Cervical microdiscectomy is an operation that involves removing all or a portion of the damaged intervertebral discs to relieve pressure on the nerve roots and/or the spinal cord. If necessary, cervical microdiscectomy is done using minimally invasive methods in select patients. Get in touch with Dr. Rappard's clinic in Los Angeles for more details about microdiscectomy and to find out if it will help your pain and other problems. Our professionals will engage with you to establish the best plan of action for your condition and provide you with the best care possible to help you recover quickly.
An Overview of Cervical Microdiscectomy
Cervical microdiscectomy is a type of surgery that relieves pressure on the nerve roots or the spinal cord caused by a bone spur or a herniated disc. This method involves making a small incision on the front part of the patient's neck, followed by the surgical removal of disc materials or a portion of the bones around the spinal nerves or spinal cord to ease pressure on neural tissues and provide them with ample room.
Cervical microdiscectomy is also known as a decompressive spinal treatment because the doctor relieves pressure on nerve roots by getting rid of the whole or a portion of the discs and bony structure that is causing pain. Depending on your health and the precise surgical objectives, your surgeon may opt for a minimally invasive procedure. Unlike traditional open spine operations, which involve cutting or stripping of muscles, minimally invasive cervical discectomy only requires a tiny incision and muscle dilation to distinguish the muscle fibers around the spine.
Types of Cervical Microdiscectomy
There are two different types of cervical microdiscectomy. These include:
Posterior Cervical Microdiscectomy
Some surgeons may favor the posterior technique for a cervical microdiscectomy. This method is often used for major soft disc herniations on the lateral side of the spinal cord. The main benefit of the posterior technique is that no spine fusion is required once the disc is removed. The major downside is that the disc space can't be opened up with a bone graft to allow more space for the spinal nerve as it exits the spinal column. Furthermore, since the posterior technique leaves the majority of the disc column in place, there's a slight possibility that a disc herniation would recur in the future. The standard procedure for posterior cervical microdiscectomy includes:
A small cut is made in the middle line of the neck's back. The paraspinal muscles are raised above the level of the spinal column that will be accessed
An x-ray is taken to ensure that the spine surgeon operates at the appropriate spinal column level. A high-speed burr is used to eliminate a portion of the facet joint, after which the nerve root is found beneath the facet joint. A surgical microscope is then utilized for enhanced visualization. The disc would be directly underneath the nerve root, which must be carefully moved to the side to release the disc herniation. If bleeding occurs, there's often a plexus of veins over the disc that could impair visualization.
Anterior Cervical Microdiscectomy
Anterior cervical techniques have been employed for decades to treat and address spinal cord compression and disc rupture. Unlike anterior procedures, posterior cervical microdiscectomy doesn't require fusion along the disc space. In this situation, the surgeon accesses the affected disc from the spine's front part via the throat.
The disc and bone vertebrae get exposed when the trachea, esophagus, and neck muscles are moved sideways. Surgical operation from the neck's frontal part is more accessible than that from the back because the disc could be accessible without affecting the spinal nerves, spinal cord, or the powerful neck muscles. Based on your symptoms, one or more discs could be removed.
Once the damaged disc is eliminated, a gap is left between the bony vertebrae. To prevent the vertebrae from rubbing together or collapsing, a spacer graft is implanted to occupy the open disc area. This graft acts as a link between the two vertebrae, allowing for spinal fusion. Screws and metal plates are used to secure the vertebrae and bone graft in place.
After surgery, the body's natural recovery process begins, and new bone cells form around the grafts. The bone graft should merge with the vertebrae and form a solid piece of bone after 3 to 6 months. Similar to reinforced concrete, fusion and instrumentation operate together.
Who Requires This Procedure?
Disc herniation is a condition whereby the disc's soft, gel-like interior (nucleus pulposus) has pushed through the hard outer ring of the disc (annulus fibrosus). Bony outgrowths, also referred to as bone osteophytes or spurs, are formed by the calcification of the spine joints. Pressure on the nerve roots and the spinal cord's ligaments caused by herniated discs or bone spurs could lead to neck pain or soreness on the arms, weakness or numbness in the arms, fingers, or forearms, and a loss of coordination.
Since most nerves from the brain pass through the neck region (cervical spine) into the body, compression on the spinal column in the neck area can be particularly problematic. Patients who exhibit these signs are only eligible for a cervical microdiscectomy procedure after non-surgical treatments have failed. A cervical discectomy can relieve the discomfort by easing compression on the spinal nerves.
Potential Risks of Cervical Microdiscectomy
Treatment outcomes and results differ for each individual. All surgeries are risky, and it's crucial to understand the dangers before proceeding with the operation. In addition to anesthesia issues, spinal surgery could result in blood loss, infections, nerve damage, blood clots, and bladder and bowel problems. A major side effect of cervical microdiscectomy that may demand repeat surgery is the failure of the vertebral bones to fuse with the bone graft. Discuss the advantages, dangers, and complications of the cervical microdiscectomy technique with your physician before scheduling the operation.
What To Expect During Surgery
The surgery is carried out while you are lying on your back and are administered with sedative or anesthetic medication. Your doctor makes a small incision on the front part of your neck and carefully separates the soft structures and muscles. Following that, several small tubes known as dilators are placed into the incision in the direction of the spinal column. The removal of disc materials and bone spurs relieves the pressure. Finally, the surgeon will remove the small tubes, return the muscles and soft tissues to their proper positions, and cover the incision.
