Cervical disc herniation: focus on surgical treatment

Surgical treatment will be offered by the surgeon (neurosurgeon or orthopedic surgeon) only if there is a perfect match between the symptoms and the imaging.

The surgery is done under general anesthesia. In the majority of cases, the skin incision is located in front of the neck (in a skin fold) after radiological identification. This is called in medical terms, the "anterior way". This is the most direct way to access the disc, because passing behind the neck, the spinal cord blocks the road to access the disc (see diagrams below).

The surgeon will very quickly arrive on the anterior cervical spine, and he will then be able to perform a dissectomy, that is to say that he will remove the disc with the herniated disk, to release the nerve root or to see the spinal cord if this one is compressed. It will replace the disc with synthetic material ("cage" or disc prosthesis).

Left: Drawing representing the incision in a fold of the neck. Right: Diagram in axial section, showing the path to access the cervical spine

This surgery gives good results with a disappearance of the pain in the majority of the cases. Cervicalgia and tingling may persist and should decrease in the coming weeks. The decrease in sensitivity in the hand may take a long time to come back. In case of motor deficit present before the intervention, physiotherapy sessions will be necessary in most cases to increase the chances of recovery. Cervical physiotherapy may be proposed in a second time if cervical stiffness persists.

The duration of hospitalization is generally quite short, from 2 to 4 days. Like any surgery, there are operational risks, even rare, that your surgeon will explain before surgery.

In some cases, surgery called "posterior", ie behind the neck, may be proposed by the surgeon, especially in case of compression of the spinal cord by osteoarthritis on several floors. The disc will not be touched, but the surgeon will remove the back of the affected vertebrae to make room for the spinal cord in the spinal canal.

Author : Dr. Louis-Marie Terrier, neurosurgeon at CHRU Bretonneau in Tours

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