Cervical Spine Surgery

Patients who have failed conservative treatment for their cervical spine disease or patients who have sudden onset or worsening of their neurological symptoms, may need to undergo cervical spine surgery. Cervical spine surgery is usually done from the front or the back of the neck.

It involves decompression of the nerves or the spinal cord as dictated by the pathology. These patients have usually undergone prior advanced imaging to confirm their diagnosis. Patients with emergency deterioration or new onset motor weakness or bowel or bladder or gait involvement may need cervical spine surgery on an emergent or urgent basis.

Rest of the patients have usually tried conservative means with no or little benefit. Surgery done from the front of the neck, usually involves removal of the disc material with placement of a cage between the two vertebrae and a plate in front. It can be done on one or more than one levels as required.

MRI of the cervical spine

MRI of the cervical spine

Patients who have compression from the back of the vertebra may need surgery from the back in which the lamina is removed and the spinal cord and the nerve roots are decompressed. This is usually combined with fusion using screws and rods.

Occasionally, the patient may be a good candidate for motion sparing surgery like Microdiscectomy or Laminoplasty. When indicated, patients may be a good candidate for cervical disc replacement in which the disc from the front of the vertebrae are removed and replaced with the artificial disc.

This surgery allows retention of the mobility between the vertebrae and results in preservation of the neck motion after the surgery. All cervical spine surgeries are performed under general anesthesia after endotracheal intubation.

CERVICAL MICRODISCECTOMY

This is a minimal invasive procedure which is usually done in carefully selected patients to remove the pressure of the disc over the nerve root causing the pain. This surgery is done from the back of the neck in which a limited amount of bone is removed to form a window to decompress the nerve root and remove the bulging disc material. This surgery allows retention of movement between the vertebrae as there is no fusion involved. The recovery and rehabilitation from this surgery is faster and has good results.

CERVICAL LAMINECTOMY

Cervical laminectomy is the procedure of removal of the lamina or the bone on the back of the vertebrae of the neck. This procedure is usually done for patients who have compression of the spinal cord from the back or patients who have narrowing of the spinal canal at multiple levels. This surgery is combined with fusion of the neck from the back using screws and rods. The patients usually have to use a neck collar for a few weeks and there is a gradual recovery over a span of two to three months. The patients usually will have some restriction of movement after the surgery, especially if it is performed at multiple levels.

CERVICAL LAMINOPLASTY

Laminoplasty is a motion sparing surgery that is performed over multiple levels on the back of the neck. This surgery is usually performed in stable spine. Window is made on the lamina of the cervical vertebrae and this window is held open with use of mini plates. This surgery is performed in patients who have narrowing of the spinal canal at multiple levels, especially from the back side. This surgery allows retention of movements of the neck as oppose to laminectomy and fusion surgery in which there is some restriction of movements. The patients usually must wear a neck collar for a couple of weeks and there is a gradual recovery over a span of two to three months.

ANTERIOR CERVICAL DISCECTOMY AND FUSION (ACDF)

ACDF is one of the most common surgical procedure performed over the cervical spine. It is usually performed for degenerative disc disease of the neck along with disc herniation causing compression on the spinal cord or nerve roots. It is also performed in cases of fracture or dislocation of the spine. This surgery is performed from the front of the neck in which the disc is removed and is replaced with cage along with autograft and the two vertebrae are fixed to each other with use of plate and screws. It can be performed at one or more than one levels as required. The success rate of the surgery is very good, and patients have a gradual recovery over a span of six to eight weeks.

Rigid distraction forceps

The rigid distraction forceps in the image above are used to create space between the diseased cervical vertebrae to remove the disc material and subsequent insertion of bone cage.

ACDF plate

The image above shows a plate used to fuse the cervical vertebrae in anterior cervical decompression and fusion surgery. The surgery is performed from the front of the neck and a plate is fixed with the help of screws.

ANTERIOR CERVICAL CORPECTOMY AND FUSION (ACCF)

ACCF is another form of surgery on the neck from the front in which the body of one or more than one vertebra are removed and replaced with cage with or without bone graft along with fixation of the spine using plate and screws. This surgery is usually performed if there is compression at multiple levels or especially behind the vertebral body which cannot be removed by doing a simple discectomy as in ACDF. The recovery from this surgery is slower than ACDF and the patient may require wearing a brace for a longer period.

TOTAL DISC REPLACEMENT (TDR)

Total disc replacement of cervical spine is an excellent procedure done in well selected candidates. As opposed to fusion, TDR helps in retaining the movements of the cervical spine and at the same time taking care of the degenerated disc and removing the pressure over the spinal cord or nerve roots. Total disc replacement can be usually performed at one or two levels and helps preventing the problems associated with fusion surgery. Total disc replacement is contraindicated in patients with instability or infection of the cervical vertebrae, tumors, osteoporosis.

