For the 500,000 Americans suffering from arm and neck pain caused by a herniated disc or bone spur in the neck, an improved microsurgical technique developed by UCLA neurosurgeons may bring them the relief they seek. The new procedure avoids fusion surgery in the neck, reduces recovery time and enables patients to return to their normal routine often within a week after surgery.
The new surgical technique, called anterior cervical foraminotomy (ACF), was developed at UCLA to improve the treatment of cervical radiculopathy -- nerve problems in the arm and neck as a result of nerve compression in the neck due to herniated discs or bone spurs. Patients afflicted with this problem experience symptoms such as pain, numbness, limb immobility, a 'pins and needles' sensation, a burning sensation or a swollen feeling in the affected limb.
The new procedure has an advantage over the current method of treatment - a complete disc removal procedure -- because ACF preserves the disc within the vertebrae, thus retaining the normal mechanical function of the spinal column. The new technique is reported in the April issue of the journal Spine by Dr. J. Patrick Johnson, lead author, co-director of the UCLA Comprehensive Spine Center and associate professor of neurosurgery.
"Cervical radiculopathy is as common as low back problems," said Johnson. "With this new procedure, we've essentially taken an operation that was devised in the '60s and revamped it with 21st century technology. It's now like taking a pebble out of your shoe to relieve the pain."
In the standard cervical fusion method of treatment, surgeons remove the disc causing the arm or neck pain and replace it with bone from the patient's hip or treated bone from a cadaver obtained from a bone bank. Then the two vertebrae on either side are fused together with the inserted bone sandwiched in between. This surgery changes the mechanics of the patient's spine and puts more stress on areas next to the fused vertebrae.
The UCLA neurosurgeons say that by removing only the herniated portion of the disc, they can preserve normal disc function and avoid bone fusion. They add that the recovery period for patients is half of the current discectomy procedures and patients can often return to full activity within two weeks of surgery. With the standard discectomy, a patient's total recovery time is usually between four to eight weeks.
"The outcomes appear to offer excellent results," said Johnson. "Patients maintain range of motion in the neck and definitely get the sought-after relief from their arm and neck pain. They also don't need to wear a neck collar since spinal stability is not affected by the surgery. Additionally, patients require less pain medication since there is very little incisional pain."
Using delicate microsurgical instruments and techniques, surgeons can perform ACF quickly and easily usually as an outpatient procedure with the actual surgery lasting about one to one-and-a-half hours. The surgical approach exposes the lateral aspect of the spinal column through a small incision at the front of the neck in a naturally occurring crease. This exposes the affected nerve root, allows for removal of a herniated disc or bone spur, and decompresses the entire segment of the nerve.
"Before this surgery, I couldn't lift my head off of my shoulder without great pain," said 36-year-old Thomas Crahan. "I woke up from surgery pain-free and I can now do almost anything I want. In fact, I was able to get back into road racing go-carts and I even won the very next race I was in."
Ideal candidates for ACF are usually patients 30 to 60 years old with arm pain primarily related to nerve compression from a herniated disc or bone spur.
In the study reported in Spine, UCLA neurosurgeons treated 21 patients over a three-year period ranging in age from 27 to 58 years old. Of the patients treated, 91 percent had improved or resolved radicular symptoms after follow-up visits ranging from six to 36 months. UCLA surgeons stress that ultra long-term follow-up outcomes are important in any study of this type.
In addition to Johnson, Drs. Ulrich Batzdorf, Aaron G. Filler and Duncan Q. McBride contributed to the study. All are members of the UCLA Division of Neurosurgery. For more information, log onto http://www.neurosurgery.medsch.ucla.edu.
-UCLA-
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