Q&A Topic: Cervical Spine Surgery
Haroon F. Choudhri, M.D., FAANS
Q: What conditions are treatable with cervical spine surgery?
A: Cervical spine pathology causes a wide variety of symptoms and problems. Pain in the neck, shoulders or arms, headaches, numbness and tingling in the hands, dropping things, loss of fine motor skills, problems with balance and gait as well as weakness all could potentially be due to problems in the cervical spine and may respond to surgery. However, like the flu, these symptoms may be common, and making the diagnosis can be difficult since no one symptom is characteristic or defining of a surgical problem. The key is to have expert analysis of which symptoms are caused by treatable pathology and which may hint at more serious problems. Good quality imaging and a careful history and physical examination can help to properly evaluate patients with these symptoms.
Q: At what point do you determine a certain patient is a candidate for cervical spine surgery? What alternatives would you recommend first?
A: Surgery is typically reserved as a last resort for patients who cannot be made better with non-surgical treatments. I feel that straightforward cervical disc herniations which cause pain but have no "red flag” warning symptoms should be treated conservatively for at least 2-3 months prior to proceeding with surgery. Injections, pain medications, cervical collars, acupuncture, isometric exercises, chiropractic manipulation and other treatments may be appropriate for some, but not all patients. I strongly discourage generalizing all patients wishing to avoid surgery into a "one size fits all" treatment plan. Everything should be tailored to fit the specific nuances of a patient’s condition.
Q: What recent advances in technology or medicine have made this surgery easier, safer and/or less invasive?
A: There are many new technologies which have made spine surgery safer than ever. I favor approaches which minimize radiation exposure, reduce the need for painful iliac crest bone graft harvesting and utilize smaller incisions while still endeavoring to adequately address the condition at hand. Minimally invasive should not be the goal if the result is minimally effective! High quality imaging also allows us to identify problems more specifically so we can individualize care. In our practice, everything is custom; nothing is “off the shelf.” Anesthesia techniques have also improved, significantly allowing us to care for patients who were previously told they were too old, too sick or too fat to undergo spine surgery.
Q: What do you feel is the best part of your job as a neurosurgeon?
A: One of the biggest thrills of spine surgery is seeing patients resume the ability to walk independently where they had previously been using a wheelchair. I also enjoy seeing patients live in a largely pain-free manner where they previously had suffered with unimaginable pain that wasn’t addressed despite high doses of strong narcotics. Not every patient can be helped, but many people who were previously told that their problems were “inoperable” might benefit tremendously if someone takes the time and uses their experience to develop the right care plan.
Haroon F. Choudhri, MD, FAANS
Boyce Thompson Center
First Floor, Suite 101
1088 North Broadway
Yonkers, NY 10701