Surgery for cervical radiculopathy from a herniated disc should only be considered in those cases when 6 to 12 weeks of nonsurgical treatment fails to relieve neurological deficits in the arm, such as pain, numbness, and/or weakness.
An MRI scan or CT with myelogram can confirm the presence of a disc herniation and its specific location within the cervical spine. If the patient’s symptoms and neurological deficit match the results of the scan, surgery is very reliable in terms of relieving arm pain and has a low complication rate.1
In general, neck surgery to relieve cervical radiculopathy symptoms from a herniated disc is done one of two ways: through the front of the neck (anterior approach) or through the back of the neck (posterior approach).
Anterior Approach to Treat Herniated Cervical Disc
When a herniated disc in the neck is treated surgically, it is usually with an anterior approach to remove the entire disc, called discectomy. Two common types of this surgery include:
- Anterior cervical discectomy with fusion (ACDF). This procedure involves the surgeon approaching the cervical spine from the front and removing the entire herniated disc. Then the normal disc height is maintained by inserting a spacer (plastic, metal, or bone) and fusing the adjacent vertebrae together.
- Artificial cervical disc replacement. Similar to ACDF, this procedure removes the entire herniated disc from the front. However, instead of fusing the spine, the disc is replaced with an artificial disc with the goal of preserving movement at that vertebral level.
Most herniated discs are safer to reach via the anterior approach. Another benefit is that the larger muscles at the back of the neck go undisturbed. However, the anterior approach could cause swallowing to be painful or uncomfortable for a couple of days or weeks while recovering.
Posterior Cervical Decompression (Microdiscectomy)
Sometimes surgeons remove part of a herniated disc while approaching the cervical spine from the back. This procedure, called posterior cervical decompression or microdiscectomy, tends to only be feasible if the herniated disc is located to the side of the spinal cord. A potential benefit of microdiscectomy is that no fusion is required, but a potential downside is that that the remaining disc material might herniate again.
Surgical Success Rate for Treating Cervical Radiculopathy
All surgeries have some risk, including the possibility of acquiring a life-threatening infection. However, surgery to treat cervical radiculopathy symptoms from a herniated disc is relatively safe and predictable.
Regardless of whether the procedure is anterior or posterior, studies show that neck surgery to treat arm pain from cervical radiculopathy has an 80% to 90% success rate.1 Patients can usually go home the next day and return to work within a week or two.