Cervical Spine Surgery constitutes a significant portion of our
practice. We are pleased to share our information and experience with
some of the latest technologies, materials and advanced techniques that
have considerably enhanced
CERVICAL SPINE SURGERY.
In most cases these surgeries are now conducted on an OUT-PATIENT
BASIS. (For additional information and/or to determine who qualifies
for any of these procedures, please consult the
Cervical Spine Surgery
section on this website. A comprehensive Series of
Monographs relating to Cervical Spine Disease and the treatment options
is available to you in our
Downloads & Information
Section under Patient Education Library.)
For those patients with conditions that are amenable to a MINIMALLY
INVASIVE approach (such as has been described in
What is Minimally Invasive
and Endoscopic Neurosurgery?), we are pleased to offer this
alternative. The conditions that do lend themselves to this technique
include FAR LATERAL EXTRUDED Cervical Intervertebral Discs, FORAMENAL
STENOSIS secondary to CERVICAL FACET HYPERTROPHY (See Figures 1, 2 & 3
below), SPINAL STENOSIS secondary to HYPERTROPHIC LIGAMENTUM
FLAVUM as well as some
SPINAL CORD TUMORS.
Figure 1A (Left): Post-myelographic CT Scan
of C3 in a 34 year old Female to
demonstrate a markedly hypertrophic (overgrown) Left facet
(Arrows). The one on the opposite side is considered to be
Figure 1B (Right): Post-operative CT Scan
demonstrates the resection of the
We specialize in the reconstruction of the Cervical Spine for
complex and extensive problems such as high grade Spinal
Stenosis resulting from Calcified Posterior Longitudinal
Ligament/Large Bone Spurs as well as Cervical Bone Tumors and/or
Cervical Spine Instability. We can routinely remove and
replace entire vertebral bodies with highly advanced and
engineered materials such as with Medtronic's
Titanium "Pyramesh" Cage System.
We use the patient's own bone, harvested from the vertebral bone
that we remove, in order to fill the cage. This usually obviates any
requirement to obtain bone from any other area of the patient nor do
we generally need cadaver bone. The remarkable development of Bone
Morphogenic Protein (please see the explanation in the next paragraph)
has resulted in earlier, more extensive and stronger bone growth
through the cage.
We are pleased to also offer the very latest in Medtronic's
BIOREABSORBABLE CERVICAL SPINE "PLUGS" (or "SPACERS") for those
patients requiring an Anterior Cervical Spine Fusion operation. THESE
BIOABSORBABLE "PLUGS" ARE USED AS "SPACERS" BETWEEN EACH VERTEBRA TO
REPLACE THE DAMAGED DISC THAT HAS BEEN REMOVED. THIS DEVICE
MAINTAINS THE CRITICAL DISTANCE BETWEEN EACH VERTEBRA IN ORDER TO
SUSTAIN THE CRITICAL SIZE OF THE "WINDOW" (the Neural Foramen) THROUGH
WHICH EACH NERVE ROOT EXITS THE SPINAL CANAL. This "SPACER"
has a HOLLOW CENTER WHICH IS FILLED WITH THE PATIENT'S OWN BONE
THAT IS SAVED WHEN WE REMOVE THE PATIENT'S BONE SPURS AT THE TIME OF
OPERATION. THE "SPACER" WILL BE REPLACED BY THE PATIENT'S OWN BONE
OVER THE SEVERAL POST-OPERATIVE MONTHS. THE "SPACER" WILL DISAPPEAR
IN APPROXIMATELY 18 MONTHS WHEN IT TURNS TO WATER (AND CARBON
BONE MORPHOGENIC PROTEIN* (BMP) is a bone growth
accelerant that is also used within the "Spacer's" hollow center.
THE USE OF BMP HAS CONSIDERABLE ADVANTAGE IN ASSISTING THE PATIENT TO
GROW BONE FASTER RESULTING IN AN EARLIER AND STRONGER BONE UNION
(FUSION) WHICH IS ONE OF THE IMPORTANT GOALS OF THIS OPERATION. (Please
see *DISCLAIMER below.)
Among the latest advances in Cervical Spine surgery is
the adaptation of the bioreabsorbable materials for the Anterior
Internal Fixation devices. These plates and screws are
now available for 1 and 2 level operations in qualified patients;
strength is not adequate for multilevel procedures. Nevertheless, they
do offer the advantage (for the appropriate patient) for the plate
and screw to "disappear" in 18 months without having a permanent
implant. These devices are now available from several different
surgical equipment manufacturers including Inion and Medtronic
For more complex and extensive operations, it is important to
stabilize the spine with a special "internal fixation" device.
This is a "permanent" titanium plate placed on the front
(anterior) aspect of the cervical spine and held in position with
special titanium fixation screws placed into the cervical
vertebrae. We utilize the latest in Aesculap, Inc.
technology in the form of their Titanium ABC Plate and screw
One of these new CERVICAL SPINE "REPLACEMENT DISC"
devices, the Prestige® Artificial Disc distributed by
Medtronic Sofamor Danek,
became available in mid-July 2007. (Currently there are
several other similar technologies in a "clinical trial" phase
awaiting FDA approval and are available ONLY ON AN EXPERIMENTAL
BASIS.) For additional information about these devices, including
the indications for and contraindications to their use as well as
images of the devices, operative photos and x-rays of the devices in
place, please consult the
Cervical Spine Surgery
section (Paragraph "E") on this website.
The initial long term (now up to 9 years) follow-up for one such
device was reported at the American Association of Neurological
Surgeons Annual Meeting, San Francisco, April 2006. The report
identified certain important issues that are reviewed in more detail
in our documents on
Cervical Spine Disease.
Other scientific reports have since become available which further
document the potential usefulness of these technologies.
The Prestige® Artificial Disc has a history dating to 1991 and
has been extensively tested both at the "bench" and in patients.
Currently, it is the one device that most closely permits "normal"
motion of one cervical vertebra relative to its adjacent level at the
disc space. The CURRENT DESIGN RESTRICTS ITS USE TO ONLY ONE DISC
For additional information and/or to determine who qualifies for
any of these procedures, please consult the
Cervical Spine Surgery
section on this website or
CONTACT OUR OFFICE.
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This page last edited on 2/22