Neck Surgery

Anterior Cervical Discectomy and Fusion (ACDF)

Anterior cervical discectomy and fusion (Figure 1) is an operation performed on the front of the neck to relieve pressure on one or more nerve roots or on the spinal cord. The term is derived from anterior (front), cervical (neck), and fusion (joining the vertebrae with a bone graft).

When an intervertebral disc ruptures in the cervical spine, it may put pressure on nerve roots or the spinal cord, causing pain and other symptoms in the neck, arms, and sometimes the legs. In this operation, the surgeon reaches the cervical spine through a small incision in the front of the neck. After the muscles are gently separated, the intervertebral disc is removed and a bone graft is placed between the two vertebral bodies. Over time, the bone graft creates a fusion between the vertebrae.

A small cervical plate is used to stabilize the spine immediately after surgery and reduce the risk of graft displacement. Today, collars are typically worn for a shorter period after surgery due to improved fixation techniques.

Anterior Cervical Corpectomy

Cervical corpectomy (Figure 2) is an operation that removes a portion of the vertebral body and adjacent intervertebral discs to decompress the cervical spinal cord and spinal nerves.

In some patients, the cervical spinal canal becomes narrowed by bone spurs arising from the back of the vertebral body or the ligament behind the vertebrae. In such cases, one or more vertebral bodies and the discs above and below may need to be removed to adequately decompress the spinal cord and nerve roots. A bone graft with a metal plate and screws is then used to reconstruct the spine and provide stability.

Anterior Cervical Discectomy and Artificial Disc Replacement

Artificial cervical disc replacement (Figure 3) is a newer development in neck surgery and serves as an alternative to anterior cervical discectomy and fusion. The advantage lies in its ability to replicate the mechanics of a normal disc at the treated level, potentially reducing stress on adjacent spinal levels.

Most of the procedure is similar to anterior cervical discectomy and fusion, except for the method used to fill the space after disc removal. Instead of using a bone graft with plate and screws, an artificial disc made of titanium plates with a plastic core is placed and secured in the disc space, allowing motion to be preserved.

Posterior Decompression (Laminectomy or Laminoplasty)

In some cases, the spine surgeon may recommend operating from the back of the neck (posterior approach). This is usually indicated when multiple levels of nerve and spinal cord compression are present. The objective of posterior surgery is to increase the space available for the spinal cord and nerves.

This can be performed through minimally invasive laminectomy, where the lamina (bone covering the spinal cord) is removed. In some cases, titanium screws may be placed to stabilize the decompressed levels and maintain spinal alignment.

Laminoplasty (Figure 4) is an alternative to laminectomy and is recommended when there is narrowing of the spinal canal at multiple levels. One prerequisite for this surgery is that the spine must not be significantly kyphotic or misaligned, otherwise nerve compression may persist after surgery.

This procedure is performed from the back of the neck with the patient in a prone position. In simple terms, laminoplasty creates more space for the spinal cord by opening a hinge-like door in the lamina. Unlike laminectomy, the lamina is preserved, which reduces the need for fusion. Modern techniques use mini plates and screws to secure the opened lamina while preserving neck mobility.

Posterior Foraminotomy

Cervical foraminotomy is an operation performed to enlarge the space where a spinal nerve root exits the cervical spinal canal, relieving symptoms of a pinched nerve. This procedure is commonly used to treat cervical nerve root compression and radiculopathy.

It is often performed together with laminectomy or laminoplasty and is less commonly done as a standalone procedure.