Cervical Spine Surgery - Type and Average Treatment Cost in India

You might require cervical pain surgery if you are experiencing spinal cord dysfunction, neck pain, abnormal neck motion, or dysfunction of the nerves to the arms or neck. The goal of this surgery is to restore spinal stability and reduce pain.

If you want to know more about cervical spine surgery, its types and the average cost of treatment in India, keep reading.

Surgery of the cervical spine is typically done to address cervical radiculopathy, spinal instability, or nerve or spinal cord impingement. Pain that travels from the neck to the arms is a defining feature of cervical radiculopathy.

Any type of cervical spine injury or ailment, such as a pinched nerve that aggravates a nerve there, will cause discomfort. Patients who choose to undergo the procedure will experience alleviation as a result of the technique's ability to reduce pain or discomfort.

As a decompression may destabilise the spine and necessitate a fusion to add stability, the two procedures are frequently combined. The spinal construct can also benefit from the application of spinal instrumentation, such as a tiny plate.

This technique can help to strengthen and stabilise the spine, which might help to relieve severe and persistent neck pain.

The aims of all the surgical methods remains the same, that is:

• Releasing the pressure on the spinal cord and/or nerves
• Maintaining or enhancing the spine's stability
• Keeping or adjusting the spinal alignment

The different cervical spine surgery types are-

1. Cervical Spine Fusion

A cervical spinal fusion is utilised to combine two of your vertebrae into a single, stable piece of bone. This method is useful when a neck region is unstable or when movement at the affected region creates pain.

Moreover, very severe cervical fractures are treated with a spinal fusion. Additionally, doctors might suggest it as a part of a surgical procedure to treat a compressed spinal cord or a pinched nerve.

Depending on your unique condition, your surgeon may make the incision at the front or rear of your neck. A bone graft subsequently treats the damaged area. You or a donor may provide bone transplants. If you need a bone graft, surgeons often use your hip bone.

Additionally surgeons can also use metal screws or plates to hold the two vertebrae that are also placed together with the help of plates or metal screws  together. These vertebrae will eventually fuse together to provide stability. Due to the fusion, you can experience a loss of flexibility or range of motion.

Benefits:

• The process of fusing at the end of this surgery naturally joins two or more vertebrae, which is more effective than an artificial connection.
• This approach provides the surgeons better access to your spine and body than the posterior approach.
• This surgery offers quick recovery to the patients.
• It helps to get significant relief of pain and other symptoms regarding the spine.

Success Rate After Surgery

• Simple fusions - 0.256% (OR, 0.63 [95% CI, 0.55–0.72])

• Complex fusions - 0.534% (OR, 1.10 [95% CI, 0.95–1.28])

Cost of Surgery

Approximately ₹ 2,50,000 to ₹ 5,00,000

2. Anterior Cervical Discectomy and Fusion (ACDF)

Anterior cervical discectomy and fusion, or ACDF, is a method to treat spinal cord compression or a pinched nerve.

The front of your neck will be where the surgeon makes the surgical incision. The pressure-causing disc and any adjacent bone spurs will be removed following the incision. By doing this, the pressure on the nerve or spinal cord might be reduced.

The next step is to do a spinal fusion to stabilise the region.

Benefits:

• This surgery is effective for realigning your spine and eliminating the problems in this area.
• It helps to create space for nerve roots that travel from the spine to the arms, making its functions more effective.
• It also helps to restrict the movement of the nerve roots across the damaged part of your spine.

Success Rate After Surgery

• Surgery for arm pain - 93% to 100%

• Surgery for neck pain - 73% to 83% 

Cost of Surgery

Approximately ₹ 3,60,000

3. Anterior Cervical Corpectomy and Fusion (ACCF)

This treatment is identical to the ACDF and is used to treat spinal cord compression. It can be your best surgical choice if you have bone spurs that an operation like ACDF cannot remove.

The surgeon creates the incision at the front of your neck, much like in an ACDF. Whether completely or in part, instead of removing a disc, the vertebral body and any encircling bone spurs are removed.

The remaining gap is subsequently filled with a tiny bone fragment and the spinal fusion. This operation is more complex; thus, healing may take longer than with ACDF.

Benefits:

• It is capable of curing arm and neck pain in almost every patient.
• It helps the patients to prevent loss of nerve and spinal cord functions, ensuring better function.
• It also ensures relief in the spinal cord from compression.

Success Rate After Surgery

Pain relief - 80% to 90%

Cost of Surgery

Approximately ₹ 7,20,000

4. Laminectomy

Surgeons perform a laminectomy to release pressure from your spinal cord or nerves. The back of your neck is where the surgeon makes the incision during this surgery.

After making the incision surgeons will remove the lamina, a bony, ridged region at the back of the vertebra. Additionally, they will also remove any discs, bone spurs, or ligaments causing compression.

A laminectomy increases the amount of space available for the spinal cord by removing the affected vertebra's rear portion. The surgery, meanwhile, has the potential to weaken the spine's stability. Frequently, Laminectomy patients simultaneously have spinal fusion.

