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Surgery for neck pain.

Abstract

Axial neck pain is a common finding that typically represents a spectrum of clinical Arlington Orthopedic Associates, disorders affecting the cervical spine. Controversy exists concerning the ultimate treatment of the patient who presents with cervical spondylosis and primarily axial neck pain without radicular symptoms or myelopathy and who has failed to respond to extensive nonoperative treatment methods. Cervical discography has been used to assist in determining the specific level or levels causing the neck pain and, potentially, which levels to fuse; however, controversy regarding the specificity of cervical discograms has also been debated in the literature. Los Angeles, California We recommend exhausting all conservative means of treatment of axial neck pain. Surgery is offered only after conservative treatment fails and appropriate psychological testing is performed, as well as diagnostic imaging and discography that confirm a specific level or levels as the pain source. Cervical fusion may demonstrate good results in appropriately chosen patients with cervical spondylosis and axial neck pain.

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BibTeXRIS

Eric S Wieser, Jeffrey C Wang. 2007. Surgery for neck pain.. https://doi.org/10.1227/01.neu.0000215376.14375.d

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Surgical treatment of cervical kyphosis in Larsen syndrome: report of 3 cases and review of the literature.

STUDY DESIGN: A retrospective case series. OBJECTIVE: To review the surgical results for midcervical kyphosis in 3 cases with Larsen syndrome, and to discuss the choice of surgical treatments. SUMMARY OF BACKGROUND DATA: Cervical kyphosis is the most hazardous and serious manifestation of Larsen syndrome due to the risk of life-threatening paralysis, and thus usually requires surgical treatment. However, little information has been reported concerning surgical treatments for this challenging condition. METHODS: Three patients with Larsen syndrome were surgically treated for midcervical kyphosis at our institution. RESULTS: An infant with mild cervical kyphosis was successfully treated with posterior arthrodesis using a halo immobilization, and anterior vertebral growth with a mature posterior fusion mass resulted in spontaneous correction of the kyphosis. In the remaining 2 infants with myelopathic symptoms due to severe and structural kyphosis, anterior decompression and fusion via a lateral approach followed by posterior fusion with segmental spinal instrumentation and halo immobilization resulted in improved neurologic symptoms and solid fusion. CONCLUSIONS: Posterior spinal fusion is only indicated for patients with mild and flexible cervical kyphosis, and anterior decompression and circumferential arthrodesis is required for patients with severe kyphotic deformity, who usually develop myelopathic symptoms. Anterior surgery for such a small patient with severe kyphosis involves much higher risk of spinal cord injury during decompression maneuvers and difficulty in stabilization of the reconstructed cervical spine. Therefore, all patients with Larsen syndrome should be screened with radiographs at the first visit to detect cervical kyphosis early so that posterior alone fusion is possible.

Cervical Vertebrae↗