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.
Article continues below
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
The major advantage of approaching a cervical disc herniation through a posterior approach is that a fusion need not be performed. This preserves the normal motion of the cervical spine, and may provide for a shorter healing time.
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.