Benefits:

• It is a safe surgery and hardly involves any complications.
• It removes pressure from the spinal cord, which naturally reduces your pain and difficulties.
• This surgery allows you to recover from the symptoms of nerve damage.

Success Rate After Surgery

Lumbar central spinal stenosis patients - 85% to 90%

Cost of Surgery

Approximately ₹ 2,00,000 to ₹ 3,00,000

5. Laminoplasty

Pressure on your spinal cord or nerves is relieved via a laminectomy. The surgeon makes the incision at the back of your neck during this surgery. To relieve pressure on the spinal cord and related nerves, laminoplasty is an alternative to laminectomy. A cut must also be made on the back of your neck.

The surgeon constructs a hinge resembling a door rather than removing the lamina. The lamina can then be opened via this hinge, releasing the spinal cord's compression. To hold this hinge in place, metal implants are implanted.

The benefit of a laminoplasty is that it keeps some range of motion while also enabling the surgeon to treat various compression points. A laminoplasty might not be advised if your neck pain is brought on by movement.

Benefits:

• It helps to decompress the spinal cord and the neuroforamen without removing the anterior pathology.
• It allows you to preserve the dorsal elements of the spine and relieve pain and discomfort.
• It improves the spine stability and alignment while decreasing the risks of postlaminectomy kyphosis and instability.

Success Rate After Surgery

Within 5 years of surgery - 15% of patients died (out of 100)

Cost of Surgery

Approximately ₹ 6,80,000

6. Artificial Disk Replacement (ADR)

This form of surgery will be able to treat a pinched nerve in your neck. Your front neck will be where the surgeon makes the incision.

The surgeon will remove the disc pressing on the nerve during ADR. The disc will subsequently be removed, and an artificial implant will fill the area. The implant could be made entirely of metal or out of metal and plastic.

In contrast to ACDF, an ADR procedure lets you keep some of your neck's range of motion and flexibility. However, do not opt for ADR if you have:

• Osteoporosis
• Severe neck arthritis
• Rheumatoid arthritis
• Allergies to the implant material
• Cancer
• Ankylosing spondylosis
• Existing instability of the spine

Benefits:

• This surgery is preferable for its quick recovery time, as it is less complicated than other procedures.
• you can get more spine mobility after this surgery.
• This surgery will reduce the stress on the adjacent discs without needing a bone graft.  

Success Rate After Surgery

Success rate - 87.5%

Cost of Surgery

Approximately ₹ 3,80,000 to ₹ 4,35,000

7. Posterior Cervical Lamino Foraminotomy

Another option for treating a pinched nerve is this kind of surgery. The back of the neck is where the surgeons make an incision.

The surgeon removes a portion of your lamina using a specialised tool after making the incision. Following this, any more bone or tissue that is putting pressure on the afflicted nerve is removed.

The posterior cervical lamino foraminotomy procedure does not involve spinal fusion, in contrast to other neck procedures such as the ACDF and ACCF. Your neck can remain more flexible as a result. Minimally invasive techniques can also be used to carry out this procedure.

Benefits:

• This surgical procedure helps to reduce neck and spinal pain.
• It decompresses your spine by removing large, arthritic osteophyte(s) and a part of the herniated disc.
• It reduces pain and discomfort in the spinal area.

Success Rate After Surgery

Success rate- 82% to 100%

Cost of Surgery

Approximately ₹ 11,65,000

To prepare for cervical surgery, you should keep in mind the following.

• Stop Smoking

Smoking can cause respiratory issues prior to, during, and after the operation. Additionally, it reduces blood flow, which delays healing.

• Get your Home Ready

Avoid bending and place clothing, pots and pans, and bathroom supplies, in places that are simple to access. Prepare meals in advance. To prevent tripping, remove the rugs in your house.

• Medications

Two weeks before the surgery, stop taking aspirin and NSAIDs like ibuprofen and indocin, as well as any other medications or dietary supplements. Take extra-strength Tylenol before surgery if you're in pain. Please discuss your supplements with your surgeon or doctor to make sure they are approved for your operation.

Surgeons frequently order pre-surgical blood tests to rule out any conditions that might make surgery more difficult. If you have any queries or worries regarding any of the tests your doctor has recommended for you, discuss them with him or her.

• Prepare a Hospital Bag

Your hospital stay can be more comfortable if you bring your own slippers, comfortable clothing, and amenities. Remember to bring the neck brace or collar you were fitted for if applicable. Keep your priceless items at home.

• Transportation

Arrange a ride to and from the hospital with someone responsible to make it easier for you to get there and back after your procedure. After your surgery, you'll probably find it more comfortable to lie down in the rear seat or recline in the front seat.

Bring any cushions or other items you think you'll need for a comfortable travel home. Keep in mind that your surgeon must first give you the all-clear before you start driving.

