hot compress and cupping are only local soft tissue treatment methods. As long as the cervical spine does not have violent passive activities, the effect is not significant, but it is also meaningless for the treatment of cervical spondylosis.
Fourth, what are the hazards of not operating when surgery should be performed?
Without surgery, the harm lies in not being able to resume normal work and life as soon as possible, and the damaged nerve function cannot be recovered as soon as possible. Many times, patients worry that if they do not have surgery, they will face the possibility of paralysis immediately. This concern and worry is actually unnecessary because the occurrence of cervical spondylosis is a process that develops slowly over time. Sometimes, the lesion will not change for years (such as further aggravation), so there is enough time for you to consider whether you need surgery.
V. Is it true that the earlier the surgery, the better the result?
For spinal cord cervical spondylosis, the earlier the surgery, the better, and for neurogenic cervical spondylosis, the earlier the better. The timing of surgery depends on the needs of the condition, the patient’s mental preparation, and finding the right doctor to believe in, which is most important.
Is there an age limit for cervical spine surgery?
There is no age limit, as long as the condition requires it and the patient’s general condition can accept the surgery.
What conditions are contraindications to surgery?
1.The patient’s condition does not require surgery.
2.The patient’s physical condition is not acceptable for surgery
3.The patient’s neck is infected and the soft tissue condition is not good.
4.The doctor will not do the surgery.
5.The hospital where the patient is located does not have the equipment and conditions for emergency resuscitation.
VIII. What are the procedures of cervical spine surgery? What kind of cases are they suitable for?
1.Anterior surgery: It is suitable for relieving the compression in front of the spinal cord through the front. Removal of intervertebral disc, posterior vertebral body bones and hook vertebral joint bones, release of spinal cord, nerve root and vertebral artery compression, intervertebral body bone graft fusion to stabilize the spine or artificial disc replacement. Surgical methods include.
Percutaneous puncture cervical discectomy
discectomy + bone graft fusion
discectomy + fusion with implants + Hallo-vest external fixation
Discectomy + implant fusion + internal fixation
Discectomy + Cage + Implant fusion + Internal fixation
Subtotal discectomy + implant fusion + internal fixation
Subtotal laminectomy + peptide mesh + bone graft fusion + internal fixation
Discectomy + artificial disc replacement
Smith-Robinson method (1958)
Cloward method (1958) (no longer used clinically)
Simmons and Bhalla method (1969)
Cervical Corpectomies method (subtotal vertebral body decompression)
Artificial cervical disc replacement
2, posterior surgery: suitable for the posterior decompression of the spinal cord via the posterior side, or for the anterior decompression of the spinal cord via the anterior side. Supplemented with posterior spinal fusion if necessary. The surgical modalities are
laminectomy
Expanded spinal canalplasty
single-opening spinal canal enlargement
Double-opening spinal canal enlargement
IX. How to choose the surgical approach? Under what circumstances should the anterior and posterior approaches be combined?
Choice of surgical approach for cervical spondylosis
1.Cervical disc herniation
a. Single gap: anterior discectomy, decompression, implantation and fusion internal fixation (ACDF)
b. Two gap: anterior discectomy decompression implant fusion (ACDF) or anterior subtotal discectomy decompression implant fusion (ACCF)
c. Three gaps: anterior discectomy decompression implant fusion (ACDF) or anterior subtotal discectomy decompression implant fusion (ACCF), or posterior vertebroplasty due to the large scope of anterior surgery, the many complications of implants and the long postoperative time. There is no significant difference between the two surgical results, but the latter is shorter, simpler, and less bleeding.
d. Four gaps: vertebroplasty
e. Disc herniation combined with canal stenosis: vertebroplasty
2, degenerative and developmental spinal stenosis: vertebroplasty
3. OPLL (ossification of the posterior longitudinal ligament):
a. Two gap isolated type: anterior subtotal laminectomy (no spinal stenosis)
b. Multi-gap: vertebroplasty
I, personally, never do combined anterior and posterior surgery to treat cervical spondylosis, either anterior or posterior. If the condition requires that only posterior surgery can be done, anterior surgery is no longer necessary.
