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Surgery may be necessary in patients who did not benefit from other therapies. The goal of surgery is removal of the part of the disc that is pressing on the nerve. This is done with a procedure named discectomy. The hernia is accessed through a skin incision on the front or back of the neck. The decision to perform surgery from the front (anterior approach) or the back (posterior approach) is affected by numerous factors such as the location of disc herniation, experience of the surgeon, and the patient’s preference. In both approaches, the part of the disc pressing on the nerve is removed, often with good results. In the front approach, most of the disc will need to be removed to reach the herniated disc, which will generally require a fusion.
The greatest disadvantage of fusion surgery is elimination of the movement at the fusion site. Discectomy at a single level does not pose a significant disadvantage with respect to neck mobility. This is because the lost mobility of this segment is compensated and tolerated by other intact levels. However, increased movement and workload imposed on the upper and lower segments will result in wear, neck hernia and pain in these areas. Today, because of developing technology, mobile prostheses can be inserted in the space created by disc removal instead of perfomring a fusion.
However, prostheses are not appropriate for every patient. Ideal candidates are patients who are relatively younger, whose facet joints have not degenerated, and have preserved disc heights. Your doctor will decide best whether a prosthesis is appropriate for you.
What Can I Expect Post-Surgery?
Most patients can go home shortly after surgery—sometimes less than 24 hours. Your doctor will inform you of when you can return to your normal daily activities after surgery.
A comprehensive postoperative rehabilitation program is essential to completely fulfill the activities of daily life. Most patients benefit from a postoperative exercise and physical therapy program under surveillance. Ask your doctor about exercises that will facilitate your recovery. Surgery is very effective in the alleviation of shoulder and arm pain due to herniated disc. However, some pain may continue after surgery.
Most patients respond well to discectomy, however as in all types of surgery, there are some risks. Bleeding, infection, or injury to the spinal cord or nerves are among the risks. Also, persistence or recurrence after surgery are also possible. In 3-5 percent of patients, the disc may rupture again and result in future symptoms.