Preserving Motion of the Cervical Spine with Surgery

If you’re suffering from neck and arm pain, arm numbness, and/or weakness due to a cervical spine condition, you may be considering surgery. Advances in spine surgery now afford options that preserve motion in the neck, helping to maintain quality of life, reduce long-term complications, and support better outcomes for many patients. Understanding the anatomy of the cervical spine, how it can become altered, and the possible surgical options are essential as you navigate this decision.

The cervical spine consists of seven vertebrae (C1–C7) that support the head and enable a wide range of motion, including turning, bending, and nodding. These vertebrae are separated by intervertebral discs that act as shock absorbers and allow the neck to remain flexible. Over time, conditions such as degenerative disc disease, herniated discs, and cervical spondylosis (age-related arthritis) can lead to nerve compression and cause significant pain and disability.

Why Preserve Motion?

For many years, the most common surgical treatment for these issues has been Anterior Cervical Discectomy and Fusion (ACDF), a procedure that removes the diseased disc, decompresses the nerves and spinal cord, and fuses the bones together to stabilize the spine. With greater than 70 years of excellent data, an ACDF is still one of the most successful procedures, in terms of relief of neck and arm pain and improvement in quality of life, performed in spine surgery and is still frequently the operation of choice. While effective in relieving nerve compression, fusion eliminates motion at the treated level and increases stress on adjacent levels as the body tries to compensate for that lost motion. These altered biomechanics may lead to Adjacent Segment Disease (ASD) - a condition where nearby spinal segments break down more quickly.

Types of Motion-Preserving Cervical Spine Surgeries

Modern techniques, such as Cervical Disc Replacement (also known as Cervical Arthroplasty), have aimed to minimize the potential downsides of loss of motion and possibly alter the course of adjacent segment disease. A disc replacement allows the surgeon to remove the damaged disc, decompress the nerves or spinal cord, and replace it with an artificial one that maintains motion. Evidence suggests that disc replacement not only preserves flexibility but may also result in less neck pain and a lower re-operation rate (Kaye ID, Hilibrand AH. Adjacent segment disease-background and update based on disc replacement data. Curr Rev Musculoskeletal Med. 2017;10(2):147-152.)

It should be noted that not all disc replacements are the same. Devices vary in material (metal, PEEK [plastic], and ceramic) and design, specifically in how much movement they allow. A constrained disc replacement limits motion to a more fixed range, which may provide greater stability, especially in patients with weaker neck muscles or borderline spinal alignment. Alternatively, an unconstrained disc replacement may more closely mimic the natural motion of the spine, allowing for greater flexibility but possibly increasing mechanical stress on the implant or surrounding structures. The choice of implant should be tailored to the individual patient to achieve the best outcomes.

Sometimes, surgery can be performed without implants at all. A Posterior Cervical Foraminotomy (performed through the back of the neck rather than the front) is a minimally invasive procedure that relieves pressure on the nerves by removing a small part of the bone and potentially small disc fragments, relieving the pressure on the spinal nerves. This technique, which is performed without any permanent hardware, preserves natural neck movement, may similarly prevent adjacent segment disease, and may be appropriate for specific patients depending on the nature of the stenosis (or nerve compression). But, by leaving the disc in place, there is an increased risk of re-herniation compared to disc replacement or fusion.

Benefits of Motion-Preserving Surgery

• Quicker recovery time
• Reduced pain and stiffness
• Improved range of motion in the neck
• Lower risk of problems in adjacent spinal segments compared to fusion

When is Motion-Preserving Surgery Right for You?

Motion preservation is not the right choice for everyone. Patients with spinal deformity, severe arthritis, poor bone quality, or other health concerns may benefit more from traditional fusion surgery. Moreover, even after 20 years of debate, it is still not settled whether Adjacent Segment Disease (one of the very problems we are trying to avoid by using a replacement vs. a fusion) is a consequence of surgery itself or more related to the natural history of spinal disease (not necessarily influenced by surgery at all). Ultimately, a spine surgeon can help determine the best approach based on your unique anatomy and overall health.

Conclusion

At Rothman Orthopaedics, our surgeons are nationally recognized leaders in motion-preserving spine surgery and are actively involved in clinical research to evaluate outcomes and refine techniques. If you’re considering cervical spine surgery, consult with a Rothman spine specialist to explore whether a motion-preserving approach is right for you.