Cervical Herniated Disc Surgery
The anterior cervical discectomy and fusion technique is considered the gold standard surgery for cervical disc. It is the most common and traditional operation for symptomatic cervical disc disease. The surgery aims to relieve pain and pressure on the spinal cord and nerve roots.
The procedure involves making an incision on the front of the neck to allow the surgeon to access and remove the damaged or herniated (protruding) disc along with associated bone spurs. Once the damaged disc is removed, the gap that remains between the two bones is filled using a bone graft (a piece of bone taken from either a cadaver or from the patient’s own pelvic bone) or with a synthetic graft, made of medical grade plastic or titanium, with cage device. As the pressure on the nerves gets relieved, the two bones grow together and fuse to form a unified structure which makes it unable to move on that level. During the anterior cervical discectomy and fusion procedure, the surgeon uses a plate that is fixed with screws to the front of the spine in order to maintain its stability. This helps in achieving a solid fusion over time. After the fusion surgery, patients are typically immobilized for almost six weeks and need a cervical collar. The surgeon will perform X-rays imaging test at different time intervals post surgery to check on the fusion progress and healing.
Another approach for surgery is posterior discectomy or lamino-foraminotomy. It is an option for some patients who have a herniated disc localized off to one side of the spinal canal. This procedure is performed on the back of the neck (posterior approach), instead of the front.
Cervical disc replacement, also known as total disc arthroplasty or artificial cervical disc replacement surgery, is a relatively new procedure. It has been approved by Food & Drug Association (FDA) in 2007 as option for surgical treatment of symptomatic cervical disc disease. This procedure is similar to the anterior cervical discectomy and fusion surgery, as it also involves removal of the damaged or degenerated disc. The difference is that the gap created after the removal of the disc from between the two vertebrae is filled using a disc replacement device, rather than bone graft. A disc replacement is an artificial device usually made of two metallic surfaces, one surface is attached to the upper vertebra of the affected disc level and the other to the lower vertebrae. These metal implants may slide over each other directly or a piece of medical grade plastic can be put to separate them. The replacement disc enables the motion between the two vertebrae to be maintained and prevents the need for a fusion, which causes loss of motion at that level. The disc replacement is secured in its place using screws or a press fit anchor that holds the device between the bones.
When a patient is eligible for anterior cervical discectomy and fusion (ACDF) as well as cervical Disc Replacement, the doctor will discuss the potential benefits and risks of both these procedures. The benefits of choosing an artificial disc replacement may include:
- Provides a more natural neck movement
- Less risk for damage or development of degenerative disc disease in the adjacent segments of the cervical spine
- No risk of potential complications that may occur due to the need for a bone graft and spinal instrumentation in a spinal fusion surgery
- A faster return to neck motion post surgery