Cervical spondylosis is a chronic degenerative process. Degenerative disease of the cervical spine is a common cause of locomotor disability in patients over the age of 50 years. Cervical spondylosis results from progressive biomechanical stress and strain and can be compounded by repetitive trauma. It involves disc degeneration and is accompanied by facet joint osteoarthritis and ossification of posterior longitudinal ligament. There is gradual decrease in viscoelasticity of the nucleus pulposus and reduction in disc volume and height.
There are various operative procedures for treating the degenerative disease of cervical spine.Various types of neurosurgical procedures can be grouped widely into two categories : Anterior and Posterior approaches.
The anterior approaches for cervical spine surgery are
1. Anterior cervical discoidectomy ( or discectomy)
2. Anterior cervical discoidectomy with grafting [autograft/ allograft ( disc prosthesis)]
3. Anterior cervical discoidectomy with grafting and plating
4. Anterior cervical corpectomy with adjacent discoidectomy with cage graft and fixation with plating
The relevance of any of these procedures is debatable. However, there is no question about the significance of learning the surgical technique of anterior cervical discoidectomy. All neurosurgeons should know the anterior approach of surgery of degenerative disease of spine. It is easy and direct.
This procedure is performed under general anesthesia with patient in supine position and cervical spine in the neutral or very minimally extended position. Hyperextension of the neck is avoided because during surgery greater force is required to retract the tracheal and esophagus. A vertical incision along the medial border of the sternocleidomastoid on the right side is usually preferred by many neurosurgeons. Theoretically there is risk of damage to recurrent laryngeal nerve on right side but actually there is minimal risk because this nerve runs in tracheoesophageal groove. Some prefer midline horizontal incision.
After skin incision, platysma muscle is cut , then investing layer of fascia is cut and sternocleidomastoid muscle and carotid sheath is retracted laterally and trachea and esophagus is retracted medially with the Cloward retractor. Then, vertebral body is felt and prevertebral fascia is cut and retractor is applied between longus colli muscle on the anterior aspect of vertebral body. level of the disc is confirmed and discoidectomy is performed.
Closure of the surgical wound is done only in two layers- one layer of Platysma and subcutaneous tissue and then skin is closed.
So, for every neurosurgeon who wishes to specialize in spinal neurosurgery it is must to learn anterior cervical discoidectomy.
For a single level degenerative cervical disc PIVD , anterior cervical discoidectomy may be sufficient. There is lot of evidence in support of various additional procedures like Anterior cervical discoidectomy(ACD) with grafting, ACD with grafting and plating, ACD with artificial disc ( disc prosthesis), Corpectomy with adjacent discoidecomy with grafting with Plate and Screw fixation, or cage with graft with plate and screw fixation. In traumatic cervical disc prolapse fixation is advisable.
Anterior cervical discectomy with fusion ( ADCF) is regarded as the gold standard for treatment of cervical disc disease.
The anterior approaches came into practice in 1950s. Bailey & Badgley performed first anterior stabilization of the cervical spine in 1952. In 1955 Robinson and Smith described their method to stabilize cervical spine disc disease using iliac bone graft.
Cloward published his technique of anterior cervical discectomy.
The Posterior approaches for cervical spine surgery are
Laminectomy
Laminoplasty
These approaches are more suitable multisegmental cervical spondylosis.
There are various operative procedures for treating the degenerative disease of cervical spine.Various types of neurosurgical procedures can be grouped widely into two categories : Anterior and Posterior approaches.
The anterior approaches for cervical spine surgery are
1. Anterior cervical discoidectomy ( or discectomy)
2. Anterior cervical discoidectomy with grafting [autograft/ allograft ( disc prosthesis)]
3. Anterior cervical discoidectomy with grafting and plating
4. Anterior cervical corpectomy with adjacent discoidectomy with cage graft and fixation with plating
The relevance of any of these procedures is debatable. However, there is no question about the significance of learning the surgical technique of anterior cervical discoidectomy. All neurosurgeons should know the anterior approach of surgery of degenerative disease of spine. It is easy and direct.
This procedure is performed under general anesthesia with patient in supine position and cervical spine in the neutral or very minimally extended position. Hyperextension of the neck is avoided because during surgery greater force is required to retract the tracheal and esophagus. A vertical incision along the medial border of the sternocleidomastoid on the right side is usually preferred by many neurosurgeons. Theoretically there is risk of damage to recurrent laryngeal nerve on right side but actually there is minimal risk because this nerve runs in tracheoesophageal groove. Some prefer midline horizontal incision.
After skin incision, platysma muscle is cut , then investing layer of fascia is cut and sternocleidomastoid muscle and carotid sheath is retracted laterally and trachea and esophagus is retracted medially with the Cloward retractor. Then, vertebral body is felt and prevertebral fascia is cut and retractor is applied between longus colli muscle on the anterior aspect of vertebral body. level of the disc is confirmed and discoidectomy is performed.
Closure of the surgical wound is done only in two layers- one layer of Platysma and subcutaneous tissue and then skin is closed.
So, for every neurosurgeon who wishes to specialize in spinal neurosurgery it is must to learn anterior cervical discoidectomy.
For a single level degenerative cervical disc PIVD , anterior cervical discoidectomy may be sufficient. There is lot of evidence in support of various additional procedures like Anterior cervical discoidectomy(ACD) with grafting, ACD with grafting and plating, ACD with artificial disc ( disc prosthesis), Corpectomy with adjacent discoidecomy with grafting with Plate and Screw fixation, or cage with graft with plate and screw fixation. In traumatic cervical disc prolapse fixation is advisable.
Anterior cervical discectomy with fusion ( ADCF) is regarded as the gold standard for treatment of cervical disc disease.
The anterior approaches came into practice in 1950s. Bailey & Badgley performed first anterior stabilization of the cervical spine in 1952. In 1955 Robinson and Smith described their method to stabilize cervical spine disc disease using iliac bone graft.
Cloward published his technique of anterior cervical discectomy.
The Posterior approaches for cervical spine surgery are
Laminectomy
Laminoplasty
These approaches are more suitable multisegmental cervical spondylosis.
These approaches are more suitable multisegmental cervical spondylosis. - I agree with this. Keep us updated in this of information. For sure you are helping us in a passive way. Keep it up. By the way, do you know Cervical Corpectomy in India Prices?
ReplyDeleteI am working as Assistant professor in a Government Institute where there is no operative charge for this procedure. Similarly in some other Government hospitals there is either no or minimal fee for the operation.In some hospitals even the medicines are provided free of cost to the poor patients. But most of the people who are either insured or can afford prefer to undergo treatment at the private hospitals. Even some poor patients also opt for treatment at private hospital due to long ques, waiting list , and other hassles at Government hospitals. Private hospitals promise a good service and hire the best professionals and surgeons. The quality of care comes at some cost. Most of the private hospitals are maintaining very good interactive websites and have good infrastructure for medical tourism. Medical tourism in India is in vogue. I think if you are interested to know the cost you may directly contact the neurosurgeons in different Private hospitals through their hospital websites. Definitely the cost is quite less as comparable to that in western countries. Max Hospital ( Delhi, Gurgaon, Dehradun), Fortis Hospital, P.D. Hinduja Hospital,Mumbai, Lilavati Hospital, Mumbai, Medanta Medicity, Gurgaon,etc are few among many hospitals which may be of help. I presume that total cost of investigations (including MR)I, medicines, surgery ( including implant) and hospital stay should not exceed 2000 Dollars.
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