Surgery may be considered if conservative treatments fail to improve symptoms after some time, usually 6 to 12 weeks, or if there is significant weakness, loss of function, or severe pain.
Surgical options include:
Anterior Cervical Discectomy and Fusion (ACDF)
This is the time-tested traditional surgical treatment option for a herniated cervical disc when there is severe or progressive neurological damage and significant pain that does not respond to non-surgical treatments. It involves removing the herniated disc (discectomy) to relieve pressure on the nerve roots or spinal cord and then fusing the bones with a graft of bone or synthetic materials. Plates and screws may be used to stabilize the spine.
ACDF is indicated for patients with symptomatic cervical herniated discs that have not improved with conservative treatment, especially when accompanied by nerve compression symptoms such as pain, numbness, and weakness in the arms.
Cervical Artificial or Total Disc Replacement (ADR or TDR)
In this procedure, which is becoming the gold standard surgically, instead of fusing the vertebrae after removing the herniated disc, the surgeon inserts a motion-restoring artificial disc into the surgically decompressed, vacated disc space. The artificial disc is designed to mimic the form and function of the natural disc, preserving motion at the operated level of the spine.
ADR may be considered for patients with cervical disc herniation causing nerve compression symptoms who have not found relief with non-surgical treatments. It is particularly suited for patients where preserving neck motion is desirable and who do not have conditions that would necessitate fusion, such as significant spinal instability or multi-level disc disease.
Posterior Cervical Discectomy
This approach involves removing part of the herniated disc that is compressing a nerve root from the back of the neck. Posterior cervical discectomy is indicated for certain cases of cervical disc herniation, especially when the herniated disc is located more laterally (to the side). It might be more accessible from the posterior approach without requiring the removal of too much bone or other tissue and does not require any pressure or retraction on the spinal cord.
The choice among these surgical options depends on several factors, including the location and severity of the disc herniation, the presence of other cervical spine issues, the patient’s overall health, and personal preferences regarding recovery and outcome expectations.
Recovery times and post-operative care vary between procedures, depending on factors like the patient’s health and lifestyle, the specific technique used, and the presence of complications. Post-surgical rehabilitation typically involves physical therapy to strengthen the neck muscles, improve flexibility, and support a quicker return to normal activities.
The decision to proceed with surgery is taken after a thorough evaluation and discussion between the patient and the healthcare provider, considering the potential benefits and risks of the procedure. Contact Dr. Hieu Ball to schedule a consultation to learn more about your treatment options.
