Cervical Herniated Disc Treatments: Doctor Answers Patient Questions

Peter Ullrich, MD

The following explanations, insights and advice about cervical herniated discs - including diagnosing the source of the pain, non-surgical treatments and surgery - are provided by Peter F. Ullrich, Jr., MD, an orthopedic spine surgeon and Medical Director for Spine-health.com.

Patients frequently e-mail us questions about cervical herniated disc treatment options, and while we don’t provide individual responses, periodically, Dr. Ullrich will take time to respond to the more frequently asked questions and we publish the responses in this section of the site.

Please understand that the following responses to cervical disc herniation questions represent the opinion of one physician, and are intended for informational purposes only and not as a substitute for professional medical help or advice.

Cervical herniated disc treatment questions and physician responses

Question:

I have been diagnosed with a C5-C6 cervical herniated disc that is compressing the spinal cord. Anterior cervical fusion surgery has been recommended with urgency. However, I am concerned that the discs adjacent to the fusion site may become vulnerable and that the fusion may not be successful. What less invasive procedures can treat a cervical herniated disc affecting the spinal cord?

Doctor’s response:

There aren’t really any more effective options for a large cervical herniated disc with spinal cord impingement than anterior cervical fusion surgery. That is the bad news. The good news is that it’s a reliable surgery that usually leads to good results.

Spine fusion in the neck is not usually as bad as it is thought to be. Since there are many motion segments in the cervical spine, fusing one segment does not excessively limit the motion in the neck. Most patients with a one level fusion do not notice any difference in their cervical range of motion. Likewise, a one-level fusion in the neck does not place considerably more stress on adjacent levels of the spine (which is thought to be the cause of the adjacent disc problems). In my own practice, I have done many one-level cervical fusions and only had a few patients come back after the surgery with a herniation at an adjacent level.

Part of what is hurting your spinal cord is the motion at the segment with the disc herniation. Without stopping the motion by fusing the spine, it can continue to move and injure the cord. A cervical discectomy with a fusion is generally a reliable procedure with an excellent track record. It is generally considered the gold standard in surgical care for a cervical herniated disc that is impinging the spinal cord.

Although cervical artificial disc technology has come a long way in possibly replacing cervical fusion, as of the publishing of these responses, there are currently no FDA approved cervical artificial disc devices available on the market. However, there currently are at least four FDA-approved trials testing artificial disc technology.

Question:

I have a large cervical herniated disk (C5-C6) pressing into the spine. I have seen four neurosurgeons who have convinced me that I need surgery, and quickly, as I have signs of spinal cord damage. One spine doctor recommended the Bryan artificial disk, one recommended a cage, and another recommended autograph bone fusion. I am concerned with the long-term risks and post-operative effects of each option for treating the cervical herniated disk and would appreciate your advice.

Doctor’s response:

For a cervical herniated disc surgery, the gold standard is an anterior cervical discectomy and fusion. Autograft bone is believed to heal the best, although harvesting the graft from the patient has a fairly high chance of graft site morbidity (20-25%), such as postoperative pain where the graft is taken from the patient’s hip. Most surgeons also add a plate to the front of the cervical spine at the fusion site, as it provides for added stability. Cage techonology is just a different way of obtaining a fusion.

At this point, the Bryan disc is still being investigated, and you are right that there is no long term track record.

Practically speaking, a one level fusion does not greatly affect the mechanics of the neck. There are a lot of motion segments in the neck and fusing one does not put all that much pressure on the unfused disc segments. However, in certain cases, artificial disc technology may prove to be useful in the future to help maintain the normal mechanics of the spine.

What next?

If you have questions about cervical disc herniation, please use this site to find peer-reviewed health information about spinal conditions, diagnosis and treatment options. The quickest way to locate information on the site is to use the “keyword search” box located in the upper left hand corner of each page. Also, if you want to talk online with others who may be in a similar situation or exchange information with other patients with a cervical herniated disc, please go to the Spine Forum Message Boards.

Additional disclaimer: Spine-health.com does not offer medical advice or treatment. This information does not replace the physician-patient relationship, and the information is not medical advice or treatment. It should only be considered as one physician's opinion based on an extremely limited amount of information. Patients should always seek the advice of a trained health professional for back pain or any health condition. Please note that the contents of this section have not been peer reviewed by Spine-health.com’s Medical Advisory Board.