Spinal surgery is still most often a last resort however is a great option for many patients who have not had success with conservative measures. The three main categories of cervical spine surgery are the clean out, the fusion and the disc replacement.
The broadest category includes debridement of arthritis, disc material, hypertrophy of ligament, and decompression of the back side of the spinal column or even removal of some bone. Recovery form this type of surgery is typically is a little quicker and often less painful due to the fact the structure was removed rather than inserted.
The second category is segmental fusion. This involves hardware to bind two or more vertebral levels together. Most commonly screws with bars or pins or “cages” fixate the bottom of one segment to the top of the next segment below. Most commonly the fixation is done posteriorly however both anterior and posterior approach is becoming the approach of choice due to better outcomes, however requires surgeons that are specialists in providing access to the spine for the orthopedic spine surgeon to compete the procedure.
The third category is disc replacement. With recent advances in procedures, instruments, and medical devices, the replacement of the disc to preserve motion at that faulty segment is really the gold standard for spinal restoration. IN cases where this is an option, outcomes are generally best with a significant decrease in chance of adjacent segment breakdown and also provide the fastest recovery due to the ability to move through the segment much sooner than it is safe to put the stress of movement through a fused segment.
In all these cases, significant increase in spinal stability needs to be achieved to support the area that was originally injured due to the inherent risk of reinjury of a surgically treated spinal segment. Accordingly, rehab through the first stage focuses on decreasing pain and inflammation and restoring motion available given the surgery. The later stages involve significant concentration on muscle stretching of the LE and exercise to stabilize the spine through core strength and positional awareness.