Posterior Cervical Decompression (Microdiscectomy) Surgery

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.

Posterior Discectomy Advantages and Disadvantages

  • 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.

What Occurs During Posterior Cervical Decompression?

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

  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.
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  1. 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.

Posterior Cervical Discectomy Risks and Complications

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.

Posterior Versus 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 from the anterior, 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 from the anterior when possible because it is:

  • A more reliable and definitive procedure
  • Generally less demanding technically than a posterior approach.
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