Monday Medical: Pinched nerve — surgical options
For Steamboat Pilot & Today
Editor’s Note: This is Part 2 in a two-part series on diagnosing and treating pinched nerves in the neck. Part one covers conservative treatment options.
Most people who experience a pinched nerve in their neck can find relief with conservative treatments, such as physical therapy. But for about 3% of patients, a surgical fix is needed.
Below, Dr. Clint Devin, an orthopedic spine surgeon in Steamboat Springs and a member of the medical staff at UCHealth Yampa Valley Medical Center, outlines how to know if a pinched nerve may require surgery and how surgical options stack up.
The main sign that surgery may be the best solution is muscle weakness.
“In the absence of weakness, you can try various conservative treatments,” Devin said. “But if you have weakness that is worsening, surgery is often necessary. If the condition is left unchecked, you can end up with an irreversible deficit.”
In cases where a patient does not have muscle weakness, conservative treatments are usually tried for two or three months. After that, if pain has not improved or a patient is having trouble sleeping or working, surgery might also be considered.
Selecting a procedure
With each procedure, Devin has three goals. “First, we’re trying to do a good, thorough job of decompressing the nerve,” Devin said. “Second, we’re trying to do that in the least invasive way possible. And third, we want a solution that’s durable and that will last as long as possible.”
Surgical option 1: Cervical posterior foraminotomy
In this procedure, the surgeon goes in through the back of the neck and uses microscopic instruments to create a small opening where the nerve root exits the spinal cord, giving the nerve more space and relieving pressure. This option is often best for patients who only experience shoulder blade and arm pain.
“You tend not to lose a lot of motion with this procedure, and it has a quicker recovery than other procedures, without as many restrictions,” Devin said. “It’s also very predictable. Ninety percent of people are happy they did it and would do it again when asked one year later.”
Surgical option 2: Anterior cervical disc replacement
In this option, the spinal disc that’s creating the issue is removed, and the space between the vertebrae is filled with a disc replacement. This procedure can help patients primarily experiencing neck pain, who do not have arthritis in their joints.
By replacing a disc, patients maintain motion in their neck. This procedure also has a 90% success rate.
“We’re unique in that we really try to utilize foraminotomy and cervical disc replacements when possible, as those are both motion-preserving,” Devin said. “I’ve done a lot of these and, so, am able to employ these technically more challenging procedures.”
Surgical option 3: Anterior cervical discectomy and fusion
In this procedure, the surgeon goes through the front of the neck to remove the damaged disc and any bone spurs, relieving pressure on the nerves. The space is then filled with a piece of bone graft or synthetic device, so the remaining vertebrae can grow together or fuse. Patients who experience neck pain and who also have arthritis may benefit most from this procedure.
An individualized approach
“It’s important to tailor each procedure and treatment plan for the patient, based on symptoms, imaging and more,” Devin said. “You can’t just use the same procedure for everyone.”
Devin tracks patient’s satisfaction rates with each surgery — and the results are positive.
“We’re trying to be very transparent about the quality of care provided, and we are far outperforming the national benchmarks in terms of quality and safety,” Devin said. “With cervical surgery, people can go on and live healthy, happy productive lives. It doesn’t create long-term limitations.”
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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