Cervical Spine Surgery

Cervical spine surgery can be performed using an anterior and/or posterior approach. An anterior cervical discectomy and fusion (ACDF) is a routinely performed surgery whose purpose is to relieve spinal stenosis, remove intervertebral disk and bony matter which may be impinging upon neural elements, and to mechanically stabilize the cervical spine after such material is removed. The safety of an ACDF for patients with cervical radiculopathy, with or without neurophysiologic monitoring, is extremely high, with very low rates of temporary or permanent neurologic sequelae. The risk of neurologic injury during an ACDF for those patients with myelopathic symptoms and requiring a cervical corpectomy, laminectomy, or foraminotomy, while unknown, is thought to be higher than that for patients with radiculopathy alone. Posterior cervical spine surgery is usually performed for multilevel compression, instability of the spine, fracture, degenerative disk disease, or stabilization. Common posterior cervical surgical procedures include laminoplasty, laminectomy with or without instrumentation and fusion, and laminotomy. Multimodality neurophysiologic monitoring including somatosensory-evoked potentials (SSEPs), spontaneous electromyography (EMG), and transcranial motor-evoked potentials (MEPs) may play a significant role in detecting, and hopefully averting, impending neurologic injury.