Jeffrey R. Carlson, MD
Patients ask me if surgery on the cervical spine (neck) will relieve their pain and disability. This isn’t an unusual question for those contemplating the potential outcomes of a surgical procedure compared to their current state of dysfunction. The considerations can be especially important for older patients who are losing their balance, finding it harder to type on a computer or that handwriting has become more difficult. These are signs of a cervical (neck) spinal cord compression called spinal myelopathy.
As we get older, we all develop arthritis and our cervical spine discs wear out. As the discs collapse, they will also bulge and will cause the formation of bone spurs which may compress the spinal cord. This spinal cord compression (spinal stenosis) limits the constant flow of information from the brain to the rest of the body, causing a slowing of our response times. This results in difficulty performing some of the daily tasks that require lighting fast information relays. Balance, for example, requires our brain to know where our feet are at all times and on all types of surfaces and terrain. A slowing of the information flow makes our brains less able to adjust to subtle changes in walking surfaces, which may result in a stumble or fall.
Cervical myelopathy may eventually be very limiting for patients, decreasing their ability to perform daily tasks and forcing them to be more secluded. Patients sometimes think this is just part of getting older, but the good news is, that isn’t the case. Fortunately, the compression on the nerves can be removed through a surgical procedure called posterior cervical decompression and fusion. This procedure allows the flow of information from the brain to the hands and feet to return and is used in older patients who have several deformed discs that are pinching the spinal cord.
A recent article by Jim Youseff, MD in The Spine Journal, details the substantial improvement in a patient’s ability to walk, balance and perform daily tasks after posterior decompression and fusion surgery. The study reviewed patients that were treated with surgery for spinal myelopathy from 2001-2018 and found that more than 70% of these patients improved. In some of the studies, 95% of the patients actually improved. This improvement included a 50% improvement in their actual neurologic functions. This increase in function after surgery can quickly return patients to an independent and socially active life.
Surgery is never a decision to be taken lightly, especially for older patients. This study gives surgeons and older patients confidence that cervical myelopathy can be treated very successfully with surgery. Helping patients return to a vibrant, active life is the most valuable part of the surgical experience and what I enjoy the most about my role as an orthopaedic spine surgeon.