The disc tissue protrudes into the spinal canal (spinal canal, spinal cord canal) through the annulus fibrosus, which is either completely or partially torn. There, it presses on the nerve roots and the spinal cord.
In most cases, it is sufficient to treat a herniated disc in the cervical spine conservatively (without surgery). If there are no neurological deficits, but only pain in the shoulder and neck area, conservative therapy is recommended initially.
This usually consists of:
- Rest
- Supervised physical therapy and
- Regular use of medications for pain and muscle tension
These measures often lead to a significant reduction in pain and restricted movement.
Surgery is only necessary if conservative treatment does not lead to any improvement in symptoms. This is especially true if neurological symptoms accompany the pain.
In cases of moderate to severe paralysis in the arms, as well as gait disturbances with a risk of paraplegia, disc surgery is strongly recommended.
If mild paralysis and pain persist for longer than 3 to 4 weeks despite conservative therapy, surgical treatment should also be performed.
Disc surgery on the cervical spine is usually performed by a neurosurgeon. The goal of disc surgery on the cervical spine is to relieve pressure on the compressed spinal nerves.
To achieve this, the neurosurgeon removes either part of the intervertebral disc material or the entire disc using a surgical microscope.
Access to the affected area of the cervical spine is gained either from the front or the back of the neck.
When Is Cervical Spine Surgery Necessary? — Common Evaluations Before the Procedure
Prior to disc surgery, the doctor takes the patient’s medical history (anamnesis) and performs a thorough physical examination.
These include, in particular:
Since this is an inpatient procedure, the patient is admitted to the hospital one day before the surgery.
Disc surgery on the cervical spine is performed as an inpatient procedure under general anesthesia and takes between 60 and 90 minutes. This applies regardless of whether the procedure is performed from the front or the back of the neck.
Following the surgery, the patient spends about an hour and a half in the recovery room. Afterward, care is provided on the general ward.
Depending on the patient’s condition, the surgery is followed by a hospital stay of 4 to 6 days.
Cervical disc surgery is a minor procedure performed using a surgical microscope.
There are two surgical options available. Access to the affected cervical spine area can be achieved as follows:
- From the front (neck side) or
- From the back (neck side)
Which approach is used depends on the location of the herniated disc. In most cases, neurosurgeons perform the disc surgery from the front of the neck.
- Access from the front of the neck
If the procedure is performed from the front of the neck, the patient lies on their back during surgery. At the start of the procedure, the neurosurgeon makes a 4-centimeter-long, transverse incision at the level of the cervical spine. This allows the surgeon to separate the flat layer of neck muscles.
He then moves the neck muscles, arteries, and veins aside to gain a clear view of the front of the cervical spine.
Using a surgical microscope, the neurosurgeon then begins removing the herniated disc. In doing so, the surgeon must take care not to damage the spinal cord or the nerve fibers.
Finally, he inserts an artificial disc into the space created by the removal of the intervertebral disc.
- Access from the side of the neck
If the disc surgery is performed from the side of the neck, the patient is in a semi-seated position during the operation. The patient lies on their stomach. At the start of the operation, the neurosurgeon makes a 4- to 5-centimeter-long, straight skin incision at the spinous processes.
The neurosurgeon then carefully pushes the neck muscles aside to gain a clear view of the intervertebral disc. Using a surgical microscope, the neurosurgeon removes portions of the vertebral arch from the two adjacent vertebrae. They also remove the herniated disc material that is compressing the nerve root.
During this procedure as well, the surgeon must take care not to damage either the spinal cord or the nerve fibers. The stability of the spine is not compromised by the missing bone fragments or the removed intervertebral disc material.
Possible complications of the surgical methods and what to keep in mind after surgery
Complications and risks associated with cervical disc surgery are rare.
When approaching the spine from the neck, the following complications may occur in rare cases:
- Injuries to the major neck vessels and nerves
- Injuries to the trachea and esophagus
- Injuries to the spinal cord and nerve roots (very rare)
If the surgeon injures the nerve being decompressed during the disc surgery, this can lead to, among other things, sensory and motor disturbances in the legs.
In addition, the general risks of surgery also apply here, such as:
- Risk of wound infection
- Impaired wound healing
- Postoperative bleeding in the surgical area
Cervical disc surgery is usually followed by a hospital stay of 4 to 6 days. During the first 4 to 6 weeks after discharge from the hospital, the patient should take it easy physically.
After this period, the patient can resume normal physical activity. After about 8 weeks, they can begin outpatient physical therapy to specifically strengthen the neck and cervical muscles.
If necessary, medications for pain and muscle tension may also be taken.
A herniated disc in the cervical spine, also known as a cervical disc herniation or a herniated disc in the cervical spine, affects the cervical spine and, depending on the location of the herniation within the spinal canal, can result from degenerative changes in the annulus fibrosus and nucleus pulposus, which can cause disc herniations, herniated discs in the cervical spine or a herniated disc in the cervical spine.
In neurosurgery, the decision regarding when cervical spine surgery is appropriate is based on the segment, vertebra, location, nerve structures, and possible compression of the spinal cord—particularly in cases of neurological deficits, severe pain, or when a herniated disc or suspected spinal cord compression is present.
Depending on the surgical method, a microsurgical procedure is performed on the cervical spine involving an incision, removal of the intervertebral disc, where the intervertebral disc is removed and either fusion with a cage or the implantation of a cervical intervertebral disc prosthesis—or the implantation of an intervertebral disc prosthesis with artificial discs—is performed; these are inserted into the cervical spine to preserve spinal mobility.
The surgery is performed at a clinic specializing in neurosurgery and the treatment of spinal disorders, taking into account risks and complications as well as the presence of herniated discs, the risk of a recurrent herniation, or involvement of the lumbar spine, herniated discs in the cervical spine, and whether a herniated disc in the cervical spine is causing symptoms.
The patient can often be mobilized as early as the day after surgery, depending on the surgical methods chosen—whether a disc prosthesis was implanted or spinal fusion was performed.
Surgery is considered when conservative treatments do not provide sufficient relief or when neurological deficits such as loss of strength, sensory disturbances, or compression of the spinal cord occur.
Depending on the findings, either the intervertebral disc is removed followed by spinal fusion, or an intervertebral disc prosthesis is implanted to preserve the mobility of the cervical spine.
In most cases, the procedure is performed on an inpatient basis under general anesthesia to ensure safe monitoring and optimal postoperative care.
Many patients can begin moving around shortly after surgery, but full recovery depends on the surgical method, the patient’s individual tolerance, and postoperative care.
An experienced specialist in spinal surgery or neurosurgery is crucial for an accurate diagnosis, the correct choice of surgical method, and the minimization of risks and complications.
