"Health Food" for thought...

A Courtesy of Healing Touch Chiropractic and Dr. Gary L. Easter

Each year thousands of people go through the very painful and potentially dangerous procedure of neck surgery without having exhausted all conservative options.  To better inform you, I have placed the actual surgical procedure below along with possible problems and complications.  Before you or someone you love has this procedure, make sure they have tried chiropractic first.

Neck Surgery

The surgical procedure

The surgery is performed with the patient in the supine position under general anesthesia. Usual requirements include adequate padding of bony and soft tissue structures. Sequential compression boots are applied to the patient's lower extremities to avoid development of blood clots during the operation.

Most surgeons prefer to use Somatosensory Evoked Potentials (SSEPs) or Motor Evoked Potentials (MEPs) to monitor spinal cord function during the surgery. However, this is not essential. The surgical procedure is done as follows:

  • The procedure begins with either a longitudinal or transverse incision in the lower front of the neck. The underlying musculature of the neck is carefully dissected, allowing the surgeon to expose the anterior cervical spine by retracting the esophagus and trachea toward midline and the carotid artery and associated structures laterally.
  • Muscles and membranes overlying the anterior cervical spine are dissected as well, and retractors are placed to protect the soft tissues of the neck as the operation proceeds.
  • After the surgical level(s) have been confirmed by X-ray or fluoroscopy, intervertebral discs are removed at the level(s) to be decompressed. In some instances it is only necessary to remove the abnormal discs, with or without small bone spurs at their margins.
  • If multiple levels are to be decompressed, especially if large osteophytes are present, the surgeon may opt to remove the vertebral bodies between the evacuated disc spaces. Biting instruments (rongeurs) of varying sizes and shapes and high speed drills are used to remove the remaining bone and disc material, creating a trough measuring 15-16 mm in width extending superiorly and inferiorly across the entire longitudinal extent of the involved portion of the cervical spinal cord. Removal of the vertebral body(s) comprises a 'corpectomy'.
  • Bone and disc are removed down to the level of the posterior longitudinal ligament (PLL), which overlies the dura directly. The surgeon may chose to remove the PLL if it is felt that it contributes to the compression of the spinal cord, or there are fragments of herniated disc material beneath it. In that case the posterior longitudinal ligament is then carefully grasped and incised, and then removed in a piecemeal fashion.
  • The surgeon will often use either an operating microscope or surgical loupes to provide for magnification and illumination as the operation proceeds. Although the dural sac is visualized during the decompression, the spinal cord and nerve roots are not directly seen.
  • After the spinal cord and nerve roots have been decompressed at the appropriate levels, the portions removed must be reconstructed so as to support the normal loads of the cervical spine. This means either inserting bone grafts within each disc space ('interbody' grafts), or inserting a longer 'strut' graft which spans the defect created in the process of removing a vertebral body(s). In either case the intent is to promote the formation of a living bridge of bone between the previously distinct vertebrae (a fusion). The surgeon may employ either the patient's own bone (autograft) or banked human cadaver bone (allograft), or an synthetic scaffold into which bone graft may be inserted (metal or carbon fiber cages). The reasons for selecting among these are many and complex. Patient and surgeon should discuss these issues pre-operatively, keeping in mind that the chosen strategy will influence the likelihood of healing success. Failure of bone graft healing is among the principal reasons for repeat surgery in these cases.
  • In many cases, the surgeon will recommend internal fixation of the operated/grafted segments with a titanium plate and screw device, which is secured to the remaining vertebral bodies at the margins of the corpectomy, providing for further stability and promoting adequate fusion as well as preventing dislodgement of the bone graft (see Figure 1). Factors thought to increase the probability of bone graft/fusion failure include: 1) increasing numbers of levels to be fused, 2) smoking or other sources of nicotine, 3) patient non-compliance with activity restriction and/or brace wear, 4) poor bone quality (osteoporosis), 5) certain medications (e.g. predisone, anti-inflammatories, chemotherapy), 6) malnutrition, etc.

The usual length of stay in the hospital varies from one to four days.

Potential risks and complications

While uncommon, as with all surgery there are a number of risks and potential complications that can occur, including:

  • Hemorrhage or formation of a wound hematoma
  • Damage to the carotid or vertebral artery resulting in a stroke or excessive bleeding, even death
  • Damage to the recurrent laryngeal nerve resulting in hoarseness
  • Damage to the superior laryngeal nerve resulting in swallowing disturbance
  • Damage to the esophagus or trachea resulting in infection
  • Damage to the dura, resulting in a cerebrospinal fluid leak or pocket of cerebral spinal fluid beneath the incision (pseudomeningocele)
  • Mechanical complications of the graft and plate (including graft migration, breakage of the plate, screw pullout, etc.)
  • Wound infection
  • Development of painful pseudoarthrosis (failure of adequate fusion to occur)
  • Damage to the spinal cord or nerve root(s) resulting in pain, weakness, paralysis, loss of sensation, loss of bowel or bladder function, impaired sexual function, etc.

There is a time and a place for neck surgery, make no mistake.  However, that time and place is AFTER all other conservative approaches have been tried.  Chiropractic care has been helping people avoid this procedure for over 100 years.  Let us know if we can help you or a family member.

Call from GOD

Isn`t it amazing how God works in our lives!  On a Saturday night several weeks ago, this pastor was working late, and decided to call his wife before he left for home.  It was about 10:00 PM, but his wife didn`t answer the phone.

The pastor let the phone ring many times.  He thought it was odd that she didn`t answer, but decided to wrap up a few things and try again in a few minutes.  When he tried again she answered right away.  He asked her why she hadn`t answered before, and she said that it hadn`t rung at their house.

They brushed it off as a fluke and went on their merry ways. The following Monday, the pastor received a call at the church office, which was the phone that he`d used that Saturday night.   The man that he spoke with wanted to know why he`d called on Saturday night.

The pastor couldn`t figure out what the man was talking about.  Then the man said, "It rang and rang, but I didn`t answer." The pastor remembered the mishap and apologized for disturbing him, explaining that he`d intended to call his wife.

The man said, "That`s, OK.  Let me tell you my story. You see, I was planning to commit suicide on Saturday night, but before I did, I prayed, `God if you`re there, and you don`t want me to do this, give me a sign now.` At that point my phone started to ring.  I looked at the caller ID, and it said, `Almighty God`.  I was afraid to answer!"

The reason why it showed on the man`s caller ID that the call came from "Almighty God" is because the church that the pastor attends is called Almighty God Tabernacle!!

“ANYWAY”
 
(On the wall of Mother Teresa's 1st children's ashram)
People are unreasonable, illogical, and self-centered…love them anyway.
  • If you do good people will accuse you of ulterior motives…do good anyway.
  • If you are successful you win false friends and true enemies…succeed anyway.
  • The good you do today will be forgotten tomorrow…do good anyway.
  • Honesty and frankness make you vulnerable…be honest and frank anyway.
  • People favor underdogs but follow only top dogs…fight for some underdogs anyway.
  • What you spend years building may be destroyed overnight…build anyway.
  • People who need help may attack you for helping them…help people anyway.
  • No matter what you do or what you give, someone will not be happy with it…give your best anyway.
Best wishes for a wonder St. Patricks Day from Healing Touch Chiropractic