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• W2316693577 abstract "To the Editor: Now that I am semiretired and no longer performing operative neurosurgery, I have been disappointed to find that some of my younger colleagues decline to perform cervical fusions for patients whom I refer to them if those patients have only neck pain and do not have severe radicular symptoms and/or neurological deficit. I am told that this is because of an impression of a universally poor outcome, although perhaps it is also in part a reaction to some of the excessive surgical zeal for doing cervical fusions that we all encounter in the community. My own recollection, based on more than 40 years of performing cervical spine surgery, has not been so pessimistic, and I believe that it is a disservice to my patients for them not to be able to undergo potentially quite beneficial fusion surgery. Surgery for painful joints elsewhere in the body is certainly widely practiced and accepted, with large numbers of artificial hips, knees, and so on being used to treat painful joints as our population ages. Because the cervical disc is another joint that can be locally damaged, producing arthralgic pain, I fail to see the logic of not operating on a painful cervical disc when indicated. To reinforce my memory, I did a quick chart review of my own last 10 patients operated on for arthralgic cervicalgia during the years 1995 to 2002. Like most spinal neurosurgeons, the majority of the cervical operations that I performed were for disc ruptures with radiculitis, cervical fractures, spondylotic myelopathy, tumors, and other conditions. However, I did retrieve the records for 10 patients on whom I had operated for neck pain as their principal symptom. All these patients had severe 1- or 2-level cervical disc degeneration, and none had associated neurological deficits. All were incapacitated by intolerable pain despite aggressive and often prolonged therapy, including anti-inflammatory drugs, bracing, exercises, and often intradiscal steroid injections. There were 5 men and 5 women, 8 with single-level disease and 2 with adjacent 2-level disease. Their ages were younger than those of typical patients with degenerative spondylopathy (mean age 45.5 years, range 36-64 years), most having a history of remote neck injury of limited severity. All underwent anterior cervical fusion, 4 with a Cloward technique and 6 with instrumentation. Follow-up varied from 2 to 64 months (mean 8 months). Four patients reported excellent results (fully functional without medication), 3 good results (functional but requiring medication), and 2 fair results (decreased pain intensity but functionally limited), and only 1 reported a poor result (no pain relief). Undoubtedly the results that can be achieved with cervical fusion for cervicalgia will be determined chiefly by patient selection because most neurosurgeons and orthopedists are likely to be technically adept at such surgery. My patients were selected after I got to know them, all had severe and focal degenerative disc disease on imaging, and all had intolerable neck pain despite vigorous and varied alternative therapy. It should not be overly difficult for neurosurgeons to select patients likely to benefit from fusion surgery for cervicalgia, just as they select appropriate patients for surgery for other disorders. It seems to me that “the myth of poor outcome from fusion surgery for cervicalgia” is likely to become self-fulfilling if proper patient selection is not carried out, but these patients do exist, many suffer greatly, and many of them can benefit greatly from surgery to become grateful patients. Harold A. Wilkinson Boston, Massachusetts" @default.
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• W2316693577 date "2011-02-01" @default.
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• W2316693577 title "Should Cervical Fusions Ever Be Done for Cervicalgia Alone?" @default.
• W2316693577 doi "https://doi.org/10.1227/neu.0b013e31820208bf" @default.
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