What are the problems of anterior cervical spine surgery, the purpose of internal fixation and complications?
Problems of anterior cervical spine surgery.
Complications related to anterior surgery bone graft and internal fixation
Risks of anterior surgery (laryngeal edema, asphyxia, hematoma compression, death)
Risk of damage to large cervical blood vessels, trachea and esophagus with anterior surgery
Spinal stenosis is difficult to resolve
Alteration of the adjacent space for anterior surgery
The purpose of anterior internal cervical fixation is to
Provide immediate stability of the reconstructed area
Improve fusion rates
Avoid dislocation of graft bone
Rapid rehabilitation
Avoid the use of external fixation
Complications of anterior cervical spine surgery.
Dural tear cerebrospinal fluid fistula
Accelerated degeneration of adjacent vertebrae
Injury to the recurrent laryngeal nerve
Infection
Vertebral artery injury
Spinal cord and nerve root injury
Reduced biomechanical stability
Esophageal perforation
Loose and broken plate screws
Collapse of bone graft, bone discontinuity, prolapse
Complications in the bone donor area (hematoma, lateral femoral cutaneous nerve injury, etc.)
Difficulty in swallowing (causes: vocal cord paralysis, loose and dislodged internal fixation, hematoma, adhesions, loss of innervation of the pharynx, etc.)
XI. What are the problems, indications, complications and advantages and disadvantages of posterior cervical spine surgery?
Problems of posterior cervical total laminectomy.
Impact on the stability of the cervical spine
Scar compression
Gooseneck deformity
Indications for cervical vertebroplasty.
1.Multi-segmental spinal stenosis (anterior-posterior diameter of spinal canal less than 13 mm)
2.Osseointegration of the posterior longitudinal ligament of the cervical spine (OPLL)
3.Cervical disc herniation with or without spinal stenosis above double interval
4.Spinal cord tumor resection
5.Cervical instability caused by rheumatism, etc., and bone graft fusion when cervical spinal canalplasty is performed
Advantages and disadvantages of cervical vertebroplasty.
Advantages:
1.Expand the spinal canal and preserve the natural structure. Maintain the stability of the spine
2.Relief of spinal cord compression without removing degenerative tissue
3.Reducing nuisance to the spinal canal, avoiding nerve damage and bleeding.
4.The nerve root canal can be decompressed at the same time to maintain the stability of the spine.
5.The spinal fusion can be performed at the same time
Disadvantages:
1.Reduction of cervical mobility
2.Neck pain
Complications of posterior cervical kyphoplasty and internal fixation.
Intramedullary injury due to spinal cord enlargement
Upper extremity motor nerve palsy (C5,C6)
Infection
adjacent segmental disc herniation (after short segmental kyphoplasty)
Cerebrospinal fluid fistula due to dural tear
Spinal cord injury
Collapse and fracture of the formed vertebral plate
Loose and broken steel plate screws (posterior internal fixation)
Factors affecting the mobility of the cervical spine include the following.
The method of vertebroplasty
The extent of intraoperative exposure
Location of the laminectomy
Application of bone graft and internal fixation
The duration of cervical fixation
Postoperative physiotherapy
12.How to choose bone graft material?
Currently, the available bone graft materials are: autologous iliac bone, allogeneic bone, synthetic material, and autologous bone obtained by fusion plus local decompression. If you are not a spine surgeon, it is better to take the advice of your treating doctor. The kind of bone grafting material that the surgeon is used to using and the kind of bone grafting material that your hospital can provide will determine what kind of bone grafting material to use for you.
Under what circumstances should I have a cervical artificial disc replacement?
