Cervical Herniated Disc (Neck Hernia) Treatment
Cervical herniated disc, known as cervical disc herniation, most commonly occurs between the C6-C7 and C5-C6 vertebrae. Herniation does not occur between the C1-C2 vertebrae as there is no disc structure present.
Symptoms of cervical herniated disc typically include tingling, pain, weakness, loss of sensation, burning, and numbness that radiates to the arms. In more severe cases, walking difficulties, headaches, and even paralysis may develop.
In the treatment of cervical herniated disc, non-surgical methods should be tried initially, except in some special cases. These methods include pain relievers, muscle relaxants, rest, neck collars, physical therapy, and injection methods performed by pain management specialists for some patients. Over 90% of patients can recover without surgery using these treatments. The important consideration is identifying which patients require surgery.
When is Surgery Necessary for Cervical Herniated Disc?
If a significant loss of strength (neurological deficit) is detected during the initial examination when visiting the doctor and if it is progressive, surgery should be planned without much delay. Evaluating the severity of the strength loss is essential. Surgery is not always necessary in cases of mild strength loss. In such instances, the physician's examination is crucial. If the patient is being monitored with non-surgical methods for mild strength loss, they should be regularly examined by the same spinal surgery specialist. If there is an increase in strength loss during these follow-ups, surgical interventions may become necessary.
Surgical treatment should also be considered when symptoms related to cervical herniated disc do not resolve with non-surgical methods and negatively impact the patient's quality of life.
How Long Should Non-Surgical Methods Be Tried?
Non-surgical treatments can generally be tried for up to six months. However, this period can vary based on the patient's tolerance and how much their quality of life is affected. In patients with severe symptoms that do not improve despite strong pain relievers and pain management procedures, persistently monitoring them for an extended period without surgery can severely impact their quality of life and work life. The patient's regular examinations will determine the decision for surgery. Factors such as the patient's social life, pain tolerance, and the presence or absence of strength loss should be considered during follow-ups, and the patient should be informed about surgical options.
What Types of Surgeries Are Performed for Cervical Herniated Disc?
Surgeries for cervical herniated disc can be performed through both anterior (front) and posterior (back) approaches. The goal in both types of surgery is to remove the herniated disc causing pressure. Today, anterior approaches are more common. Posterior approaches are not suitable for every herniated disc and are used in select cases.
Among anterior surgeries, anterior cervical discectomy and fusion (ACDF) procedures are still considered the gold standard for treating cervical herniated discs. In this surgery, a 3-4 cm incision is made at the front of the neck, and the herniated disc pressing on the spinal cord is removed under a microscope, with a cage-like material placed in the disc space. In some cases, the system is supported with a plate at the front to facilitate the fusion of the operated vertebrae.
Another method is the use of cervical disc prostheses, which allow for movement between the vertebrae. This procedure is performed similarly, but instead of a cage, a prosthesis is placed. The prosthesis option should be discussed with patients without instability, which is abnormal movement between the cervical vertebrae. A significant disadvantage is the development of excessive bone formation around the prosthesis, known as heterotopic ossification, which may impair its function in the long term. However, outcomes in selected patients are quite favorable.
Posterior or back approaches are typically used in cases called foraminal disc herniations, where the herniation is located on the outer side. This involves a 5-6 cm incision or minimally invasive methods with approximately 1 cm incisions, and the herniated material is removed under microscopic guidance. However, not every patient is suitable for this method. Attempting to remove centrally located herniations from the back can increase the risk of paralysis.
Post-surgery recovery varies depending on the technique used, but patients typically need to limit neck movements using a simple neck collar for one month. After one month, all daily activities except contact sports are allowed. If no issues are detected in radiological exams at the end of six months, contact sports may also be permitted.