Cervical microdiscectomy is a procedure used to remove a herniated disc (or portion of a disc) without the need for spinal fusion. Spinal fusion offers excellent results, but it does limit some mobility afterward, as the fused segments are now joined as one. Unlike other forms of minimally invasive surgery of cervical spine, this procedure is done from the back of the neck (posterior approach).
Surgery for cervical disc disease generally involves one of three operations:
- Posterior cervical foraminotomy and microdiscectomy
- Anterior cervical discectomy and fusion
- Anterior cervical discectomy and artificial disc replacement
Posterior Cervical Foraminotomy and Microdissection
This is a procedure performed at the back your neck; It involves making a small incision in the midline of your neck and performs a minimally invasive muscle dissection to expose the level of where your nerve or spinal cord is compressed. This operation involves creating a window between two vertebrae. The foraminotomy is made over a nerve root to alleviate pressure on your nerve. The nerve may be trapped by bone overgrowth, or spurs (osteophytes) or there may be a disc protrusion which is pressing on the nerve. Foraminotomy can be done with an endoscope or a microscope. If the disc fragment is removed this procedure is called a microdiscectomy.
Anterior cervical discectomy and fusion (ACDF)
Performed from front of neck, this procedure involves removal of the affected cervical intervertebral disc and placing a artificial cage ( Polymer or Titanium) in its place. Overtime patient own bone grow through the cage and the two vertebrae fuses together. sometimes a small piece of Iliac bone ( part of Pelvic bone) can be harvested and put instead of the cage. This surgery produces excellent results and is very safe in expert hands. Most patients are discharged next day of surgery. Multilevel discectomy may requiring putting a small plate over spine to keep cages in there place. almost all cases are closed with subcuticular stitches with leaves no or minimal scar.
Anterior cervical discectomy and artificial disc replacement
This procedure is similar to ACDF but involves putting an artificial disc instead of cage. It has advantage of preserving motion as your normal disc would have allowed. However, this surgery can be done in only selected few patients who are suitable candidates and also is more expensive than conventional ACDF.
Following anterior cervical discectomy and fusion, or an artificial disc replacement, you are encouraged to walk the day after your surgery. Your neck is stable and it’s best to mobilise it as soon as possible, within the limits of discomfort. Most patients will have mild swallowing difficulties immediately after surgery. This usually resolves over a few days. Hoarseness is also possible following this surgery, but very rare. It usually occurs with surgery at the lower-most disc, as at this level that there is a nerve that controls the voice box. There are usually no stitches to remove; the stitches are buried and will be reabsorbed and dissolve with time. You can shower with the dressing on the first two days after surgery. Dressings are removed on the third day and can be left open. The wound should not be soaked – such as swimming or sitting in a bath – for one week after your operation. After surgery it is not uncommon to have various aches and pains in and around the wounded shoulders. This should improve over 6 to 12 weeks. In the first two weeks after surgery, mild nerve pain may persist because of nerve swelling. Recurrent pain usually resolves within two weeks. If the pain is severe, you should contact the surgeon for checkup and if needed pain killers. Avoid heavy exercise and heavy lifting for few weeks after the surgery, at which time you can resume normal activities.
Risks of cervical spine surgery
There is risk with any surgery. Simply cutting the skin exposes the body to infection and bleeding. The more complicated the operation, the greater the risk.
For all surgery, risks include infection and post-operative bleeding. While bleeding during an operation can be a problem in major surgery, the bigger risk lies after surgery when bleeding can recommence. While infection or bleeding complications do not mean your surgery has failed, but if they occur it could mean you need another operation, sometimes urgently. Other rare complications includes leakage of spinal fluid, implant failure or dislodgement, there is also a risk of death or paralysis with any brain or spinal operation, but these are extremely rare.