Cervical Brochure

Introduction
Neck pain is the price human beings pay for prolonged sitting, repeated bending, whip lash, and other injuries from high-speed traveling accidents. It is providing the United States with an economic headache.

Approximately 85 percent of inhabitants of the Western world are afflicted with some degree of neck pain at some point in their lives. About 15 percent of our population has been incapacitated for two weeks or more, and approximately 3 million people have permanent disability.

In most cases, simple treatments, such as cervical collars, heat, physiotherapy, rest, traction, exercise, and pain medication bring relief. But many sufferers are not so fortunate. If one or more of their vertebral discs ruptures and presses on the nerve roots, the pain radiating from the neck and down the arms can be incapacitating and results in a severe headache.

For many, the only treatment is the surgical removal of part of the herniated disc, a major traumatic operation that requires general anesthesia, the dissection of muscle, removal of bone, and bone fusion. Often, the increased stress from a fusion procedure on adjacent vertebral levels can cause a second herniation.

Now there is a less traumatic procedure for some patients with disc problems known as microdecompressive endoscopic cervical discectomy with laser application, which is an outpatient procedure.

What is Microdecompressive Cervical Discectomy with Laser Application?
Microdecompressive Endoscopic Cervical Discectomy with Laser Application is an outpatient procedure to shrink and remove a portion of the herniated disc. Using local, or in some cases, brief general anesthesia with the help of x-rays and endoscope for guidance, specially designed micro-instruments (a discectome and a laser probe) are inserted into the disc space. A portion of the offending disc is removed with suction and then shrunk with a laser, instead of open surgery.

Microdecompressive cervical discectomy is different from standard cervical disc surgery because there is no muscle dissection, bone removal, bone fusion, or large incision. Therefore, most complications that occur with conventional surgery are eliminated with this procedure.

Who Should Consider This Procedure? This procedure is specifically designed for patients with uncomplicated, herniated discs accompanied by the following:

Pain radiating from the neck downward to the arm

1. Symptoms including severe headache, tingling, numbness, and findings of muscle weakness, and sensory loss
2. A positive CT or MRI scan for disc herniation
3. No improvement of symptoms after six to eight weeks of conservative therapy
4. Positive electromyogram (EMG) study is helpful
5. Positive provocative discogram

The procedure is not designed for:

1. Patients with evidence of acute or progressive degenerative spinal cord diseases
2. Evidence of advanced spondylosis (significant bony spurs blocking the anterior disc space) with disc space narrowing, diffuse annular bulging and other spine irregularities
3. Evidence of significant spinal stenosis
4. Evidence of a large extruded disc or a migrating free fragment
5. Existence of other pathologies or conditions such as fractures, tumors, or active infections
6. Neurological or vascular pathologies mimicking a herniated disc

Other surgical procedures including micro-surgery and fusion might be used for those patients who cannot have this Microdecompressive procedure. Only patients with clinical abnormalities confirmed by physical examination, x-rays and tests are considered for this endoscopic procedure. Testing is done prior to the procedure.

The Procedure
The procedure is performed under local anesthesia with sedation or in some cases, under brief general anesthesia with the patient in a supine position. A small needle is inserted into the disc.

Over this probe, a slightly larger sleeve is inserted to permit a 2mm incision to be made in the disc itself. Using x-ray guidance, the micro-instruments (forceps, curettes, trephines, rasps, burrs, and cutters), the discectome (a hollow probe with a cutting tublar blade inside), and the laser probe are inserted into the disc space through the sleeve. Very small pieces of the disc material are removed and suctioned. The laser further shrinks the disc. The procedure takes about 30 minutes for each disc, on average. X-ray exposure is minimal.

The amount of disc removed varies, however the supporting structure of the disc is not affected. Upon completion the needle is removed and a small Band-Aid is applied to the needle incision.

Postoperative Course
The patient could feel relief from pain immediately following the procedure. Walking and light exercising are usually encouraged the day after surgery. Some patients experience muscle spasms that can generally be relieved with mild analgesics.

Pain in the area of the operation is usually minimal and requires little or no medication. The day after discharge, a daily exercise program is recommended and there is a re-evaluation several days later. Little, if any, postoperative medication is required for most patients. Normal activities can usually be resumed at the doctor's discretion within a couple of weeks.

Advantages
There are numerous advantages to microdecompressive endoscopic cervical discectomy compared to open spinal surgery. Patients who have large free fragments of disc in the spinal canal, as determined by the x-ray, might not benefit from this procedure. However, the laser can shrink the bulging disc further for disc decompression. Some advantages are:

1. The patient experiences much less tissue trauma when compared to an open surgical procedure.
2. Hospitalization is not required since it is an outpatient procedure.
3. Faster recovery since it is an outpatient procedure.
4. Minimal to no scarring in and around the nerves post operatively.
5. Earlier return to work and to daily activities.
6. Patients can begin an exercise program the day after surgery.
7. We estimate the cost of endoscopic surgery is 40% less than conventional spine surgery.

It is essential to understand that not all patients are relieved of their pain with this procedure. Approximately 90 percent of patients with 1-2 herniated discs will experience pain relief. Patients who do not obtain relief may still be candidates for future open micro-cervical disc removal.

Summary
Microdecompressive cervical discectomy with laser application requires no hospitalization, usually allows for earlier return to work and earlier return to previous daily activities when compared to open surgery. Rare patient complications include: mild cervical muscle spasms and transient pain. A small percentage of patients do not get relief of symptoms. Patients who initially have obtained good results usually remain pain free. This procedure does not prevent or preclude any future spine surgery including fusion, if necessary.

If you have any questions concerning this procedure, please feel free to further discuss them with us.