Although it is safe, a few cervical spine surgery complications which might arise are-

• Excessive bleeding
• Reaction to anaesthesia
• Chronic neck pain
• Failure to heal
• Infection
• Damage to the nerves, spinal cord, blood vessels, vocal cords, oesophagus

Before the surgery, your doctor will schedule a few pre-admission evaluation tests, which might include-

• Blood and urine tests
• Anaesthesia interview
• Medical history and physical examination by a nurse practitioner
• Electrocardiogram
• Patient teaching
• Spine X-rays, CT scans, MRI or myelogram

The night before your surgery, it's crucial that you don't eat or drink anything after midnight. Do not consume any solid foods after 9 p.m. or any liquids, even water, after 12 a.m. if you are admitted the morning of your surgery. The night before surgery, take off all jewellery, including wedding bands, to avoid swelling in the morning.

Most patients are admitted the morning of their procedure, so you should report to the Admission Unit so that you can get ready. On the morning of your surgery, you may bring two visitors.

• Please allow your visitors to hold your personal items while you are having surgery and until you are in your designated room.
• Before leaving your room, use the restroom to empty your bladder.
• About an hour prior to your surgery, an escort will carry you on a stretcher to the operating room.
• The nurse will then direct any guests to the family waiting area so they can wait there while you have surgery.
• Your surgeon will call your visitors there after the procedure is complete.
• An anaesthesiologist will interview you before going into the operating room, and they will start an intravenous line in your arm.
• To reduce the chances of infection, the anaesthesiologist will start intravenous antibiotics and continue them following the operation.
• The anaesthesia that you and the anaesthesiologist have discussed will be administered to you once you are in the operating room.
• Skin preparation, positioning, and anaesthetic time are all included in this time frame.
• To help safeguard their spinal cord and nerves throughout the surgery, some patients require spinal monitoring known as somatosensory evoked potentials (SSEP) during the process. A technician will apply sticky electrodes to your body if you have SSEP.

During the surgical procedure, surgeons attempt a discectomy at the end of the thoracic body, where they remove multiple vertebrae. They then attach the disks above and below the broken vertebrae. This causes a decompression, relieving the stress from spinal cords and nerves.

The following stages include the development of a spinal fusion while filling the gap between disks and vertebrae with implants. Surgeons use two kinds of implants here: strut graft and cage augmentation. The former uses the patient’s bones. Surgeons insert a bone bank in a part of the spine using titanium screws and plates.

Cage augmentation refers to using metal, synthetic bone, and ceramic implants. Surgeons place these in the spinal area and fix them with plates and screws. They then use potent sutures to close the incision and a surgical adhesive to close the skin, which might leave a scar.

• You will awaken following the surgery in a recovery room or Post-Anaesthesia Care Unit (PACU) to recover from anaesthesia. Usually, this takes between one and two hours.
• A nurse will routinely monitor your vital signs (heart rate, blood pressure, temperature and respiratory rate).
• Your nurse will examine your legs and feet to ensure they move freely.  The nurse can also provide you with an Incentive Spirometer (blue inhalation tube) in order to aid in lung expansion and ward off pneumonia.
• There might be a replacement or removal of dressing in your incision site. Your wound will have been closed with surgical tape, sutures, or adhesive tape.
• Use an ice pack or cooling pad to help reduce swelling and improve your comfort. For the first day or two, intravenous fluids are frequently continued.
• To prevent infection, antibiotics may be administered intravenously for 24 hours.
• There are painkillers available to make sure you're comfortable. You'll likely receive painkillers via injection during the first 24 hours following surgery, either intravenously (IV) or intramuscularly (IM) into the arm or buttock region.

Compared to oral pills, these drugs typically provide a considerably stronger and quicker-acting effect. Please inform your nurse if you feel uneasy. It's critical to feel comfortable enough to engage in your fitness regimen.

You should call the doctor when you experience the following symptoms-

• If you experience neck pain after a blow or injury to the neck or head
• Stiff neck, which will prevent you from touching your chin to your chest
• Headache and fever accompanying the neck pain
• Numbness of legs and/or arms or increased weakness of the legs/arms
• Even after conservative management, the pain does not subside

You can also consult a doctor if you experience any cervical spine surgery side effects.

You can try non-surgical treatments to treat cervical degenerative disc symptoms. Here are a few options.

• Rest or Modification of Activities

At first, it makes sense to take it easy and stay away from things that make your arm and/or neck pain worse. For instance, if work-related tasks aggravate the discomfort, taking some time off or altering the workday to avoid particular chores may help.

• Managing Pain

You can also try pain-relief medications which will provide you relief for a short time. As alternatives, you can also try heat therapy and ice packs. Moreover, acupuncture, manual manipulation and massage can also be effective.

Neck epidural steroid injections may function as a temporary pain reliever as well as a diagnostic tool to determine which disc level is causing pain.

• Physical Therapy:

The muscles in the neck, shoulder, and back tend to become stiff and weakened when someone has chronic neck discomfort. You can take the help of physical therapy, which any physical therapist or other competent medical experts can plan. It will help in stretching and strengthening the muscles that surround the neck.

• Behavioural Changes

Some people may find relief from uncomfortable symptoms and a reduction in stress through healthy food, restful sleep, regular exercise, and social support. You should also quit smoking as it can increase the chance of a spine surgery failing.