Newer surgical options for neck pain: a shot at better function
by Robert F. McLain, MD
Some years back I saw a 21-year-old Major League Baseball (MLB) pitcher
referred in with pain in his neck and back that would not improve with rest or physical
therapy. He had just finished his first MLB season, pitching successfully. However, every
time he would complete his throw, he’d experience sharp pain at the base of his neck.
Towards the end of the season, his neck hurt after every pitch.
An MRI demonstrated a small, marble-sized, but growing, tumor at the junction
of the base of his neck and the upper portion of the thoracic spine. The tumor was starting
to destroy bone, and it was putting pressure on the nerve where it exited and went into the
shoulder.
The tumor was determined to be benign. Traditional removal would have
involved either an extended resection of the bone - with a fusion of the neck and upper
back - or an approach through the front of the chest, cutting the collar bone. Either one
would have ended this professional baseball player’s career.
Instead, I used a modification of an endoscopically assisted technique I had
pioneered a few years earlier1 at the University of California, to treat upper thoracic spine
tumors. This procedure used a 4-millimeter endoscope inserted through a 3 cm incision
to carry the bone resection down past the nerve root, past the spinal cord and into the
vertebral body – all without damaging muscles in the front or cutting any of the muscles
in the back.
Used with a minimally invasive image-guidance system, we could safely resect
more bone and verify removal of the whole tumor more effectively.2 T A minimally
invasive fixation plate was placed to stabilize the point of resection without damaging the
adjacent muscles. The patient returned to MLB pitching and had several more successful
seasons.
This case represents an extreme application of minimally invasive techniques for
complex spinal problems, but it suggests what new technology can do in the most
common neck and arm pain cases. For many patients with herniated discs or bone spurs,
today’s emerging technologies allow disc replacement (Total Disc Arthroplasty) instead
of fusion, or Stand-Alone interbody cages instead of extended plate fixation. This is
especially good news for young and active people and those with careers which require
neck mobility and range of motion.
With respect to Total Disc Arthroplasty, the FDA recently approved two devices
for surgical use. The ProDisc-C Total Disc Replacement system developed by Synthes
and the Mobi-C developed by LDR. Both spinal implants were designed to treat
symptomatic cervical disc disease. The ProDisc was approved for one level. The Mobi-C
is the first, and currently the only, approved for one and two levels. A few surgeons in
Northeast Ohio now offer TDA.
The good news is, progress in technologies now allows specially-trained spine
surgeons to easily manage problems that weren’t readily treatable even a few years ago.
As a result, patients are returning to good, and safe, function, with reliable pain relief,
faster than ever before.
So, while some patients, even just a year or so ago, may have been told nothing
could be done for them, it may be worth getting another opinion today.
References
1. McLain, RF. Endoscopically Assisted Decompression for Metastatic Thoracic Neoplasms. Spine,
23:1130-1135, 1998.
2. Moore, T, McLain, RF. Image-guided surgery in resection of benign cervicothoracic spinal tumors: a
report of two cases. The Spine Journal, Vol 5 (2005), Issue 1, pp. 109–114.