Cervical Disc Surgery

After Cervical Surgery

There are two basic approaches to a cervical disc herniation. The approach is tailored to the patient, depending upon the exact location of the their disc herniation. No single approach is appropriate for all disc herniations. Some disc herniations are located in front of the spinal cord and some are more lateral than this. When a surgical approach is planned, the safest and most efficient route that will accomplish the goal is selected.

Anterior Cervical Discectomy

For disc herniations that are at least partially located in front of the spinal cord, the anterior approach is used. It is not safe to approach an anteriorly situated disc herniation from a posterior operation. This would require some displacement or retraction of the spinal cord, which would carry considerable risks. Instead, a safer and more direct route is chosen. This is also chosen if the main problem is compression of the spinal cord by arthritic bone. This operative approach may also be chosen if the spinal cord is compressed by arthritic bone, if the majority of the bone compression is anterior to it.

After you are asleep, an incision will be made in the neck as illustrated. Within a few minutes we will be looking at the anterior aspect of the spine. With the use of x-ray and the operating microscope the offending disc is removed. All material touching the spinal cord and nerve will be taken away, approximating about 50 % of the disc.

Benefits: Less painful and a little quicker to recover

Downside: Requires a boney fusion of the disc.

Disc herniations that are laterally located are best approached posteriorly. That is, if the herniation is lateral to the spinal cord but still compressing a nerve, it can be removed with a posterior operation.

This is done by through a 1.5-2 inch midline incision in the back of the neck. The muscles are pulled aside and a small window is made in the bone over top of the disc herniation. With the use of the operating microscope the small amount of disc compressing the nerve is removed. Sometimes it is not possible to remove much disc material, so the bone opening around the nerve will be enlarged. The incision is then closed.

Benefits: No fusion and most of the disc remains after surgery.

Downside: More painful and a little longer recovery required. Not appropriate for herniations more towards the midline

Posterior Cervical Foramenotomy

Links

Congress of Neurological Surgeon

Cervical Spine

Chicago Institute of Neurosurgery

Neurosurgery On-Call