Cervical discectomy is surgery to remove one or more discs from the neck. The discectomy may or may not be combined with a fusion of the two vertebrae that are separated by the disc. Generally, fusion is avoided for people in the younger age group who have symptoms due to a herniated disc.
The surgery can be done through the front (anterior) or occasionally done through the back (posterior) of the neck. Discectomy may be done to alleviate symptoms of a herniated disc. A disc herniation happens when the nucleus inside the center of the disc pushes through the annulus. This causes pain, numbness or weakness in the arm because of pressure exerted on the spinal nerve root. Central herniation is of greater concern where the nucleus herniates straight backward into the spinal cord.
Discectomy is also commonly used when the surgeon plans to fuse the bones of two neck vertebrae into one solid bone. The disc is removed and replaced with a block of bone graft, a procedure called cervical fusion.
Cervical discectomy is usually done through the front of the neck. In cases where many pieces of theCervical Discectomy herniated disc have squeezed into the back of the spine, the need to operate through the back of the neck using a procedure called posterior cervical discectomy is preferred.
As in the case of most spine surgeries general anesthesia is used
In anterior Discectomy the patient's neck is positioned facing the ceiling with the head bent back and turned slightly to the right. A two-inch incision is made above the collar bone across the left-hand side of the neck. The neck muscles and soft tissues are moved and held suitably with retractors. The muscle and the ligaments that cover the front of the vertebral bodies are carefully pulled to the side. A needle is inserted into the herniated disc under guidance from a C-Arm to confirm the correct disc. A forceps is used to take out the front half of the disc and the back half of the disc is removed with a burr which is a small rotary cutting tool. The muscles and soft tissues are put back in place and the skin is stitched together.
Posterior Discectomy
This method is used when the herniated disc has fragmented into small pieces near the spinal nerve.
The patient is made to lie face down with the neck bent forward and held within a headrest. A short incision is made down the center of the back of the neck and the skin and soft tissues are separated to expose the bones along the back of the spine.
A C-Arm identifies the injured disc. The edge off the lamina bones which is the back part of the ring over the spinal cord is shave off with a burr. If there is a central herniation both lamina bones may be completely removed in order for better visual and access to remove the disc.
After shaving the lamina bone, a small opening is cut in the ligament within the spinal canal and in front of the lamina bone. Using a surgical microscope the surgeon is able to remove the disc fragments that are pressed against the spinal nerve. The muscles and soft tissues are put back in place and the skin is stitched together.
As with all major surgical procedures, complications can occur. Some of the most common complications following discectomy include:
If a person is on some medication, the anesthesia given during surgery can cause a reaction with the other drugs the patient is taking. Sometimes a patient may have problems with the anesthesia itself. But these are very rare cases. The lungs don't expand as well while a person is under anesthesia, which can affect the basic function of the lungs. You must discuss the risks and concerns with your anesthesiologist.
Deep venous thrombosis or thrombophlebitis where the blood in the large veins of the leg forms blood clotscan occurs after any operation. This could lead to swelling in the legs and become warm to the touch and painful. These blood clots could break apart, they can travel to the lung, where they lodge in the capillaries and cut off the blood supply to a portion of the lung and is known as pulmonary embolism.
Preventive Measures
Infection
Infection though rare but can be a very serious complication. Infections on the surface can be treated with antibiotics. Other deeper infections that spread into the bones and soft tissues of the spine may need to be tackled with a repeat surgery.
Nerve Damage
A nerve injury can occur from touch or cut of the nerve tissue with a surgical instrument or from swelling around the nerve. This could lead to muscle weakness and a loss of sensation to the areas supplied by the nerve.
In an anterior neck surgery, the incision is done on the left side of the neck where the path of the nerve to the voice box is more predictable than on the right side. The nerves could get stretched too far along with the muscles and soft tissues when retractors are used to hold . Patients may have a hoarse sound for a few days or weeks after surgery. In rare cases where the nerve is actually cut, patients may end up with problems related to sounds
Continuous Pain
Most patients get a complete relief of prior symptoms from the discectomy procedure. Pain would be there as with any surgery, but if it persists or becomes unbearable, treatments need to be undertaken that can control your pain.
Patients are usually mobilized within a few hours after surgery. A hard or soft neck collar would be advised to be worn for sometime. Most patients leave the hospital within 2 days after surgery. Driving is possible after 10 to 14 days. In normal cases total recovery takes two to three months.
Physiotherapy is advised for people who have low muscle tone in the shoulder or arm. It is advisable to use guidance before returning to heavy work. Physiotherapy is aimed at controlling pain and muscular inflammation or spasm.
The other Orthopedic Procedures are:
Few Major Hospitals for Cervical Discectomy are:
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