Most episodes of arm pain due to a cervical herniated disc will resolve over a period of weeks to a few months. However, if the pain lasts longer than 6 to 12 weeks, or if the pain and disability is severe, spine surgery may be a reasonable option.
Spine surgery for a cervical herniated disc is generally very reliable and can be done with a minimal amount of postoperative pain and morbidity (unwanted after effects). With an experienced spine surgeon, the neck surgery should carry a low risk of failure or complications. The success rate of surgery for a cervical herniated disc is about 95 to 98% in terms of providing relief of arm pain.
Anterior cervical discectomy and spine fusion is the traditional operation for treating patients with symptoms related to a degenerative or herniated disc in the neck. In this surgery, the disc is removed through a small one-inch incision in the front of the neck.
This procedure consists of removing the damaged disc entirely, decompressing the nerve or spinal cord, and replacing the disc with bone graft. The bone graft material may come from a number of sources:
- The patient’s own bone from the iliac crest (pelvic bone)
- Cadaver of banked bone
- Synthetic bone
InFuse (RhBMP2) or bone morphogenic protein is a protein molecule contained in a collagen sponge which stimulates bone cells to make bone. A wedge of bone or a titanium, carbon fiber of plastic cage filled with bone graft material is placed in the space where the disc was removed and supports the vertebrae.
A metal plate with screws may be used to help hold the bone graft or cage in place, add stability (eliminating the need for an external brace or collar) and provide support to allow this segment of the neck to fuse together. The purpose of an anterior cervical discectomy and fusion surgery is twofold:
- To remove the painful structure – either the herniated disc or the osteophytes (bone spurs) that are compressing the nerves and/or spinal cord.
- To eliminate motion by inducing a fusion at the disc space where the disc has been removed, aided by the use of bone grafts.
Anterior Cervical Discectomy and Fusion Video
This type of surgery typically improves the pain in over 90% of people with one-level disease. However, there are potential complications in using bone grafts in pursuit of a fusion. Harvest of one’s own bone may be associated with both acute and potentially long-term pain from the donor site. Any type of bone graft may fail to heal, resulting in a so-called ‘non-union’, which may require another fusion operation. Sterile bank bone (cadaver bone) is more convenient and not associated with donor site complications, but it tends to heal a lesser percentage of the time. Studies have also shown that by fusing a segment of the spine, the levels of the spine above and below the fused area are now forced to absorb more load since there is no longer any intervening motion shock absorption. These adjacent levels may then wear out and become symptomatic in up to 25% of patients within ten years, possibly requiring more surgery. This is called adjacent-segment degeneration.
Possible complications from spine surgery for a herniated disc include:
- Damage to either the trachea/esophagus or one of the major blood vessels in the anterior spine (front of the neck). This should happen in less than 1 in 1,000 cases.
- In about 4 – 25% of cases, retraction on the nerve to the voice box (recurrent laryngeal nerve) can cause hoarseness. The hoarseness usually resolves in the majority of cases over a two to three month period.
- Fusion rates run about 95%. Occasionally, there may be a postoperative nonunion that requires a re-fusion. Without a cervical plate there is a possibility (less than 1%) that the anterior bone graft will displace.
- With either the anterior or posterior approach there is a 1 in 10,000 chance that there would be either nerve root or spinal cord damage.
- Infection or cerebrospinal fluid leak happens less than 1% of the time.
Postoperative Care Following Spine Surgery for a Cervical Herniated Disc
For anterior surgery, there usually is not a great deal of postoperative pain. The surgery is done through a small incision in the front of the neck, and the spine can be accessed in between tissue planes that do not require cutting. This type of surgery usually can be done either outpatient (going home the same day as surgery) or with one overnight stay in the hospital.
The pain in the arm usually goes away fairly quickly, although it may take weeks to months for the arm weakness and numbness to subside. It is not uncommon to have some neck pain for a while.
Postoperatively, most spine surgeons prescribe a soft neck brace, although the type of brace and length of usage is variable. Also, most spine surgeons will ask their patients to limit their activities postoperatively, although the amount of restrictions and the length of time tend to vary. Ask your spine surgeon before the surgery what his or her usual protocol is regarding postoperative care.