The vertebrae that start at the base of your skull and are in your neck are called cervical vertebrae. You have 7 cervical vertebrae and your surgery will name which ones surround the damaged disc. For example, you may have been told you “need a discectomy and fusion of C 6-7.” You may hear your surgeon say that your disc herniation was due to “degenerative disc disease.”
Degenerative disc disease can cause a variety of problems, with herniation being one of them and may require a variety of solutions in addition to discectomy. A cervical herniation is when a disc has moved from its correct spot between the vertebrae to protrude or extend on one side or another.
In the simplest terms, it means that a disc or several between the vertebrae in your neck region ruptured or tore and the soft inner jelly-like layer has bulged out of the harder outer edge. This is also sometimes erroneously called a “slipped disc,” though there is no actual “slipping,” and the appearance is more of a protrusion of the disc.
The disc rupture may result in neck pain associated with a cervical radiculopathy or myelopathy (pain that radiates down an arm or leg). Pressure on a nerve root results in a radiculopathy or pain, numbness, tingling or even weakness in the distribution of that nerve down your arm. Compression of the spinal cord by the ruptured disc may result in a cervical myelopathy characterized by neck pain, numbness/tingling/weakness in all extremities, lack of coordination, loss of balance with walking, and even bowel and bladder dysfunction.
Disc herniation can be due to aging, but can also be caused by sports, exercise or lifting injuries.
Sometimes disc herniations will resolve themselves if they are not severe. Other times the pain and neurologic dysfunction can subside with non-surgical methods such as physical therapy, chiropractic manipulation, and spinal injections. Disc herniations can also be seen on imaging but may not always cause symptoms.
However, many disc herniations will continue to cause chronic pain and dysfunction that will persist until the physical structure or ruptured disc is surgically altered to alleviate the pain. Surgery is recommended for severe/incapacitating pain, nerve dysfunction or when all the other treatments have failed and the herniation looks likely to be alleviated with surgery. The disc herniation surgery seeks to eliminate the root cause of pain and nerve dysfunction and improve the quality of life for the patient.
Surgery for disc herniations is called a “discectomy,” which means essentially removing the portion that is protruding and irritating the nerve or spinal cord.
Unlike a disc herniation in the lower back, surgery for a cervical disc herniation is frequently performed through a small incision in the front of the neck. The injured disc or discs are removed. Because of the important need for stability in the neck area and the crucial need to make sure the spinal cord and nerves or protected and unobstructed, stabilizing measures like a fusion of the vertebrae or disc replacement (arthroplasty) are sometimes necessary. Less commonly, the injured disc or discs can be addressed from the back of the neck.
The majority of disc herniation surgeries result in significant relief from pain and dysfunction for the patient. If the patient is properly diagnosed and fits the criteria for the discectomy procedure, the outcomes are generally excellent assuming the patient participates in the right aftercare procedures. Each patient is unique and we will discuss your particular case with you in great detail as well as what your expectations should be.
Cervical disc herniation surgery is not a one size fits all, but a minimally invasive surgery with a small incision usually means you may have the surgery in the morning and go home that evening or the next morning, depending on how involved the surgery is. You will be given medication to help manage any post-surgical pain that your surgeon will discuss with you in great detail.
A physical therapist will help you get out of bed and help you walk and get around before you leave the hospital or surgery center, and physical rehabilitation plan will be prescribed to help you safely learn to move around as you heal. A neck brace may be necessary for a time after the surgery. Most discectomies do not involve major convalescence and patients do not need excessive time off from work (though several days are generally needed).
Your surgeon will discuss whether your surgery will result in any permanent restrictions, usually that is only after more complicated surgeries. You will not be able to lift anything heavy for a few weeks or engage in similar strenuous activity, therefore those patients whose jobs involve strenuous activity such as construction will need more time off than someone who is seated all day. Your doctor will develop a detailed return to work and activity plan for you.