Surgical Management of Cervical Disc Herniation

Nonoperative Management of Cervical Radiculopathy
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In most cases, surgery for cervical radiculopathy involves removing pieces of bone or soft tissue such as a herniated disk —or both. This relieves pressure by creating more space for the nerves to exit the spinal canal. There are three surgical procedures commonly performed to treat cervical radiculopathy. They are:. The procedure your doctor recommends will depend on a number of factors--most importantly, the type and location of your problem.

Other factors include:. ACDF is the most commonly performed procedure to treat cervical radiculopathy. The procedure involves removing the problematic disk or bone spurs and then stabilizing the spine through spinal fusion. An "anterior" approach means that the doctor will approach your neck from the front. He or she will operate through a 1- to 2-inch incision along the neck crease. The exact location and length of your incision may vary depending on your specific condition.

Disk herniation: Mayo Clinic Radio

During the procedure, your doctor will remove the problematic disk and any additional bone spurs, if necessary. The disk space is restored to the height it was prior to the disk wearing out. This makes more room for the nerves to leave the spine and aids in decompression. Spinal fusion. After the disk space has been cleared out, your doctor will use spinal fusion to stabilize your spine.

Spinal fusion is essentially a "welding" process. The basic idea is to fuse together the vertebrae so that they heal into a single, solid bone. Fusion eliminates motion between the degenerated vertebrae and takes away some spinal flexibility. The theory is that if the painful spine segments do not move, they should not hurt. All spinal fusions use some type of bone material, called a bone graft, to help promote the fusion. The small pieces of bone are placed into the space left where the disk has been removed. Sometimes larger, solid pieces are used to provide immediate structural support to the vertebrae.

In some cases, the doctor may implant a metal, plastic, or bone spacer between the two adjoining vertebrae.

Who Needs Cervical Herniated Disc Surgery?

This spacer, or "cage," usually contains bone graft material to allow a spinal fusion to occur between the two vertebrae. After the bone graft is placed or the cage is inserted, your doctor will use metal screws, plates and rods to increase the rate of fusion and further stabilize the spine. An anterior cervical diskectomy and fusion from the side left and front right. Plates and screws are used to provide stability and increase the rate of fusion.

Bone graft sources. The bone graft will come from either your own bone autograft or from a donor allograft. If an autograft is used, the bone is usually taken from your hip area. Harvesting the bone graft requires an additional incision during your surgery.


It lengthens surgical time and may cause increased pain after the operation. Your doctor will talk to you about the advantages and disadvantages of using an autograft versus an allograft, as well as a traditional bone graft versus a cage. As you get older, your discs dry out and become harder.

The tough fibrous outer wall of the disc may weaken.

Related Physicians

J Orthop Sports Phys Ther. The questionnaire consists of seven questions concerning negative affectiveness and seven questions concerning social inhibition. Lumbar spine lower back : Sciatica frequently results from a herniated disc in the lower back. Nonsteroidal anti-inflammatory medications NSAIDs are analgesics and are also used to reduce swelling and inflammation that occur as a result of disc herniation. HSS J. The non-blinded evaluation by the researcher demonstrates that there is a greater need for resurgeries in patients submitted to fusion 8.

The gel-like nucleus may bulge or rupture through a tear in the disc wall, causing pain when it touches a nerve. Genetics, smoking, and a number of occupational and recreational activities lead to early disc degeneration. Herniated discs are most common in people in their 30s and 40s, although middle aged and older people are slightly more at risk if they're involved in strenuous physical activity. When you first experience pain, consult your family doctor. Your doctor will take a complete medical history to understand your symptoms, any prior injuries or conditions, and determine if any lifestyle habits are causing the pain.

Next a physical exam is performed to determine the source of the pain and test for any muscle weakness or numbness. Magnetic Resonance Imaging MRI scan is a noninvasive test that uses a magnetic field and radiofrequency waves to give a detailed view of the soft tissues of your spine Fig. Unlike an X-ray, nerves and discs are clearly visible. It may or may not be performed with a dye contrast agent injected into your bloodstream. An MRI can detect which disc is damaged and if there is any nerve compression.

It can also detect bony overgrowth, spinal cord tumors, or abscesses. Myelogram is a specialized X-ray where dye is injected into the spinal canal through a spinal tap. An X-ray fluoroscope then records the images formed by the dye. The dye used in a myelogram shows up white on the X-ray, allowing the physician to view the spinal cord and canal in detail. Myelograms can show a nerve being pinched by a herniated disc, bony overgrowth, spinal cord tumors, and spinal abscesses.

A CT scan may follow this test. Computed Tomography CT scan is a noninvasive test that uses an X-ray beam and a computer to make 2 dimensional images of your spine. This test is especially useful for confirming which disc is damaged. Small needles, or electrodes, are placed in your muscles, and the results are recorded on a special machine. Because a herniated disc causes pressure on the nerve root, the nerve cannot supply feeling and movement to the muscle in a normal manner.

These tests can detect nerve damage and muscle weakness. X-rays view the bony vertebrae in your spine and can tell your doctor if any of them are too close together or whether you have arthritic changes, bone spurs, or fractures.

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It's not possible to diagnose a herniated disc with this test alone. Conservative nonsurgical treatment is the first step to recovery and may include medication, rest, massage, physical therapy, home exercises, hydrotherapy, chiropractic care, and pain management.

Surgical Options for Cervical Radiculopathy from a Herniated Cervical Disc

If you don't respond to conservative treatment or your symptoms get worse, your doctor may recommend surgery. Self care : In most cases, the pain from a herniated disc will get better within a couple days and completely resolve in 4 to 6 weeks. Medication : Your doctor may prescribe pain relievers, nonsteroidal anti-inflammatory medications NSAIDs , and steroids. Sometimes muscle relaxers are prescribed for muscle spasms.

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Spine (Phila Pa ). Oct;15(10) Surgical management of cervical soft disc herniation. A comparison between the anterior and posterior. Cervical radicular syndrome (CRS) due to a herniated disc can be safely treated The surgical intervention will be an anterior discectomy or a.

Steroid injections : The procedure is done under x-ray fluoroscopy and involves an injection of steroids and a numbing agent into the epidural space of the spine. The medicine is delivered next to the painful area to reduce the swelling and inflammation of the nerves. Repeat injections may be given to achieve the full effect.

Duration of pain relief varies, lasting for weeks or years. Cervical Overview Group.

Conservative management of mechanical neck disorders: a systematic review. J Rhematol.

Postoperative Care for Cervical Herniated Disc Surgery

Surgery for neck pain. Casey E. Natural history of radiculopathy.


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Management of cervical radiculopathy, anterior and posterior surgical approach-a comparative study

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