Cervical spine surgery is performed to address various underlying neck disorders such as neck pain, neck and arm pain, weakness in the upper extremity and even to correct gait imbalance in some patients. Most neck surgeries can now be performed by using minimally invasive spine surgery (MISS) techniques in an outpatient setting. Patients who have failed non-surgical management for their underlying neck symptoms from cervical disc herniation, radiculopathy, cervical fractures, cervical stenosis and cervical arthritis will benefit from this new outpatient focused approach which relies on smaller incisions, less tissue disruption and faster recovery.
The main goals of MISS cervical surgery are to remove pressure from a nerve and/or the spinal cord and to stabilize the neck either with a fusion or with a disc replacement. The two main options for treating a damaged and painful cervical disc are an anterior cervical discectomy and fusion (ACDF) and a cervical total disc replacement (CTDR). Each of these options needs to be tailor to the individual patient; meaning a CTDR is a better option for some patients while an ACDF is better for other patients.
For either the cervical fusion or a disc replacement, a minimally invasive anterior approach is used to minimize tissue disruption while allowing access to the part of the neck which needs to be treated. This incision is made in a natural skin fold at the front of the neck, which, when healed, is virtually invisible in most patients. Furthermore, MISS utilizes smaller instruments along with the microscope which means the size of the surgical field or exposure is reduced. While MISS often focuses on the size of the incision, it’s really a larger concept of being minimally traumatic to the body, in this case, it’s the neck structures that matter.
Once the damaged disc is identified, it is removed and replaced with either a mechanical disc or with a bony stabilization implant and a small plate. With a CTDR, early movement is encouraged after surgery while with an ACDF motion is restricted until the fusion has occurred. Both of these MISS procedures have excellent outcomes in the right patients.
The advances in MISS techniques have given spine surgeons a new way to perform ACDF or a CTDR, and enable the surgery to be performed in an outpatient setting. After a postoperative period of recovery in the outpatient surgical center, patients are discharged home the same day of their surgery. The benefits of MISS cervical surgery are smaller incisions, less blood loss, lower risk of muscle and soft-tissue damage, lower risk of infection, reduced postoperative pain, reduced pain medication use and faster recovery. MISS cervical surgery, either a CTDR or an ACDF are typically safer, quicker, and promote a faster recovery than traditional cervical spine surgery.