Posterior cervical decompression (microdiscectomy) surgery

Some spine surgeons may prefer the posterior approach (from the back of the neck) for a cervical discectomy. This approach is often considered for large soft disc herniations that are lateral to (to the side of) the spinal cord.

• The principal advantage of the posterior approach is that a spine fusion does not need to be done after removing the disc.

• The principal disadvantage is that the disc space cannot be jacked open with a bone graft to give more space to the nerve root as it exits the spine. Also, since the posterior approach leaves most of the disc in place, there is a small chance (3% to 5%) that a disc herniation may recur in the future.

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The general procedure for the posterior cervical decompression (microdiscectomy) surgery is:

1. Surgical approach

• A small incision is made in the midline of the back of the neck.

• The para-spinal muscles are elevated off the spinal level that is to be approached.

2. Disc removal

• An x-ray is done to confirm that the surgeon is at the correct level of the spine.

• A high speed burr is used to remove some of the facet joint, and the nerve root is then identified under the facet joint.

• An operating microscope is then used for better visualization.

• The disc will be directly under the nerve root, which needs to be gently mobilized (moved to the side) to free up the disc herniation.

• There is usually a plexus (network) of veins over the disc that can obstruct visualization if they bleed.

Possible risks and complications of a posterior approach for cervical discectomy include:

• Nerve root damage

• Spinal cord damage

• Dural leak

• Infection

• Bleeding

• Continued pain

• Recurrent disc herniation

In general, however, complications are rare.

Advantages and disadvantages over an anterior cervical discectomy

Although avoiding a fusion may sound desirable, the posterior approach has many disadvantages. Because the spinal cord is in the way, visualization of the disc space is limited and typically only a disc herniation that is lateral (off to the side of the spine) can be approached. Also, by not doing a fusion anteriorly, the disc space is not distracted and the associated collapse that happens with a disc herniation can continue and place pressure on the nerve in the foramen (where the nerve exits the spine). Lastly, since the disc is not removed completely, it can re-herniate in the future.

In general most surgeons prefer approaching the cervical spine anteriorly when possible because:

• It is a more reliable procedure and more definitive.

• It is generally technically less demanding than a posterior approach.

• Article written By:
• Peter F. Ullrich, Jr., MD

October 7, 2005

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