Spinal fusion is often performed in conjunction with cervical discectomy and involves inserting a bone graft or its substitute between two damaged vertebrae to enable the bone to develop between the vertebral column. The graft acts as a base or medium for joining the two vertebrae, and it eventually grows into a single vertebra that stabilizes the spinal cord. Spinal fusion can also be carried out utilizing a minimally invasive technique with "tubes." In other cases, the surgeon would operate using a posterior technique, which necessitates an incision on the back side of the neck. Minimally invasive surgical techniques can also be used for posterior cervical discectomy.
What to Expect After Surgery
You will regain consciousness in the post-operative recovery section. The nurses will closely monitor your heart rate, blood pressure, and breathing. Any discomfort or pain felt will be addressed and treated at this stage. You can improve your activity level after you're awake, like sitting or walking to name a few. A patient who has had a bone graft extracted from his or her hip could experience more pain in his or her hip than in their neck incision.
Most patients who get a 1 or 2-degree ACDF are discharged on that day. However, if you experience difficulties breathing or have issues with your blood pressure, you will be required to spend the night. Follow the doctor's home care guidelines for the first two weeks after the operation, or until your next checkup. In general, you should expect the following:
- Avoid twisting or bending your neck
- Lift nothing more than five pounds
- Avoid labor-intensive activities, such as housework, sex, or yardwork
- Avoid smoking and the use of nicotine products, such as dips, chews, and vapes. These products suppress the new bone formation and would fail your fusion
- Do not drive or operate any vehicle until after your check-up appointment
- Don't consume any alcoholic beverages. Alcohol thins the blood, increasing the possibility of bleeding. Additionally, avoid mixing alcohol with painkillers
- You can bathe the day after the operation if Dermabond skin glue was used to cover your wound. Each day, gently wash the operated area with water and soap. Do not pick or rub the glue. After that, keep the area dry
- You can take a shower two days after the operation if you have steri-strips, staples, or stitches. Gently clean the area with water and soap daily. Pat dry
- If there is any drainage, cover your wound with a gauze dressing. If the drainage overflows through two or more coverings in a single day, contact the surgeon's office
- Do not immerse the wound in a pool or bath
- Avoid applying lotion or cream over the incision
- After each shower, change into clean clothes. Sleep on fresh bed linens. Pets are not allowed in the bed or the sleeping area until the wound has fully recovered
- It's normal for the incision to drain some clear, pinkish fluid. Keep an eye out for colored discharge, spreading redness, and separation
- At the check-up session, any steri-strips, staples, or stitches will be removed
- Take pain relievers exactly as prescribed. Reduce the frequency and dose amount as the pain reduces. Do not take painkillers if they are not necessary
- Schedule an appointment with your physician to discuss different medications if your painful constipation doesn't improve
- Narcotic drugs could cause constipation. Drink plenty of water and incorporate high-fiber meals into your diet. Laxatives and stool softeners can help with bowel movements. Over-the-counter drugs that you may use include Senokot, Colace, Miralax, and Dulcolax
- Anti-inflammatory pain medicines such as Aleve and Advil should only be used with the approval of a surgeon. They inhibit new bone formation and would lead to the failure of your fusion
- You could use acetaminophen drugs like Tylenol if necessary
- If you've been issued a brace, make sure that you keep it on at all times, except when you're sleeping, taking a shower, or icing
- To relieve pain and edema, apply ice to the wound three to four times a day for fifteen to twenty minutes
- Every three to four hours, get up and take a 5- to 10-minute stroll. Gradually increase your walking distance as you can
Your doctor will devise a post-operative recovery plan to assist you to get back to normal activity as soon as possible. Your symptoms would improve quickly or gradually over time after the operation. The treatment plan determines the length of your hospital stay. Surgery could occasionally also be done as an outpatient procedure. You would be able to walk and wake up before the end of your first day after the operation. Your body's state of recovery and the kind of activity or work you intend to resume will determine when you can go back to it. Consult with your surgeon and follow the instructions for optimal healing and rehabilitation after the treatment.
How a Spine Surgeon Can Help
A spine surgeon would order the following diagnostic tests if the patient exhibits any symptoms of disc herniation:
- Magnetic Resonance Imaging (MRI)—This is the most effective way of getting images of the spinal cord, nerve roots, intervertebral discs, and ligaments
- Electromyography (EMG)—This procedure tests the electrical impulses of the nerve root and aids in pinpointing the source of pain
- Myelography—This process involves injecting a liquid dye into the spine, which is subsequently followed by a series of computed tomography scans and X-rays
- CT Scan—This is a collection of X-rays processed by the computer into three-dimensional pictures of the entire body structure. These scans can help to identify sac indentations in the spinal fluid caused by bone spurs, bulging or herniated discs that would be pressing on the spinal cord or nerves
Find a Spine Surgeon Near Me
Most patients are delighted to learn that microdiscectomy procedures don't require spinal fusion. Although it's often a good idea to avoid fusion, you may not be a suitable candidate for the posterior method of disc herniation removal. Herniation could occur again if the disc is not removed completely. In addition, the remaining disc could rupture, putting pressure on the nerve roots.
If you would like to know more about cervical microdiscectomy or any other treatment option for neck or shoulder pain, you can contact Dr. Rappard's facility in Los Angeles. Patients suffering from severe or chronic spine issues can benefit from a wide selection of treatment options provided by our specialists. Call us today at 424-777-7463 to schedule your appointment.