Cervical surgery

Question 1

Cervical spine disc

Answer 1

• more cescent shaped
• nucleus becomes more fibrotic and can break into fragments
• more vulerable to rotation stresses than L/S

Question 2

Degeneration in the C/S indications and reasons for surgery

Answer 2

• degenerative cascade is the same
• degenerative disc and joint disease
• primary indications = pain and progressive muscle weakness
• lower C/S vertebrae are less flexiable in flexion meaning that they reach end range quicker

Question 3

common types of cervical surgeries

Answer 3

• discectomy
• discectomy with instrucmented fusion
• disc arthroplasty

Question 4

Discectomy

Answer 4

• removal of portion of the disc
• usually anterior approach

Question 5

Anterior cervical fusion

Answer 5

• placed anteriorly over bodies with a bone graft
• must move trachea, esophagus, and deep neck flexors
• adjacent sites increase degenerative processes

Question 6

Cervical cage fusion

Answer 6

• acts as a spacer
• take out the disc
• bone graft causes a physiologic fusion

Question 7

Cervical stand alone cage

Answer 7

• if fusion doesnt take = puts pressure on hardware and can accelerate degeneration of other segments
• bone graft inside cage designed to stand alone
• will be immobilized

Question 8

bryan cervical disc prothesis

Answer 8

• early generation arthroplasty type
• polyurithan disc filled with saline for shock absorption
• area for bone to grow into
• allows some motion to decrease the acceleration of degeneration above and below
• bony healing and will likely be immobilized

Question 9

Medtronics cervical disc prothesis

Answer 9

• some areas for bony growth
• allows for early mobility = 1 bony healing
• convexity and concavity

Question 10

Zimmer mobi-c cervical disc prothesis

Answer 10

• cobalt crome
• keels going into body
• porous for bony growth
• plastic disc
• allows disc tomove provides more physiological like motion
• lining similar to THA

Question 11

Simplify cervical disc arthroplasty

Answer 11

• ceramic disc = glass
• provides more normal movement
• metal on plastic can cause debride in which body will attack prothesis

Question 12

Anterior microforamenotomy

Answer 12

• newer procedures
• tries to keep things as normal as possibel
• take out only what is needed

Question 13

Surgical considerations

discectomy

Answer 13

• potential disc space collapse = take out too much
• not enough taken out = doesnt solve problem

Question 15

Surgical considerations

discectomy with fusion

complications

Answer 15

• donor site morbidity: bone graft = separate incision
• autograft vs alllograft
• nonunion risks of this = smoking, DM,
• Infection = risk with obesity
• adjacent site degeneration

Question 16

Surgical considerations

cervical fusion with cage only

Answer 16

• fusion healing
• longer immobilization
• adjacent site degeneration

Question 17

Surgical considerations

cervical fusion with cage and plate

Answer 17

• earlier motion
• adjacent site degenration

Question 18

Surgical considerations

disc arthroplasty

Answer 18

• lossening
• life expectancy
• due to movement occuring at facets = still at risk of degeneration = facet arthritis
• long term studies are just coming out

Question 19

Surgical considerations

anterior microforamenotomy

Answer 19

• enough surgery

Question 20

rehabd consideration with

1. discectomy
2. fusion including cage
3. plated fusion
4. arthroplasty

Answer 20

1. soft tissue healing 3-6 weeks
2. rigid immobilization 8 weeks
3. less rigid immobilization 4-6 weeks
4. prodisc-bony ingrowth = 6-8 weeks/medtronic potentially immediate

need to understand procedure to know how to treat, communicate with surgeon