Indications for artificial cervical disc replacement (can be done)
1.Spinal cord type cervical spondylosis and nerve root type cervical spondylosis caused by single gap or double gap simple cervical disc herniation, mainly due to soft compression.
2, those with cervical disc herniation who require anterior decompression surgery
3, those who do not have obvious intervertebral space narrowing and cervical segmental instability
4.People who are less than 55 years old and have no significant posterior small joint degeneration and good activity.
5.Cervical artificial disc replacement surgery is applicable to cervical 3-4, cervical 4-5, cervical 5-6 and cervical 6-7.
6, cervical artificial disc replacement to single gap replacement or double gap replacement is appropriate, more than 3 gaps for artificial disc replacement is not recommended.
Contraindications to artificial cervical disc replacement (can not be done).
1.Persons with severe osteoporosis.
2, those with severe cervical instability.
3.Patients with trauma, infection, tumor.
4, those with ankylosing spondylitis, rheumatoid arthritis
5, diffuse idiopathic osteophytes, posterior longitudinal ligament ossification disease (OPLL)
6, allergic to artificial disc materials
XIV. What kind of cervical spine surgery is suitable for minimally invasive? Under what circumstances is it not suitable?
The current popular “minimally invasive techniques” are listed below.
Small needle knife
Cervical disc radiofrequency ablation technology
Intervertebral discoscopy, foraminoscopy, interventional techniques, microscopic use
Cryogenic plasma nucleoplasty
Complex collagenase intervention
CT-guided ozone nucleus pulposus ablation
Percutaneous cervical disc laser vaporization and decompression
Bipolar radiofrequency ablation
1.Minimally invasive interventional ablation techniques in cervical spine.
2.The application of intervertebral foraminoscopy technology in cervical spine surgery.
3.The application of intervertebral discoscopy in cervical spine surgery
4.The application of microsurgery techniques in cervical and upper cervical spine surgery.
5.Other cervical spine minimally invasive related technologies
Minimally invasive techniques
1.Endoscopic discectomy: compared with conventional open surgery, endoscopic surgery has the advantages of less damage to surrounding tissues, fine operation and less surgical bleeding. However, there are shortcomings such as limited operating space, easy movement of the working channel and difficulty in internal fixation, so endoscopic surgery is suitable for cervical spondylosis with limited lesions, and it is not suitable for patients with multisegmental cervical spondylosis, ossification of the posterior longitudinal ligament and cervical spinal stenosis. The average increase in intervertebral height was 18.7% compared with that before surgery, and the cervical curvature was more physiological. It is believed that endoscopic ACDF has the advantages of minimally invasive, less complications, faster recovery and less cost, but there are also shortcomings such as limited operating space, difficulty in controlling intraoperative bleeding and lack of bracing equipment.
2, percutaneous disc decompression techniques: In recent years, the percutaneous disc decompression techniques carried out include percutaneous laser disc decompression, percutaneous myeloplasty, percutaneous discectomy, etc., which have the advantages of minimally invasive, quick results, few complications, and do not affect the stability of the cervical spine, and can be used as an alternative treatment for patients who do not want to undergo cervical spine surgery because conservative treatment is ineffective, but there are also risks such as damage to vascular nerves and discitis.
In terms of long-term efficacy, there is no significant difference between the efficacy of minimally invasive surgery and that of traditional surgery. However, minimally invasive cannot be pursued blindly, and now minimally invasive has been promoted and used in transition, which is not necessarily a good thing.
XV. What are the indications, advantages and shortcomings of percutaneous puncture spinal surgery technique, endoscopy-assisted spinal surgery technique and microscope-assisted anterior cervical spine surgery?
There are many minimally invasive surgical methods for cervical disc herniation, but laser, radiofrequency, plasma, etc., due to their own principles and safety restrictions, most of them can only act on intra-disc decompression and indirectly on the herniation, so they are less effective for larger herniation, prolapse, and lateral type herniation, and their indications are more limited, and they have no effect on spinal cord injury caused by cervical conus stenosis.
