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A cervical discectomy may be performed when a disc is pinching a nerve
(cervical disc herniation). The primary symptom is usually arm numbness,
weakness and/or pain. The surgery is best for relieving the pain. Surgery
is generally considered in those patients who have not responded to 6-12
weeks of conservative treatment. Generally, if the pain starts to subside
during this period of time continued conservative treatmentis advisable,
and any residual numbness/weakness can be expected to improve with time.
In this procedure the disc that is pinching the nerve is surgically
removed. The anterior approach is from the front of the neck and can
provide exposure from the second cervical vertebrae down to where the
cervical spine meets the thoracic spine. Surgeons often prefer it because
it provides good access to the spine through a relatively uncomplicated
pathway, and through a small incision. The limited amount of muscle
transection or dissection helps to limit postoperative pain. There is
little chance of the disc herniation recurring following this surgery
because most of the disc is removed during the operation.
The discectomy is commonly done in conjunction with an anterior cervical
fusion. Fusion surgery (fusing one bone to another) is often done to
prevent motion at a vertebral segment. Decreasing the motion at a painful
motion segment should decrease the pain at that segment. Fusing the two
vertebral segments together after removing the disc also prevents collapse
of the disc space where the disc was removed, which lowers the chance of
chronic neck pain.
Potential risks and complications
For the discectomy portion:
·
Nerve root damage (1 in 10,000 chance)
·
Damage to the spinal cord (about 1 in
10,000)
·
Bleeding (very rare)
·
Infection (very rare)
·
Damage to the trachea/esophagus (extremely
rare)
·
Continued pain
·
Temporary hoarseness (1%)
·
Temporary difficulty in swallowing (common
but usually not severe)
For the fusion portion:
·
The principal risk from a fusion is that it
does not heal. In general, allograft bone does not heal quite as well as
autograft bone, but both yield good results when used in the anterior
cervical spine.
·
If a graft is used without instrumentation,
there is a small chance (1% to 2%) of a graft dislodgment orextrusion. If
this happens, another operation is necessary to reinsert the bone graft,
and instrumentation (plates) can then be used to hold it in place.
·
If a donor graft is used, there is a
theoretical risk of transmission of an infection. The risk of contracting
HIV from a donor graft has been estimated to be between 1 in 200,000 to 1
in 1 million.
Results
Overall, most surgical series point to a significant improvement for most
patients who undergo an anteriorcervical decompression and fusion.
Approximately 95-98% of patients will experience significant relief of
their arm pain. It is not nearly as reliable for neck pain alone.
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