Spongy discs that support the seven bones of the neck (cervical spine) sometimes become damaged to the point where corrective surgery is necessary. Cervical microdisc surgery (cervical microdiscectomy) is a procedure where all or a portion of a herniated disc in the neck is removed. It’s sometimes performed without the need for a fusion. If this is the case, full range-of-motion in the neck is retained.
Anterior Cervical Microdiscectomy
Performed from the front (anterior) portion of the neck, an anterior cervical microdiscectomy is usually performed as a minimally invasive procedure with smaller incisions and use of special instruments. Soft tissues in the neck are gently moved to allow access to the affected disc. If the entire disc has to be removed, a bone graft may be performed to maintain stability of the neck.
When bone graft material is needed, it’s called a fusion. A fusion is often necessary if the entire disc has to be removed. The graft material may come from the patient or synthetic material may be used. It will take time for the fusion to actually form and join the two vertebra in the affected area. Screws, plates, and other special instrumentation may be used to keep the neck stable until the fusion forms.
Posterior Cervical Microdiscectomy
With a posterior cervical microdiscectomy, there is often no need for a fusion. It’s an approach that’s usually considered when the affected disc is on the side of the spinal cord. This version of the procedure is performed through the back (posterior) portion of the neck. An X-ray will allow the surgeon to confirm the location of the problem portion of the disc.
Part of the facet joint near the herniated disc may be removed to identify the irritated nerve root. The root will be moved to the side as the damaged (herniated) part of the disc is removed. The nerve root will then be put back into its proper position, as will muscles next to the spine (paraspinal muscles) that may have been temporarily moved to access the disc.
Ideal Candidates for Cervical Microdisc Surgery
Preferred candidates for cervical microdisc surgery have tried other methods of relief without success for, at least, six months or more. Results are often better for patients without any other issues that may be contributing to their neck pain, as may be the case if joints are fractured or nerves are being irritated for other reasons. Patients with underlying health issues, such as uncontrolled diabetes or high blood pressure, may have an increased risk of surgical complications.
Anterior vs. Posterior Cervical Discectomy
The ability to avoid fusion surgery makes posterior cervical microdisc surgery appealing. But since only a small portion of the herniated disc is removed, there’s a slight chance (3-5 percent) that the disc will cause problems in the future. However, it can be a successful remedy for patients without significant disc damage.
The anterior version of a cervical discectomy allows for greater access to the disc. It’s also the preferred method for access if a disc will have to be removed entirely. And in many cases, minimally invasive techniques can be used when fusion surgery is performed along with a microdiscectomy, which means less trauma to nearby tissues. The specific approach to microdisc surgery will depend on:
- The location of the herniated disc
- The extent of the damage to the disc
- Whether or not the cervical spine will become unstable after disc removal
Recovery and Return to Normal Activities
Recovery from cervical microdisc surgery will depend on which version of the procedure was performed. If no fusion was necessary, the recovery period will be shorter. With a fusion, full recovery typically takes several months when physical therapy and rehabilitation is included.
Pain in the neck that extends to shoulders, arms, or hands is a sign that a disc in the cervical spine may be pressing on adjacent nerve roots. The first attempt at relieving this pain isn’t going to be any type of surgery for most patients. But if conservative (non-surgical) treatments fail to ease discomfort, then microdisc surgery may be worth considering. Part of that determination will involve a thorough exam and a clear identification of the source of your neck pain.