Cervical discectomy

Cervical discectomy  involves removal of a cervical disc prolapse through an approach on the back of the neck. The procedure is almost identical to that of cervical foraminotomy for foraminal stenosis. The procedure is performed under general anaesthetic. An incision is made in the midline on the back of the neck. The relevant part of the spine is localized under x-ray. A high speed burr (similar to a dental drill) is used to drill out a portion of the cervical facet joint. This, combined with some removal of other ligamentous tissue, exposes the spinal nerve and allows it to be decompressed. The nerve root is retracted and access is gained to a limited portion of the back wall of the disc. Magnification with an operating microscope is usually required. Often there are multiple fragments of disc identified that are lying  in free contact with the nerve root. Whilst this approach can be used effectively to deal with cervical disc herniations  when they lie towards the side of the spinal canal,  it cannot be used for herniations that lie more towards the middle of the spinal canal, as access is limited by the spinal cord. In other words cervical discectomy is a suitable operation for some cervical disc herniations while anterior cervical fusion or anterior cervical disc replacement can be used for nearly all disc herniations.

Post-operative course

A soft neck collar may be used for comfort though it  is not essential. The neck muscles can fatique quickly because they have been bruised from the surgery. As the head is quite heavy (about 9kg or a large medicine ball)  the main feeling is one of difficulty  holding the head up for long. The soft collar is useful to put on when the neck feels tired, though it can be taken off when the collar begins to irritate the jaw. There is a significant amount of post-operative wound pain that is usually controlled by a patient controlled analgesia device (PCA). The length of the post-operative stay depends on the length of time that ongoing strong analgesia is required though, typically, this is 2-3 days. Return to light duties at work can usually be achieved at three weeks with full duties by 6 weeks.

Risks and Complications

The procedure has a quite low rate of adverse events. The most important are:

• Failure to completely relieve the compression. Frequently cervical disc herniation is caused by a complete rupture of the annulus fibrosis with multiple small fragments of disc material lying free within the spinal canal. Small fragments may be difficult to find as they may lie behind nerves or the spinal cord. After multiple fragments have been removed it is difficult to say conclusively that all the fragments have been removed. If  this is the case a further procedure at the front of the spine (anterior cervical fusion) may be needed.
• Infection
• Nerve damage (rare)