Indications for microscope-assisted anterior cervical spine surgery are suitable for any cervical spondylosis that requires surgery, both anterior and posterior. Foreign doctors cervical spine surgery are performed under microscope assistance, there is no such tradition in China, therefore, the vast majority of hospitals, do not have the support of spinal surgery microscope. However, some hospitals have started to use microscope assisted spine surgery. The microscope is only an aid, and the surgical result has little to do with the use of the microscope, but is closely related to the skill and experience of the surgeon.
16. Neck and shoulder pain syndrome after cervical spine surgery
Shoulder pain is actually a common complication after cervical spine surgery, called neck and shoulder pain syndrome. The incidence of neck and shoulder pain (axial symptoms) is much higher in posterior cervical kyphoplasty than in anterior cervical fusion (60% vs 20%), and the incidence of neck and shoulder pain syndrome is even as high as 80% in posterior cervical spine surgery. Severe neck and shoulder pain significantly affects the quality of life of patients.
XVII. What are the complications of spinal canal expansion? Can they be prevented?
See above: Complications of posterior cervical spinal canalplasty and internal fixation
XVIII. What are the complications of bone fusion and internal fixation? Can they be prevented?
See above, complications of comprehensive anterior cervical spine surgery and posterior cervical spine surgery.
What should I do if the built-in object is loose or broken?
If the built-in material loosens and breaks, if it does not affect the stability of the cervical spine and the adjacent tissues and organs, blood vessels and nerves around the cervical spine, close observation can be continued; if there is damage to the adjacent tissues and organs, blood vessels and nerves around the spine, the broken and loose internal fixation and bone graft material will be removed and revision surgery will be performed as soon as possible.
What should I do if my left leg and foot are numb and painful after anterior cervical spine surgery (no symptoms before surgery)?
Report to your surgeon in detail and let him check if there are other problems.
What are the symptoms after surgery that should be reviewed and treated as soon as possible?
If the pre-operative symptoms return and may be aggravated, such as hand numbness, unstable walking, difficulty in breathing, neck pain, poor movement of upper and lower extremities, etc., it is necessary to promptly review and consult a doctor.
22. Why do cervical spondylosis symptoms such as dizziness and hand numbness still occur after surgery?
Personally, I never operate on patients because they are dizzy. Surgery can hardly solve patients’ dizziness, etc. There are too many causes of dizziness, which may be neurological, cardiovascular, otorhinolaryngological or ophthalmological, and even many middle-aged women have such symptoms, which are mostly caused by psychological factors and cannot be solved by surgery. For patients who come to the clinic because of dizziness, it is important to be very careful in deciding on a surgical plan. If you are dizzy primarily, then undergoing cervical spine surgery should also be done with great caution. Surgery does not necessarily solve your dizziness problem.
Twenty-three: Is a herniated cervical disc after surgery a recurrence of cervical spondylosis? What kind of people are prone to it?
The problem of recurrence does not exist because cervical disc herniation surgery is basically fusion surgery nowadays. Sometimes, there is this situation, which is described by the radiology department when the radiology report is read, whether there is a recurrence or not, you must go to your own surgeon who deals with the surgery, and you should not go around to inquire about other unrelated doctors. Because only your surgeon, the best understanding of your condition.
24.When does a patient need a second-stage surgery?
Second-stage surgery depends on the stage treatment plan made by the surgeon according to the patient’s condition, the communication between the surgeon and the patient, and the degree of difficulty of the condition, and cannot be generalized, nor can we set a definite time.
Do I need to take out the built-in implants implanted in the anterior cervical spine surgery? Which ones can be removed and for how long?
The implants implanted in the anterior cervical spine surgery are placed for life and do not need to be removed, unless the implants and the fixed plates become loose, fractured, displaced, and may damage the adjacent tissues and organs, blood vessels and nerves around the cervical spine, then it may be necessary to revise and remove them and perform revision surgery.