Most episodes of arm pain due to a cervical herniated disc will resolve over a period of weeks to a couple of months. However, if the pain lasts longer than 6 to 12 weeks, or if the pain and disability are severe, spine surgery may be a reasonable option.
Spine surgery for a cervical herniated disc is generally reliable. The success rate is about 95 to 98% in terms of providing relief of arm pain.
With an experienced spine surgeon, the surgery should carry a low risk of failure or complication, and can be done with a minimal amount of postoperative pain and morbidity (unwanted aftereffects).
The surgery for a cervical herniated disc can be done a number of different ways:
- Anterior cervical discectomy and spine fusion (ACDF). This is the most common method among spine surgeons for most cervical herniated discs. In this surgery, the disc is removed through a small one-inch incision in the front of the neck. After removing the disc, the disc space itself is fused (see Figure 2). A plate can be added in front of the graft for added stability and possibly a better fusion rate (see Figure 3).
- Posterior cervical discectomy. This is similar to a posterior (from the back) lumbar discectomy, and for discs that occur laterally out in the neural foramen (the “tunnel” that the nerve travels through to exit the spinal canal) it may be a reasonable approach. However, it is technically more difficult than an anterior approach because there are a lot of veins in this area that can result in a lot of bleeding, and the bleeding limits visualization during the surgery. This approach also necessitates more manipulation to the spinal cord.
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- Cervical artificial disc replacement. Like an ACDF, an artificial disc surgery involves removing the affected disc through a small incision in the front of the neck. However, instead of a fusion in the disc space, an artificial disc is placed in the disc space. The goal of the artificial disc is to mimic the form and function of the original disc.
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Although any major surgery has possible risks and complications, with an experienced spine surgeon serious complications from cervical disc surgery should be rare. The two most common surgeries, ACDF and artificial disc, are both considered reliable surgeries with favorable outcomes in terms of reducing the patients pain.
Postoperative Care for Cervical Herniated Disc Surgery
For anterior surgery, such as an ACDF and artificial disc, there usually is not a great deal of postoperative pain. The surgery is done through a small incision in the front of the neck, and the spine can be accessed in between tissue planes that do not require cutting. This type of surgery usually can be done either outpatient (going home the same day as surgery) or with one overnight stay in the hospital.
The pain in the arm usually goes away fairly quickly, although it may take weeks to months for the arm weakness and numbness to subside. It is not uncommon to have some neck pain for a while.
Postoperatively, most spine surgeons prescribe a neck brace, although the type of brace and length of usage is variable. Also, most spine surgeons will ask their patients to limit their activities postoperatively, although the amount of restrictions and the length of time tend to vary. Ask your spine surgeon before the surgery what his or her usual protocol is regarding postoperative care.
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