What’s Behind Your Neck Pain: Case Severity and Surgical Options
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What’s Behind Your Neck Pain: Case Severity and Surgical Options

By Dr. Alok Sharan
Aug. 29, 2022

Because of neck pain, disability-adjusted life years “lost” (DALYs) across the globe increased 41 percent in the 20 years between 1990 and 2010 — from 23.9 million years to 33.6 million years. DALY is the sum of years of potential life lost due to premature death or years of productive life lost due to disability compared to standard life expectancy, according to the Institute for Health Metrics and Evaluation’s Global Burden of Disease study.

In fact, out of all 291 conditions researched in the 2010 study, neck pain ranked No. 4 in terms of measured-years of healthy life lost due to disability.

As neck pain turns into very severe cases or chronic disability in many communities across the United States, Anterior Cervical Discectomy and Fusion (ACDF) outpatient surgery is increasingly being recognized by individuals and aging populations as one of the best solutions to their problems. The 2010 study states that 30 percent of patients with neck pain will develop chronic symptoms, and 37 percent will report persistent problems for at least 12 months.

In chronic conditions, this pain may eventually stabilize or fluctuate back and forth. And in most cases, unfortunately it recurs frequently over the long term.

Environmental and Risk Factors to Consider

Neck pain shares some risk factors with other musculoskeletal conditions, like genetics, psychopathology, sleep disorders, smoking, and being sedentary. You’re more likely to get neck pain if you have a history of it; if you’ve had a traumatic brain injury, head injury, or whiplash; or if you’ve ever hurt yourself playing sports (wrestling, ice hockey, football, or other intense games). In some studies, office workers, manual laborers, and health care workers have a higher incidence of neck pain due to low job satisfaction and a poor work environment.

There are two kinds of neck pain: sudden and chronic. Millions of Americans tolerate it every day, but it can also be frustrating for so many others who are in the chronic or severe stages. There are varying degrees. In general, the neck pain population can have some serious causes behind it. There are actually times when neck pain starts in another part of the body.

Anatomically speaking (starting at your back), your neck contains the spine; and at the front, your air pipe. Beyond that, your neck is mostly muscle, blood vessels, and nerves.

Some types of neck pain aren’t serious, but others need medical attention right away. In addition to trauma, such as a car accident, there are medical reasons (like osteoporosis) that can cause neck pain. Neck pain has a lot of common causes that aren’t serious. A strain or sprain, poor posture, or too much sitting can cause it. Neck pain can also be caused by long-term bone and spine problems. Or you can get neck pain after an injury — including chest pain or a fever in the process — and it can persist or get worse even if you take over-the-counter or home remedies, depending on the situation at hand.

Here’s where the rubber meets the road: You should see a doctor if you have long-term or severe neck pain.

ACDF Surgery: When Should You Have it?

Patients with degeneration or bone spurs in the cervical (neck) spine, or those having herniated discs, might need a minimally invasive cervical discectomy and fusion.

The spinal cord and nerves can get cramped and pressured under these conditions, which means they can be compressed even more and further injured. Medications and physical therapy may be recommended before surgery. In many cases, surgery is the best way to treat a damaged spinal cord, especially if non-operative treatment doesn’t work.

Any surgery comes with risks. However, it’s usually pretty low. A surgeon can explain these factors, as well as the overwhelming, evidence-based, positive benefits of the procedure.

What’s Involved in ACDF Surgery?

A minimally invasive cervical discectomy and fusion involves cutting out the disc from the neck (cervical) to the low back (lumbar). Surgery is done from the front of the spine (anterior) through the throat. The disc and bony vertebrae are exposed by moving neck muscles, trachea, and esophagus. Because the disc can be reached from the front (anterior) rather than the back (posterior), surgery from the front is more accessible. It may be necessary to remove one disc (single-level) or more (multi-level) depending on your symptoms.

Discs are removed, so the space between the bony vertebrae is empty. Spacer bone grafts fill the open disc space to keep the vertebrae from collapsing. To fuse two vertebrae, the graft serves as a bridge. Metal plates and screws hold the bone graft and vertebrae in place. Once the graft is in place, the body starts healing itself naturally. It can take 3 – 6 months for the bone graft to connect the two vertebrae. Surgical fusion works in the same way reinforced concrete works on a construction project.

There are many ways to obtain bone grafts, and there are pros and cons to each:

  • Autograft bone comes from your body. Bone cells are taken from the hip (iliac crest). Due to its bone-growing cells and proteins, this graft has a higher rate of fusion. You’ll feel pain in your hipbone after surgery. About half an inch of bone is harvested — not the entire thickness, just the top layer — during your neck/spine surgery.
  • Allograft bone comes from a donor (cadaver). When someone dies, bone is sometimes collected from the body for donation purposes. Despite the fact this graft does not contain bone-growing cells or proteins, it is readily available and eliminates the need to harvest bone from your hip.
  • Artificial bone graft substitutes are made from plastic, ceramic, or biodegradable materials. During surgery, this graft material is filled with shavings of living bone taken from your spine.

What to Expect After Surgery

You might lose some range of motion after the surgical fusion, but it depends on how mobile your neck was before surgery and how many levels you got fused. Your range of motion may be the same or even better if only one level is fused. Turning your head, or looking up and down, may be limited if more than two levels are fused.

Alternatives to fusion include motion-preserving artificial discs. It’s like a knee replacement, but it preserves motion — whereas fusion does not preserve motion. Compared with ACDF, artificial discs have similar results, but long-term results aren’t proven for motion preservation. At the very least, consult your surgeon.

The good news: With today’s modern procedures and technology, minimally invasive ACDF outpatient surgery for your neck (much shorter and less intensive) is within reach. Awake Spinal Fusion can provide answers to your treatment, surgical, and neck pain questions. Empower yourself with the right information and advice to do what’s right for your neck and spine.