Total Cervical Disc Replacement and parts of cervical vertebrae (anterior view)

Total Cervical Disc Replacement and parts of cervical vertebrae (lateral view)

The images above show a total cervical disc replacement along with various parts of the cervical vertebrae. The PEEK (poly ether-ether ketone) polymer is used as a bearing surface. The prosthetic replaced disc re-duplicated the function of the normal cervical intervertebral disc.

PREOPERATIVE WORKUP

The patients are usually seen by the physician and appropriate preoperative investigations including advanced imaging, blood work and ECG and chest x-rays as needed are done. The patients may also need clearance from their primary care physician and anesthesiologist before the surgery. The patients are instructed to come to the hospital two hours in advance with no jewelry. The patients are taken to the preoperative area where they are seen by the anesthesiologist and appropriate procedure performed before the patient is taken to the operating room. In the operating room the patient usually is given general anesthesia and intubated before being positioned for the surgery.

POSTOPERATIVE CARE AND RECOVERY AFTER CERVICAL SPINE SURGERY

The patients who undergo cervical spine surgery are usually extubated after the surgery and some patients who undergo surgeries like ACDF can be discharged home on the same day if they meet the criteria to discharge. Most of the time cervical spine surgery patients are admitted to the hospital for one to five days depending on the surgery and recovery. Patients can mobilize in and out of bed with or without a neck collar or support depending on the surgery and recovery from anesthesia.

Immediately after the surgery, the patients are encouraged to do their activities of daily living from the first postop day. The patients are provided with medications in the hospital as well as for home to take care of pain and muscle spasms that can develop after the surgery. Incisions need to be kept clean and dry. The patients are instructed to avoid bath and hot tubs, swimming, heavy lifting, driving and smoking. The patients can take shower and remove the dressings after 72 hours from surgery and replace it with dry dressing. The patients are advised to eat healthy and nutritious diet with lot of fibers. The patients are also instructed to use over-the-counter laxatives for constipation that may develop due to pain medications.

RISKS AND COMPLICATIONS

As for all surgeries there are certain but rare risks for anesthesia including cardiac arrest, stroke, paralysis, and rarely death.

Risks of Cervical spine surgery may include though not limited to:

  • Hematoma or hemorrhage
  • Damage to the carotid or vertebral artery which may result in a stroke or excessive bleeding, even death
  • Blindness
  • Damage to the nerve in the neck resulting in hoarseness or swallowing difficulties
  • Damage to the food or wind pipe
  • Damage to the dura, resulting in a cerebrospinal fluid leak
  • Failure, loosening or pull out of the graft, cage, implant or plate
  • Wound infection
  • Failure of fusion to happen
  • Damage to the spinal cord or nerve root(s) resulting in new onset or deterioration of preexisting pain, weakness, paralysis, loss of sensation, loss of bowel or bladder function, impaired sexual function, etc., which may or may not recover.
  • A few of these conditions may warrant repeat surgery

Certain patient population is at a higher risk for complication which include but are not limited to:

  • Smoking
  • Seizures
  • Obstructive sleep apnea
  • Obesity
  • High blood pressure
  • Diabetes
  • Other medical conditions involving your heart, lungs or kidneys
  • Medications, such as aspirin, that can increase bleeding
  • History of heavy alcohol use
  • Drug allergies
  • History of adverse reactions to anesthesia

WHEN TO VISIT AN EMERGENCY ROOM AFTER A SURGERY:

  • Suspected cardiac problem: severe chest pain or pressure, shortness of breath, tightness in chest, pain in left arm, jaw pain, dizziness or fainting, unexplained weakness or fatigue, rapid or irregular pulse, sweating, cool, clammy skin, and/or paleness
  • Suspected Stroke: trouble speaking, changes in vision, confusion or other change in mental status
  • Suspected venous thrombosis: swelling of the legs, ankles, or feet, discomfort, heaviness, pain, aching, throbbing, itching, or warmth in the legs, sudden shortness of breath, chest pain, coughing up blood, rapid or irregular heart rate
  • Suspected Sepsis: high grade fever, with shivers associated with fatigue, dizziness, racing heart, pale or discolored skin, sleepy, difficult to rouse, confused, short of breath
  • Heavy bleeding from the surgical site
  • Severe allergic reaction with trouble breathing, swelling, hives

WHEN TO CONTACT A DOCTOR’S OFFICE AFTER SURGERY:

  • temperature more than 101 degrees Fahrenheit
  • increased pain or tenderness near the incision
  • poor pain relief
  • signs of infection: increased swelling, redness, increased drainage, increased warmth, pus, foul smell, bleeding at the incision, incision coming apart
  • increased numbness, numbness in genital area
  • inability to feel or move fingers or toes
  • pale blue, white or abnormally cold fingers or toes
  • nausea (upset stomach) or vomiting (throwing up) that won’t stop
  • increased tiredness
  • a generally worse feeling than you had when you left the hospital
  • problems urinating, severe constipation or severe diarrhea
  • a concern about any other symptoms that seem unusual

Call Us Now!

4.9
Based on 93 reviews
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
Sam
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18
js_loader

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.