When should cervical disc herniation surgery be performed?

Cervical disc herniation is the outflow of part of the intervertebral disc into the vertebral canal. Dr. Villarejo, a world-renowned neurosurgeon, explains that there are 7 cervical vertebrae and that herniations normally occur between the fifth and sixth, and the sixth and seventh. That part of the disc that herniates produces a compression on the structures that are in the spinal canal.

Symptoms of disc herniation

What is herniated is the nucleus pulposus within the spinal canal; if it is medial it produces a loss of strength in both upper and lower limbs, if it is from C4 to C5 and from C5 C6, C6 C7, basically what it produces is a very important pain in the right and left upper limb accompanied by sensory disorders in the form of paresthesia or tingling. Loss of strength in the upper limb may also appear.

What is herniated disc pain like?

The pain can range from very intense, when it is a soft hernia, to a pain that can be tolerated. The pain that is very intense is because the soft part of the nucleus pulposus -if the person is young- produces a very acute compression and that is why this type of pain is so intense.

Causes of disc herniation

Cervical disc herniation can be caused fundamentally by making an effort, lifting an important weight, a traffic accident or a work accident in which the skull is hit; basically, it is enough to make a flexion and extension movement and part of the disc comes out. There are also herniations that occur slowly at work, bad postures that gradually injure the disc until it herniates.

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How to treat a cervical disc herniation?

If a cervical disc herniation is small, it does not require surgical intervention, but is treated with anti-inflammatory analgesics and rest; however, if the hernia is large, the pain is so severe that patients cannot even sleep, they have to sit up to sleep and adopt very strange postures to avoid pain.

Normally, nowadays surgery is performed through an anterior approach with a small incision in the lateral part of the neck; with radiological controls the hernia is identified and with microsurgical techniques it is removed. The tendency is to place different prostheses: there are cervical disc prostheses, titanium metal prostheses, PEEK prostheses and sometimes screws and plates are placed.

In my opinion, the one that works best is the placement of a small titanium prosthesis between the vertebral body and the vertebral body, once the hernia has been removed. A posterior approach known as posterior microdiscectomy can also be performed, in which an incision is made in the back of the neck and with radiological identification and microscopic placement the herniated disc is removed; in these cases no prosthesis is usually placed.