Cervical Herniated Disk

A cervical herniated disc is also called cervical spondylitic myelopathy. The presenting symptoms of a herniated disc in the neck are often pain that radiates down the arm in a specific nerve root distribution. Each nerve has a different set of fingers and muscles which it controls. Symptoms of spinal cord or nerve root compression include: 

• Awkward, incoordination, or stumbling gate
• Difficulty with fine motor skills or dexterity in the hands
• Tingling or electric shock type feelings down into the legs or the back of the spine, particularly with neck extension (Looking up towards the ceiling)

Dr. McAfee trained with Robbie Robinson at Johns Hopkins Hospital. In fact, Dr. McAfee inherited Dr. Robinson's neck and his cervical clinical practice after Robbie Robinson passed away. Dr. Robbie Robinson was the father of cervical spine surgery, having trained 13 of the 22 Founding members of the International Cervical Spine Research Society (CSRS).

Patients present with numbness down the arms, loss of dexterity in the fingers, weakness in the biceps, triceps, or intrinsic muscles. A common symptom is if you extend your neck or look upwards this can often reproduce the electric shock or numbness feeling down into the arms or legs.

After an evaluation and a careful neurologic examination by Dr. McAfee, an MRI or magnetic resonance imaging study is performed. This localizes the size of the disc rupture and the location of the disc rupture. Often the nerves and spinal cord are compressed by both disk tissue as well as bone spurs. Anything touching the nerve or causing inflammation will be removed at surgery.

In our experience, 90% of patients presenting with these symptoms can be treated by conservative non-operative measures. These include anti-inflammatory medications, physical therapy, steroid injections, facet joint blocks, pilates, yoga, and acupuncture. It is only after a failure of conservative measures that Dr. McAfee would consider a surgical decompression would be indicated.

Dr. McAfee also performs over 400 operations a year over the past 30 years for a total of 12,000 procedures. The most common operation that Dr. McAfee performs is an anterior cervical decompression. If the pressure on the nerve or the spinal cord is severe that Dr. McAfee performs a decompression from the front of the neck before there is permanent nerve damage.

The best results are obtained with an incision on the front of the neck because the offending disc material can be pulled anteriorly away from the spinal cord where it relieves the spinal cord blood supply. Furthermore, we almost usually perform the approaches on the left side of the neck, to prevent injury to the nerve to the vocal cords.

The length of the surgery is less than one hour. It is performed under general anesthesia. The surgery is performed using spinal cord monitoring. This means that five times a second, electrical stimulation is performed along the nerves in the hands and the feet. The nerve signals are recorded from the scalp or head. This allows specialized technicians on our team to continuously monitor the function of the nerves along the spinal cord. The electrical signals of the motor and sensory nerves along the spinal cord return to normal electrical conduction after Dr. McAfee finishes the successful anterior neurologic decompression. At this point, either a spacer, a fusion, or a disk replacement is performed to restore the stability of the neck.

A typical patient is shown in the picture above. The preoperative MRI or magnetic resonance imaging study shows end-stage spinal cord compression. The spinal cord is supposed to be an oval or rounded shape in the transverse plane. If there is a large ruptured disc or a large bone spur then this causes the spinal cord to become misshapen often with an indentation in the center, exactly what is shown above.

The postoperative pictures show that the offending disc material has been removed, the patient has experienced a full neurologic recovery, the patient is able to walk normally, the patient has normal coordination, the patient had recovery of her finger movement, and her arm strength. Within three weeks of surgery, she could walk normally, return to driving her car and start going to physical therapy to build up the muscles in her neck.

The most gratifying operation any surgeon can perform is removal of a ruptured herniated disc in the neck. This is because the results are so predictable and so rewarding.

A bulging or herniated disc involving the C5 and the C6 nerve roots often cause pain in the neck arms hands or shoulders. They also cause pins and needles or tingling in the neck, arms, hands, or shoulders. They can often cause weakness of the triceps muscle or muscle spasms along the biceps or forearm muscles. The most common area to notice numbness or pain is in the thumb the index finger in the first dorsal webspace parentheses skin between the thumb and index finger and the parentheses. These symptoms often improve within the first several days following anterior cervical decompression and fusion.

Dr. McAfee and his colleagues have presented over 100 peer-reviewed papers at national meetings. The largest experience of patients with successful results occur with inserting Coalition spacer after performing the nerve decompression. A comparison was made between traditional treatment with an anterior cervical plate and allograft 93.3% of this group did not require reoperation. In other words, 851/912 patients with allograft and an anterior cervical plate did not require reoperation two years after the surgery. Dr. McAfee's results with Coalition were even better - 98% successful. About 451/460 patients two years after surgery had successful results, had a full neurologic recovery and did not require reoperation or medication. This was statistically a superior result.

Coalition is an integrated disk spacer with screws that compress the bone of the cervical spine against the reconstructed anterior column of the spine. This means that the spine is very stable, the patient can perform normal activities and start walking immediately after the surgery. It means the patient can usually start physical therapy two days after the surgery. The patient's symptom relief is permanent and once the fusion becomes solid, the symptoms cannot reoccur at the operated levels. We have been able to reduce the time the patients require a cervical neck brace. We usually do not want the patients to participate in heavy activities with impact such as skydiving, horseback riding, skiing, or sports activities requiring a helmet for a total of 6 to 8 weeks after the surgery.

The very gratifying thing about neck surgery is that patients can have a normal life after they recover neurologic function. Patients can have up to four levels of the cervical spine fused and still demonstrate a nearly normal cervical spine range of motion. The other levels of the cervical spine improve in their mobility after neck surgery provided it is performed using something like a Coalition spacer.

With traditional cervical spine surgery using a plate very often the level next to the operated level becomes degenerated and requires surgery. This is not true with the surgery performed by Dr. McAfee with the cervical Coalition spacer. The other big improvement with the Coalition spacer, because it does not require the use of a plate, is that the patient will have a much lower incidence of swallowing difficulties. Very often patients with traditional neck surgery utilizing screws and an anterior plate complain of trouble swallowing because the plate actually takes up space that the throat actually needs. Furthermore, there can be inflammation due to the plate because the throat normally moves up and down in front of the spine with swallowing.

The most important determinant of success is that the patient develops a good neurologic recovery. Secondary factors are faster return to work, return to driving, and return to sports activities. Dr. McAfee and his colleagues have been successfully performing the surgery for more than 30 years 400 operations per year for a total of 12,000 patients. 

Dr. McAfee is happy to answer any additional questions in person in an office appointment.