Before Surgery Evaluation:

• Diagnosis:

  • Imaging:

    • MRI: Identifies disc herniation, stenosis, tumors, or cord compression (80–90% of cases).

    • CT scan: Assesses bone structure, fractures, or hardware placement (50–60%).

    • X-rays (flexion/extension views): Evaluates spinal stability and alignment (70–80%).

  • Electromyography (EMG)/Nerve Conduction Studies: Confirms nerve compression or damage (20–30% of cases, especially radiculopathy).

  • Blood Tests: Checks coagulation (e.g., INR), hemoglobin, and infection markers to ensure surgical fitness.

• Preparation:

  • Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs, e.g., ibuprofen), muscle relaxants, or steroids (e.g., dexamethasone) for inflammation/pain; stop blood thinners (e.g., aspirin) 5–7 days prior if safe.

  • Fasting: 6–8 hours before surgery.

  • Consent: Includes risks like neurological deficits, infection, or hardware failure.

• Multidisciplinary Team: Involves neurosurgeon or orthopedic spine surgeon, anesthesiologist, neurologist (for pre/post-op assessment), and physiotherapist (post-op).

Surgical Techniques:

1. Anterior Cervical Discectomy and Fusion (ACDF, 60–70% of cases):

   • Performed under general anesthesia, lasting 1–3 hours.

   • Process:

     • A 3–5 cm incision is made on the front of the neck (usually right side).

     • Trachea and esophagus are retracted to access the cervical spine.

     • Herniated disc or bone spurs are removed to decompress the nerve or spinal cord.

     • A bone graft (autograft from patient’s hip or allograft) or synthetic cage (e.g., PEEK) is inserted into the disc space to maintain height.

     • A titanium plate and screws stabilize the vertebrae, promoting fusion over 6–12 months.

   • Tools: Fluoroscopy (real-time X-ray), neuromonitoring (to track nerve function), surgical microscope.

2. Posterior Cervical Laminectomy/Fusion (20–30%):

   • Used for multilevel stenosis, posterior pathology (e.g., tumors), or trauma, lasting 2–4 hours.

   • Process:

     • A midline incision (5–10 cm) is made at the back of the neck.

     • Lamina (bone covering the spinal canal) is removed to decompress the spinal cord.

     • Fusion with rods/screws may be added for stability (50–60% of posterior cases).

   • Tools: Fluoroscopy, neuromonitoring, bone graft, or hardware (rods/screws).

3. Artificial Disc Replacement (ADR, 5–10%):

   • Alternative to fusion for younger patients (age <50) with single-level disc herniation, preserving neck motion.

   • Performed via anterior approach; the disc is replaced with a prosthetic device (e.g., Mobi-C, Prestige).

   • Lasts 1–2 hours; no fusion required.

4. Corpectomy (5–10%):

   • For severe compression (e.g., tumors, multilevel fractures), a vertebral body is removed and reconstructed with a cage and titanium plate.

   • Performed via anterior approach, lasting 2–4 hours.

5. Intraoperative Considerations:

   • Neuromonitoring: Tracks spinal cord/nerve function to prevent damage (80–90% of cases).

   • Sterile technique: Minimizes infection risk.

   • Blood loss: Minimal (100–300 mL) for ACDF/ADR; higher (500–1000 mL) for posterior fusion or corpectomy.

After Surgery:

• Monitoring: ICU or ward for 1–3 days; check for neurological deficits, swallowing difficulty, or infection.

• Hospital Stay: 2–5 days; longer (5–10 days) for complex cases (e.g., corpectomy, tumor resection).

• Care:

  • Pain management: IV analgesics (e.g., morphine) for 1–2 days, then oral (e.g., paracetamol, tramadol).

  • Cervical collar: Worn for 2–6 weeks (ACDF/fusion) to support healing; typically not needed for ADR.

  • Physical therapy: Starts at 1–2 weeks to improve neck mobility and strength (₱500–₱1,500/session).

• Instructions:

  • Avoid bending, twisting, or heavy lifting (>5 kg) for 6–8 weeks.

  • X-rays at 6–12 weeks to confirm fusion or hardware position.

  • Monitor for signs of complications (e.g., fever, neurological changes).