Approximately one in ten adults will experience neck pain at some point in their lives. In most cases it will recover simply with conservative treatment which may consist of some form of physiotherapy and the ingestion of painkillers or anti-inflammatory drugs. However, in some people the persistence of pain may suggest an underlying cause that perpetuates the painful symptomatology. Dr. Hinojosa, an expert in Neurosurgery, speaks of disc herniation as the most frequent cause of this pain.
The vertebral bodies articulate with each other by means of a kind of cushion, the intervertebral disc, which has the function of giving cohesion to the spinal column while allowing a series of flexion, rotation and extension movements. Among the components of the disc are a series of cartilages and ligaments that provide stability and an inner nucleus (nucleus pulposus) that acts as a shock absorber for the forces that produce these movements.
With aging, certain traumas, chronically repeated movements and also under the influence of genetic inheritance, the discs of the spine may lose flexibility and elasticity. The ligaments around the discs may become fragile. The tearing of any of them can lead to the displacement of the intervertebral discs, and these can compress the spinal cord (myelopathy) or the nerve roots (radiculopathy), producing stiffness in the spine and cervical pain, or in the upper extremities as a result of the pressure of the herniation on the spinal nerves (or spinal nerves).
When should a herniated disc be operated on?
In people in whom pain interferes with daily life only mildly or moderately and in whom there is no evidence of radicular or spinal cord injury, cervical exercises, physical therapy and some practices (such as Pilates or Qigong) may be effective in improving symptomatology.
In those patients in whom a herniated disc manifests with chronic pain (present for more than 3 months) of moderate or intense form and with little or no response to medical (analgesics and anti-inflammatory drugs) and/or conservative (rehabilitation and physiotherapy) treatment, surgery is a recommended option. Undoubtedly, when a herniated disc presents with pain and signs of radicular (compression of the spinal nerves that manifests as tingling or loss of strength in the arm or hand) or spinal (compression of the spinal cord that may affect the mobility of the lower limbs or sphincter function) neurological involvement, surgery is a priority need.
What does the herniated disc surgery consist of, and is the result permanent?
The intervention consists of the removal of the herniated disc material, the decompression of the nerve affected by the herniation, and the replacement, in most cases, of the affected disc with a synthetic implant that reproduces its function (disc prosthesis in some selected patients) or that seeks the fusion (arthrodesis) of the altered vertebral level.
This surgery is performed under an operating microscope using minimally invasive surgery and the results are excellent and permanent in the vast majority of cases. Different publications that evaluate the results in terms of disappearance of pain (cervical and/or arm), recovery from (possible) previous disabilities, reinsertion into work or return of the patient to their daily activities and their satisfaction with the intervention speak of 80 to 90% of good results.
What are the risks of herniated disc surgery?
Complications of disc herniation surgery are fortunately rare. In addition to the risks inherent to any operation performed under general anesthesia, one could list those related to the surgical wound (infection, or unaesthetic scar), those inherent to the manipulation of the structures neighboring the spine (lesions of the carotid artery, jugular vein or esophagus) or the possibility of producing a spinal cord injury when releasing the nerve structures from the compression produced by the herniated disc. The involvement of the recurrent laryngeal nerve is exceptional and almost always transient, which can lead to transient hoarseness.
Fortunately, the complication rate of this surgery in the hands of an experienced team is very low (less than 1% of serious or very serious complications) since it is performed with microsurgical techniques and in a very controlled surgical environment.
What recovery will the patient need
Simple cervical disc herniation surgery is performed under general anesthesia, although the patient is usually discharged within 24 hours after surgery. In cases where there is a previous spinal cord injury (cervical myelopathy), admission may be prolonged for 2 or 3 days.
Under normal conditions, the use of a cervical collar is not necessary and the patient can perform independent tasks from the beginning. The only limitation is to avoid exertion and exercises involving abrupt flexion or extension of the cervical spine for 2 to 3 weeks. Generally, the return to work takes place one month after the operation. Intense physical exercise is allowed 2 to 3 months after surgery. Only a minority of patients will require rehabilitation and/or physiotherapy after surgery.