Cervical Herniated Disc
The cervical herniated disc is a name coined for a disease in which the disc in the cervical spine compresses and breaks open, leading to the leak of the inner fluid into the spinal canal. There are various conservative treatment options to relieve the symptoms, which when fail, surgery is recommended. The best surgical option considered mostly by the surgeons is anterior cervical discectomy.
Symptoms Of A Cervical Herniated Disc
- Extreme pain in the neck (cervical spine), which radiates to the arm, neck, jaw, and head.
- In severe cases, patients may experience facial numbness.
- In most of the patient, the pain resolves over a period of week or months. If the pain lasts longer or if the pain and disability is severe then surgery might be the best option.
Treatment of a Cervical Herniated Disc
The first step toward the treatment is rest and the use of non-steroidal anti-inflammatory drugs. If the pain continues for long and the severity does not lessen, then the patient is prescribed oral steroids and oral narcotic agents to decrease inflammation and pain. If the pain lasts for more than 4 weeks the various treatments recommended are,
- Exercises and physical therapies to relieve pressure on the nerve root.
- Manual traction
- Epidural injections to reduce inflammation and pain.
Surgical Options For Treating Cervical Herniated Disc
Surgery for the cervical herniated disc can be performed in the following ways:
Anterior Cervical Discectomy And Spine Fusion (ACDF)
The most common method of surgery amongst the spine surgeons is the anterior cervical discectomy. The procedure involves removal of the damaged disc through a small incision made in the front of the neck of the patient. The spine fusion involves the fusion of the space after the removal of the disc. A plate can be added in front of the graft to add to stability and for better fusion rate.
Posterior Cervical Discectomy
This procedure is known to be difficult than ACDF, as there are a lot of veins in the posterior area, and can result in excessive bleeding during the surgery. This procedure also requires manipulation of the spinal cord.
Cervical Artificial Disc Replacement
The procedure is similar to the anterior cervical discectomy, as the incision is made in the front of the neck. It only differs when instead of fusing the disc space after the removal of the affected disc an artificial disc is placed. The disc mimics and performs the function of the original disc.
Percutaneous Endoscopic Cervical Discectomy
Anterior cervical discectomy and fusion is the most favorable surgical option chosen by the surgeons, a new approach, known as percutaneous endoscopic cervical discectomy has reported encouraging clinical outcomes(1). The advantage of this procedure is that in it interbody fusion is not required and the patient’s symptoms are resolved. It has two approaches, anterior and posterior, and is chosen depending on the pathological site.
In percutaneous endoscopic discectomy, a specific and selective decompression can be achieved with minimal surgery-related trauma.
Postoperative Care For Cervical Herniated Disc Surgery
In ACDF and artificial disc procedure, the patient does not experience much pain as the surgery is done through a small incision in the front of the neck. The spine can be accessed from in between tissue plane, thus much of cutting is not required.
- The patient is discharged after a day of the surgical procedure.
- Medications such as painkillers and anti-inflammatory are prescribed by the surgeon.
- The patient is advised to increase their activity level according to how much they can tolerate. To do high-impact exercises, the surgeon’s confirmation should be taken.
- As anterior cervical discectomy is not much invasive procedure, there is no long-term limitation.
The treatment of the herniated disc is a complicated procedure, and also depends a lot on the condition of the patient and the severity of the symptoms. A treatment which helps relieves pain for one may not be successful for other. Getting consulted by the best spine specialist helps the patient in going ahead with the best-suited treatment option.
If the patient is advised surgery as a treatment option, ACDF and artificial disc are most reliable surgeries for a herniated disc and have favorable outcomes.(2)