Introduction

Cervical discectomy is surgery to remove one or more discs from the neck. The disc is the pad that separates the neck vertebra. "Ectomy" means to take out. Usually a discectomy is combined with a fusion of the two vertebrae that are separated by the disc. In some cases, this procedure is done without a fusion. A cervical discectomy without a fusion may be suggested for younger patients between twenty and forty-five years old who have symptoms due to a herniated disc.

Discectomy is used to alleviate symptoms of a herniated disc. A disc herniation happens when the nucleus inside the center of the disc pushes through the annulus, the ligaments surrounding the nucleus. Numbness or weakness in the arm occurs when the nucleus pushes on the spinal nerve root. Discectomy relieves pressure on the ligaments, nerves, or spinal cord.

Discectomy is also commonly used when the doctor plans to fuse the bones of two neck vertebrae into one solid bone. Most doctors will take the disc out and replace the empty space with a block of bone graft through a procedure called cervical fusion.

Discectomy is usually only used for younger patients (twenty to forty-five years old) whose symptoms are from herniation of the disc. But some doctors think discectomy should always be combined with fusion of the bones above and below. They are concerned the empty space where the disc was removed may eventually collapse and fill in with bone. Inserting a bone block during fusion surgery helps keep the spinal ligaments taut so they won't buckle into the spinal cord. The fusion keeps pressure off the spinal nerves because the graft widens the canal, which the spinal cord passes through.

Surgical Procedure

Cervical discectomy is commonly done through the anterior (front) of the neck, and is called an anterior cervical discectomy. However, when many pieces of the herniated disc have squeezed into the posterior (back) of the spine, doctors may need to operate through the back of the neck using a procedure called posterior cervical discectomy.

A general anesthetic is often used during spinal surgery to put you to sleep. A ventilator may be used to help you breathe while asleep.

Anterior Discectomy

The patient's neck is positioned facing the ceiling with the head bent back and turned slightly to the right. A two-inch incision is made two to three fingers' width above the collarbone across the left-hand side of the neck. The left side is chosen to avoid injuring the nerve going to the voice box.

Retractors are used to gently separate and hold the neck muscles and soft tissues apart so the doctor can work on the front of the spine.

A needle is inserted into the herniated disc, and an X-ray is taken to identify and confirm it is the correct disc. A long strip of muscle and the anterior longitudinal ligament that cover the front of the vertebral bodies are carefully pulled to the side. Forceps are used to take out the front half of the disc.

Next a small rotary cutting tool (a burr) is used to carefully remove the back half of the disc.

A surgical microscope is used to help the doctor see and remove pieces of disc material and any bone spurs that are near the spinal cord.

The muscles and soft tissues are put back in place, and the skin is stitched together.

Posterior Discectomy

This method is used when the herniated disc has fragmented into small pieces near the spinal nerve.

The operation is usually done with the patient lying face down with the neck bent forward and held in a headrest. The doctor makes a short incision down the center of the back of the neck. The skin and soft tissues are separated to expose the bones along the back of the spine.

Then the doctor may use an X-ray to identify the injured disc. A burr is used to shave the edge off the lamina bones, the back part of the ring over the spinal cord. When the disc has jutted straight backward into the spinal cord (central herniation), doctors may need to completely remove both lamina bones in order to see better and to be able to clear all the pieces of the disc near the spinal cord.

A small section of the spinal ligaments and vertebra is removed to expose the spot where the disc fragments are pressed against the spinal nerve. Next, the spinal nerve is gently moved upward. Using a surgical microscope, the doctor magnifies the area in order to carefully remove the disc fragments and any bone spurs.

The muscles and soft tissues are put back in place, and the skin is stitched together.

After Surgery

Patients are usually able to get out of bed within an hour or two after surgery. Your doctor may have you wear a hard or soft neck collar. If not, you will be instructed to move your neck only carefully and comfortably.

Most patients leave the hospital the day after surgery and are safe to drive within a week or two. People generally get back to light work by four weeks and can do heavier work and sports within two to three months.

Outpatient physical therapy is usually prescribed only for patients who have extra pain or show significant muscle weakness and deconditioning.

Rehabilitation

Patients usually don't require formal rehabilitation after routine cervical discectomy surgery. Doctors may prescribe a short period of physical therapy when patients have lost muscle tone in the shoulder or arm, when they have problems controlling pain, or when they need guidance about returning to heavier types of work.

If you require outpatient physical therapy, you will probably only need to attend therapy sessions for two to four weeks. You should expect full recovery to take up to three months.