Dr. Mina Foroohar performs surgery on the neck and upper back with the same precision she uses to operate on the brain. “As a neurosurgeon, I use microsurgical skills that are different than the methods orthopedic surgeons use,” she explains.
“During surgery, the cervical spine can be approached from either the front of the neck—anteriorly, or from the back of the neck—posteriorly,” says Dr. Foroohar. “I perform procedures using each of these approaches.”
neck or upper-back disc from the front, along with spinal fusion for stability. “We use an allograft (bone graft), or sometimes a cage, in the
inner space where the disc was removed, and also use a small titanium plate to help stabilize the cervical spine,” Dr. Foroohar explains. “This procedure is done through a very tiny incision at the front of the neck.”
Cervical laminectomy—A procedure to remove the lamina (the bone in the back of the spine) in the neck or upper back; this relieves pressure on the spinal cord and nerves. Dr. Foroohar performs cervical laminectomies with or without spinal fusion. “This surgery, performed from a posterior approach, is usually done in older patients with stenosis in more than three levels of the cervical spine,” says Dr. Foroohar.
Spinal fusion—Surgery to join and fuse two or more vertebrae with bone graft, hardware including screws and plates, or cages to stabilize the spine and relieve pain. Spinal fusion may be performed from the front or from the back, and is often done in combination with a discectomy or laminectomy. “The method of spinal fusion depends on the type of surgery we are doing it with,” says Dr. Foroohar.
Cervical laminoplasty—A procedure performed from a posterior approach to treat spinal stenosis by relieving pressure on the spinal cord and widening the spinal canal.
Cervical foraminotomy—A surgical procedure to relieve spinal foraminal (pertaining to the hole where the nerve exits the spine) stenosis by enlarging the space in the spinal column to relieve pressure on the nerves. “This procedure is performed from a posterior approach and usually done to relieve pressure on one or two cervical spinal nerves,” says Dr. Foroohar.
Cervical disc replacement—Removal of a herniated cervical disc and replacement with an artificial disc. This procedure is done using an anterior approach. “With selected patients, we can consider using an artificial disc,” says Dr. Foroohar. “Artificial disc technology continues to be developed.”
What is your approach to cervical disc surgery?
If someone has a herniated disc in their neck, we usually approach it anteriorly—from the front. Usually that involves a cervical discectomy—that is, removing the disc—along with spinal fusion with a bone graft and plate. We never perform a cervical discectomy without the fusion.
Can you explain more about spinal fusion?
Fusion is basically bringing the bone together—we're fusing one bone to another. This can be done from the front or the back.
The key is that you can do fusion in different parts of the spine, but not all spinal fusions are the same.
How do you decide whether to approach neck surgery from the front or the back?
Many factors play a role in how to approach surgery in the neck. Herniated discs are often approached from the front, while multi-level cervical stenosis procedures are approached from the back. The patient's spinal curvature also plays a role, along with patient's age and other medical conditions.
Which technique do you use for spinal stenosis surgery?
We can do surgery for spinal stenosis from the front or from the back.
What are the advantages of the anterior (front) approach to spinal stenosis surgery?
Using the anterior approach often helps keep the normal curvature of the patient's spine. If someone has straightening or reversed curvature of the cervical spine, and you go from the front and fuse, it's going to help the spine go back to a more normal curvature. This approach can also prevent further straightening or worsening of the reversed curvature.
When you remove bone from the back, you tend to put the patient at greater risk for further worsening or loss of the spinal curvature. You may consider fusing from the back, but patients will then lose a lot of their range of motion, as opposed to going in from the front. By going in from the anterior approach, patients don't lose as much range of motion with spinal fusion.