Cervical discectomy is surgery to remove one or more discs from the neck. The disc is the pad that separates the neck vertebrae; 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 20 and 45 years old who have symptoms due to a herniated disc.
Who is a possible candidate for Cervical Disectomy?
Neck pain is usually due to problems with a disc or facet joint. Disc pain tends to be worse when bending forwards. Facet joint problems tend to be worse with neck extension (arching backwards) and occur more often in the older population.
Disc and facet disease can cause neck pain directly, or may cause "referred" pain, meaning pain from the cervical spine which is felt elsewhere - into the neck, shoulders or shoulder blades. It is uncommon for disc or facet joint pain to radiate down beyond the elbow, but it does occur. Facet joint pain rarely radiates down past the shoulder.
Who may require Cervical Discectomy?
Those patients who suffer from persistent neck pain, one or both arm pain and weakness, instability while walking and lack of bowel and bladder control in spite of taking conservative treatment methods such as rest, medication, physical therapy are ideal candidates for this procedure.
The disc may herniate backwards to compress upon the cord or it may bulge sideways to compress upon the nerve. Cord compression may lead to numbness and weakness of both arms and in severe case may affect the bowel and bladder function. This procedure aims to remove the complete disc or its fragments in order to relieve compression of the cord or nerve and restore their function.
In Cervical Discectomy, disc can be accessed via Anterior or Posterior approach.
The Anterior approach is more popular with the surgeons as the access to disc is very easy with little muscle tissue on the way and complete disc removal is possible with no recurrence of disc herniation. This approach also provides a good exposure to all cervical vertebrae from C2 to cervicothoracic junction. The limited amount of muscle division or dissection helps to limit postoperative pain following the spine surgery. The main postoperative problem most patients face is difficulty swallowing for 2-5 days due to retraction of the esophagus.
Posterior approach is slightly complicated as too many tissues have to be traversed to reach the disc. There are chances of injury to spinal cord and nerve roots while accessing the disc. Also since complete removal of disc is not possible, re-herniation can occur. But the positive aspect of this approach is that spinal fusion is not required so natural spine movement is preserved.
- Anterior Approach: The patient is made to lie down on his back under general anesthesia. A horizontal incision is made just 2 inches above the clavicle on either left or right side. The thin muscle layer is cut and the trachea and esophagus are shifted to one side along with the nerves and vessels. The surgeon has a clear view of the cervical vertebrae. An X-ray is done to confirm the involved disc. An operating microscope can also be used to get a better picture of the operating field. The anterior longitudinal ligament is gently removed to reach the osteophytes and the disc fragments. The osteophytes are scraped off and the intervertebral disc is dissected. Once the disc is removed the vertebral bodies are gently distracted to their original distance to fill the space with bone graft. This helps to relieve the compression from the nerves as the diameter of the intervertebral foramen is enlarged. Sometimes cervical discectomy is followed by spinal stabilization using screws and plates.
- Posterior Approach: The patient is sedated under general anaesthesia and made to lie on his abdomen. The neck is slightly bent and head is supported on the head rest. An incision is made on the back of the neck in the midline. The skin, fascia and muscles are retraced to reach the vertebrae. An X-ray is done to confirm the level of affected disc. Edges of the lamina are shaved off to give a clearer vision. Incase of central herniation, both lamina may have to be removed in order to get full view of the fragmented disc. The posterior longitudinal ligament is incised and a small hole is made in the ligamentum flavum. The surgeon now uses a surgical microscope to magnify the operating area and the disc fragments and bony spurs are carefully removed. The muscles fascia and skin are stitched back together.
What happens after surgery?
Patients are usually able to get out of bed within an hour or two after surgery. Your surgeon 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. Surgeons 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.
