Motion-Preserving Options

Why Motion Preservation Matters

Your spine is designed to move. Each vertebra articulates with the ones above and below, creating a flexible column that allows you to bend, twist, and turn. When one level is fused, adjacent levels must compensate by moving more, potentially accelerating degeneration.

Benefits of Preserving Motion

• Maintains natural biomechanics: Spine moves as it was designed to
• Reduces adjacent segment stress: Less strain on neighboring levels
• Preserves flexibility: Better range of motion for daily activities
• May reduce future surgery risk: Less adjacent segment degeneration
• Faster return to activity: No fusion healing time required

When Fusion Is Still Necessary

Motion preservation isn't appropriate for everyone. Fusion remains the best option when:

• Significant instability or spondylolisthesis is present
• Severe arthritis has destroyed the joints
• Deformity correction is needed
• Multiple levels require treatment
• Prior surgery has altered anatomy

Cervical Disc Replacement (Artificial Disc)

How It Works

Cervical disc replacement (also called cervical arthroplasty or ADR) involves:

• Removing the damaged disc through an anterior (front of neck) approach
• Decompressing the spinal cord and nerve roots
• Inserting an artificial disc designed to mimic natural motion
• Allowing immediate neck movement without fusion restrictions

Disc Replacement vs. ACDF

Who Is a Candidate?

Ideal candidates for cervical disc replacement:

• Single or two-level cervical disc disease
• Arm pain or myelopathy from disc herniation or stenosis
• Preserved disc height and minimal arthritis
• No significant instability or deformity
• Age typically under 60-65 (though not absolute)
• No prior cervical fusion at adjacent levels

Recovery and Outcomes

• Hospital stay: Overnight or 23-hour observation
• Return to desk work: 2-3 weeks
• Return to full activity: 6-8 weeks
• Success rate: 85-90% experience significant symptom relief
• Motion preservation: Most patients maintain 70-80% of normal motion
• Adjacent segment disease: Significantly lower risk than fusion

Cervical Foraminotomy

The Procedure

Cervical foraminotomy is performed through a posterior (back of neck) approach:

• Small incision at the back of the neck
• Minimally invasive tubular approach between muscles
• Remove small amount of bone and ligament compressing the nerve
• Preserve disc, facet joints, and spinal stability
• No fusion or hardware required

Advantages

• Preserves motion: No fusion means full neck flexibility
• Preserves disc: Disc remains intact and functional
• Minimal tissue disruption: Small incision, muscle-sparing approach
• Fast recovery: Most patients home same day
• No hardware: Nothing implanted, nothing to fail

Best Candidates

Foraminotomy works best for:

• Foraminal stenosis (bone spurs narrowing nerve opening)
• Lateral disc herniations (off to the side)
• Single nerve root compression
• No central canal stenosis or myelopathy
• Preserved disc height

Endoscopic Motion-Preserving Procedures

Endoscopic spine surgery represents the cutting edge of motion preservation. Using a thin endoscope (camera), surgeons can decompress nerves through incisions as small as 0.5 inches while preserving all structural elements.

Endoscopic Lumbar Discectomy

For lumbar disc herniations:

• Removes herniated disc fragment through tiny incision
• Preserves facet joints and ligaments
• Maintains spinal stability and motion
• Often performed with local anesthesia and sedation
• Same-day discharge, rapid return to activity

Endoscopic Cervical Decompression

For cervical radiculopathy:

• Posterior approach preserves anterior structures
• No disc removal or fusion required
• Maintains full neck motion
• Minimal post-operative restrictions

Dr. Greenberg's Endoscopic Training

Dr. Greenberg completed advanced fellowship training in endoscopic spine surgery, learning from pioneers in the field. This specialized training allows him to offer these advanced techniques to appropriate candidates in Fort Wayne.