Anterior or posterior surgical treatment applied for cervical disc herniation when the spinal cord or nerve root is compressed and conservative treatment has failed.
Indication
- Neck and arm pain (cervical radiculopathy) unresponsive to at least 6-8 weeks of conservative treatment
- Progressive loss of strength or sensation in the arm
- Signs of spinal cord compression (cervical myelopathy: gait disturbance, balance loss, decreased hand dexterity)
- Sudden onset of severe neurological deficit
- MRI findings of significant spinal cord or nerve root compression compatible with the clinical picture
- Severe, intolerable neck-arm pain that significantly impairs quality of life
Preparation
- Cervical MRI, dynamic X-ray, and CT evaluation when needed
- Anesthesia consultation, blood tests, and ECG
- Adjustment of blood thinners with physician approval
- Fasting for 8 hours before the procedure
- Otolaryngology evaluation if there are pre-existing swallowing or vocal cord problems (when an anterior approach is planned)
How it's performed
- The patient is placed supine (anterior approach) or prone (posterior approach)
- General anesthesia is administered; blood pressure, heart rhythm, and oxygen levels are continuously monitored
- In anterior cervical discectomy and fusion (ACDF), a 3-4 cm incision is made on the anterior aspect of the neck
- The disc is removed using a surgical microscope, and the spinal cord and nerve root are decompressed
- A cage is placed in the disc space, or an artificial disc prosthesis may be applied
- Stabilization with a plate and screws is performed when necessary, and tissues are closed in layers
Post-procedure
- Discharge after 1-2 days of hospitalization
- A soft cervical collar is generally recommended for several days to 2 weeks (depending on surgeon preference)
- Heavy lifting, intense neck movements, and prolonged driving are restricted in the first weeks
- Physical therapy and posture training from the 2nd-4th week
- Return to desk work in 1-3 weeks, return to heavy physical work in 6-12 weeks; follow-up visits at 2nd, 6th week, and 3rd month
Risks
- Nerve root or spinal cord injury (rare; transient/permanent neurological deficit)
- Swallowing difficulty (dysphagia) and transient hoarseness (recurrent laryngeal nerve involvement in anterior approach)
- Cerebrospinal fluid leakage, hematoma
- Infection and fusion failure (nonunion; pseudarthrosis)
- Long-term degeneration at adjacent levels (adjacent segment disease)
FAQ
Does every cervical disc herniation require surgery?
No. The vast majority of cervical disc herniations resolve with conservative methods such as rest, medication, physical therapy, and injections when needed. Surgery is considered as a last option in cases of progressive loss of strength, signs of spinal cord compression (myelopathy), or severe pain unresponsive to conservative treatment.
Is disc prosthesis or fusion better?
The choice depends on the patient's age, the location of the herniation, joint degeneration, and mobility expectations. An artificial disc prosthesis may reduce stress on adjacent levels; fusion may be safer in advanced degeneration. The optimal choice differs for each patient.
Can I move my neck after the surgery?
Neck movements are largely preserved after single-level ACDF. There may be some restriction in the range of motion in multilevel fusions. With disc prosthesis, motion is largely preserved.
Is hoarseness after surgery permanent?
Transient hoarseness or swallowing difficulty may occur in some patients during the first few weeks; it usually resolves within 6-12 weeks. Permanent problems are rare.
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