Neck and Arm Pain: Do I Need Surgery?

Neck pain associated with arm numbness and pain (cervical radiculopathy) are a common reason a patient seeks help. Many times this neck and arm pain can also accompany weakness or difficulty manipulating the fingers to do common tasks, such as buttoning a shirt. Most patients see significant improvement through nonsurgical methods including medications, physical therapy, targeted pain injections and time. However, when these do not improve symptoms, surgery may need to be considered.

Today modern techniques allow us to perform many spine surgeries with minimally invasive methods. MIS means smaller incisions, less operating time and lower risk of blood loss, infection and nerve damage. This is especially true for cervical spine surgeries.

Two types of cervical spine procedures we perform we perform are a minimally invasive anterior cervical discectomy with fusion (ACDF) and a cervical discectomy with disc replacement. Both procedures begin in the same way, by making a small incision and carefully dissecting down to the spine. The injured intervertebral disc is them meticulously removed, to relieve pressure on the spinal cord/nerves. In a fusion, this space is then filled with a bone graft and secured with a small metal plate and screws. Over time, the two vertebrae grow together resulting in a fusion. In a disc replacement, a specially designed implant is secured between the two vertebrae to maintain the natural motion of the cervical spine.

While both procedures produce similar improvements in neck and subsequent arm pain, they differ in a few key ways. A cervical disc replacement presents a shorter recovery period and most patients wear a soft cervical collar for about 2 weeks post-op. On average, patients are able to return to work, with some restrictions, within 40 days of surgery. This is usually 20 days sooner than patients undergo a fusion surgery. In addition to a more rapid return to work, most patients only require post-op restrictions for 6-8 weeks to allow for soft tissue healing. In comparison, patients who have a fusion surgery are required to wear a rigid cervical collar for approximately 6 weeks. It may take 3-5 months for the bones to complete a solid fusion.

There are distinct advantages to cervical disc replacement. Preserving motion should reduce the likelihood of degeneration of adjacent spinal levels, a common drawback to fusion surgery. However, in some cases, cervical fusion is preferred for patients with cervical spine instability, significant degenerative disc disease, or those requiring surgery on more than two segments.

We aim to provide patients with the information they need to make an informed decision regarding fusion versus disc replacement. If cervical spine surgery has been recommended for your situation, I am happy to review your case, to provide a second opinion. I have extensive experience with cervical disc replacement surgery, utilizing different implants, and I have presented my own original research findings at multiple international spine conferences. It is also helpful to view the procedures — cervical fusion, cervical disc replacement implants, etc.