The operation of a slipped disc of the cervical spine

For the operation of a herniated disc in the cervical spine, there are usually two different procedures to consider:

Anterior discectomy with ventral fusion: This is a microsurgical technique that requires access from the front via the neck. Here, the patient is placed on the operating table in a supine position. The access is made through a small incision in the neck.

After opening, the muscles and surrounding structures (vessels, nerves, the trachea or thyroid gland) are carefully pushed to the side to reveal the view of the spinal column. The affected intervertebral disc is searched for and completely removed. Bony attachments of the vertebrae that constrict the spinal canal can also be removed.

Dorsal foraminotomy with relief of the nerve root: This is performed via an access from the back. Access from the back via the back is mainly carried out in the case of herniated discs to the side (laterally). In the case of additional bony attachments to the vertebral body, this technique is inferior to access from the front.

The operation is performed in the prone position/side position of the patient. After a small incision in the neck area, the muscles of the neck are carefully pushed to the side to expose the cervical spine. Then parts of the vertebral arch and the affected intervertebral disc are removed.

Depending on the type of herniated disc, the surgeon selects the appropriate procedure. In complex cases, a mixture of the two surgical procedures may also be necessary. The standard procedure is a discectomy with an access from the front via the neck, since with an access from the back the spinal cord is always in front of the vertebral body.

Both procedures are performed under general anesthesia during an inpatient stay. As a replacement for the disc, either a so-called cage made of titanium or a disc prosthesis is used. However, the prosthesis is only used in young patients without bony attachments or pronounced degeneration of the vertebral bodies.

The advantage of the disc prosthesis is a permanent mobility in the operated segment, since the prosthesis is based on a real disc. It consists of an inner soft core and a firmer outer structure. For whom this prosthesis comes into question and appears to be sensible, it must always be decided individually for each patient together with the doctor who treated him.

Instead of the cage, a bone chip from the patient’s iliac crest can be used. However, this technique is used less frequently nowadays, since patients with cage treatment can be mobilized earlier postoperatively. The disadvantage of the cage, however, is the stiffening of the affected vertebral segment, which can lead to limited mobility in this area.

Under certain circumstances, it may also be necessary to stabilize the spinal column with a screw-rod system or a plate to counteract spinal instability. As with any operation, this procedure also involves risks. First of all, the general risks of surgery should be mentioned: Post-operative bleeding in the operating area, infections or wound healing disorders may occur.

In addition, surgery on the cervical spine can result in injury to the spinal cord or nerves. This manifests itself with sensory disturbances or disturbances of movement up to paralysis. However, nerve injuries are very rare.

Furthermore, surrounding structures such as muscles, windpipe, thyroid gland or vessels can be injured. Temporary hoarseness may occur after the operation, but this usually subsides again. Painful swallowing can also occur in the first days after the operation.

Overall, complications are rare. The operation is performed as part of an inpatient stay. Usually the patient is admitted to the ward one day before the operation.

The operation itself usually takes between one hour and 90 minutes. Complications are rare, but possible. This is followed by an inpatient stay of 2 to 7 days. The length of stay varies depending on the hospital, but also on the patient’s recovery or the occurrence of complications.