Herniated Cervical Disc and ACDF
Herniated cervical disc typically causes a condition called radiculopathy, which is nerve pain that radiates down the arm. The distribution of this pain depends upon which nerve root is compressed. Most patients describe the pain as:
- electrical shooting pain
- tingling or burning sensations
- deep muscle achy pain.
This is often worse with coughing or sneezing or moving the neck.
The symptoms of a herniated cervical disc most often resolve without surgical intervention. Nonsurgical treatments that help this pain improve include physical therapy, pain medications, and anti-inflammatories. If these are insufficient, sometimes epidural steroids are injected into the cervical area. If these treatments do not lead to resolution of the pain after several months, or there is substantial weakness, then surgical intervention is an excellent option. Surgical treatment most often relieves all of the pain and helps the strength to improve.
The vast majority of the herniated cervical discs are treated from an anterior approach in the neck. There are 2 common surgeries. The most common is called anterior cervical discectomy and fusion (ACDF). During surgery, a small incision is made in a crease in the neck. The surgeon approaches the anterior cervical spine by separating the structures in the soft tissues of the neck. Using a microscope the disc material is completely removed. The herniated disc fragments at the back of the disc space are then removed and the nerve root is decompressed. At this point, a bone graft is placed between the vertebral bodies where the disc had been removed. Over months, these bones will grow together through this bone graft producing a cervical fusion. A titanium plate and screws are then used to hold these bones together while they heal.
The other surgical option is implantation of an artificial disc. The removal of the disc and disc fragments and decompression of nerve roots are essentially the same as the ACDF surgery. However the artificial disc is placed between the two vertebral bodies rather than a bone graft. This preserved the flexibility of the spine at this level.