Cervical Radiculopathy - ACDF

Cervical radiculopathy is a condition that results when a nerve is pinched or irritated as it leaves the spine in the neck.  Nerves from the spinal cord exit at various levels from the spinal column and travel throughout the body.  With cervical radiculopathy, the nerves are affected at the spine, but the symptoms may be felt in places where the nerves travel.   Spine conditions, such as a herniated disc or bone spur, can cause cervical radiculopathy.  Cervical radiculopathy is treated with non-surgical and surgical methods.

The cervical spine is located in the neck.  Your cervical spine supports your head and connects it to your trunk.  The cervical spine supports less weight than any other portion of the spine.  It also has the greatest amount of mobility and flexibility.  Your neck can bend forward and backward, tilt from side to side, and can turn or rotate to the right and left.
 
Seven small vertebrae make up the cervical area of your spine.  The back part of the vertebra arches to form the lamina.  The lamina creates a roof-like cover over the back of the opening in each vertebra.  The opening in the center of each vertebra forms the spinal canal. 

 

Intervertebral discs are located between the vertebrae in the cervical spine.  The discs are made up of strong connective tissue.  Their tough outer layer is called the annulus fibrosus.  Their gel-like center is called the nucleus pulposus.  The discs and two small spinal facet joints connect one vertebra to the next.  The discs and joints allow movement and provide stability.  The discs also act as a shock-absorbing cushion to protect the cervical vertebrae.

 

The top section of the cervical spinal canal is very spacious.  It allows more room for the spinal cord than any other part of the vertebral column.  The extra space helps to prevent pressure on the spinal cord when you move your neck.
 
Your spinal cord, spinal nerves, and arteries that supply blood travel through the protective cervical spinal canal.  The spinal cord segments in the neck are indicated as C1-C8.  Nerves exit the spine at different levels.  Nerves at this level supply the shoulders, arms, and hands.

Cervical radiculopathy results when the nerves leaving the spinal cord at the neck are pinched or compressed as they exit the spine.  Herniated discs, degenerative disc disease, bone spurs, and spinal stenosis are common causes of cervical radiculopathy.  A herniated disc occurs when the outer disc layer ruptures and the contents come out of the disc.  If the contents extend into the spinal canal, it can put pressure on the spinal nerves.  Degenerative disc disease is a condition that causes the intervertebral discs in the spine to deteriorate or break down.  As the disc deteriorates, the vertebrae may thicken and extend into the spinal canal.  Bone spurs, abnormal bone overgrowths caused by osteoarthritis, can grow into the spinal canal or nerve root openings on the vertebrae.  Bone spurs can contribute to a condition in which the spinal canal is narrowed, called spinal stenosis.  The narrowed canal causes pressure on the spinal cord and nerves, resulting in pain and nerve dysfunction.  

There are several factors which may increase the risk of cervical radiculopathy, including:

_____ People that are middle aged and older may experience age-related changes in the spine 
_____ Osteophytes or bone spurs
_____ “Wear and tear” or trauma may affect spinal structures
_____ People with herniated cervical disc, spinal stenosis, and degenerative disc disease 

Your doctor can diagnosis cervical radiculopathy after reviewing your medical history, conducting an examination, and considering the results of medical imaging tests.  You should tell your doctor about your symptoms, risk factors, and functional problems, such as difficulty getting dressed or performing household tasks.  Your doctor will check your muscle reflexes, tone, strength, coordination, and range of motion.  Your sense of touch and temperature will be tested.

 

Your doctor will order X-rays to see the condition of the vertebrae in your cervical spine.  Sometimes doctors inject dye into the spinal column to enhance the X-ray images in a procedure called a myelogram.  A myelogram can indicate if there is pressure on your spinal cord or nerves from herniated discs, bone spurs, or tumors.

 

Your doctor may order computed tomography (CT) scans or magnetic resonance imaging (MRI) scans to get a better view of your spinal structures.  CT scans provide a view in layers, like the slices that make up a loaf of bread.  The CT scan shows the shape and size of your spinal canal and the structures in and around it.  The MRI scan is very sensitive.  It provides the most detailed images of the discs, ligaments, spinal cord, nerve roots, or tumors.  X-rays, myelograms, CT scans, and MRI scans are painless procedures and simply require that you remain motionless while a camera takes the pictures.

The goal of surgery is to eliminate pressure on the spinal nerves, stabilize the spine, relieve symptoms, prevent further injury, and restore function and movement.  Anterior cervical decompression and  fusion (ACDF) surgery is commonly used to treat cervical radiculopathy.

 

You will require anesthesia for your surgery.  ACDF surgery is performed through an incision at the front of the neck.  Your surgeon will make an incision approximately two inches long carefully avoiding your throat and airway.  Your muscles and arteries will be moved aside with care to allow access to the vertebrae.  Your surgeon will remove abnormal disc and bone structures.

 

Next, the surgeon places a bone graft or interbody fusion cage to support the cervical spine and promote healing.  Surgical hardware including plates and screws may be used.  The surgical hardware secures the vertebrae together and allows the bone grafts to heal, fusing  the vertebrae.

 

At the completion of your ACDF surgery, your surgeon will close your incision with stitches.  You will receive pain medication immediately following your surgery.  You will wear a neck brace or collar while your fusion heals. 

 

You should expect to stay overnight in the hospital.  You may need some help from another person during the first few days or weeks at home.  If you do not have family members or friends nearby, talk to your doctor about possible alternative arrangements.

In some cases, cervical radiculopathy can be treated with rest, anti-inflammatory medication, and physical therapy.  Stretching, exercises, and pain relief modalities may help relieve your symtpoms.  A cervical collar may be worn for support.  Surgery may be necessary if other treatments fail. 

Following surgery, your doctor will initially restrict your activities and body positioning.  You should avoid lifting, housework, and yard-work until your doctor gives you the okay to do so.  You will wear a neck brace for support.  You will gradually increase your activity level.  Once your neck has healed, physical therapists will teach you flexibility and strengthening exercises.  You will also learn proper body mechanics for you to use when you stand, sit, and lift objects.
 
The recovery process is different for everyone.  It depends on the particulars of your surgery and the extent of your condition.  Your surgeon will let you know what to expect.  Generally, the recovery time for ACDF is several weeks.  Your arm pain should go away fairly quickly, however, it may take weeks to months for your arm weakness and numbness to resolve.

It is important to receive prompt attention for cervical radiculopathy.  Untreated conditions may progress and cause further injury.  Advanced cervical radiculopathy can cause muscle wasting, and the symptoms may affect the legs.
  
 
It is important to adhere to your restrictions and exercise program when you return home.  You should use proper body mechanics during all activities.  Do not smoke.  Smoking increases the risk of surgical complications and may hinder the bone from fusing.  If you have difficulty quitting smoking on your own, ask your doctor about medications and resources that may help you.