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| Home > Spinal Disorders > Disc Herniations > Cervical Disc Herniation - Disorder Treatment |
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CERVICAL DISC HERNIATION
Disorder Treatment
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Non-surgical Treatment
The first line of treatment is almost always non-surgical. The exception is when there is bladder or bowel incontinence or progressive weakness. A vast majority of patients suffering from neck and arm pain will naturally recover given time and non-operative treatment. Non-operative treatments include strengthening exercises, physical therapy, chiropractic, acupuncture, traction, epidural injections, pain medications, and anti-inflammatory medications including steroids.
For arm pain and mild weakness (radicular symptoms), generally at least 6 weeks of non-operative treatment is pursued to monitor for natural recovery. The waiting period is based on the knowledge that 80-90% of radicular symptoms are known to spontaneously recover. If recovery is progressing, more non-operative treatment may be prescribed.
For isolated neck pain, generally at least 6 months of non-operative treatment is pursued to monitor for natural recovery. The waiting period is based on the knowledge that most midline neck pain is known to spontaneously recover within 6 months.
Surgical Treatment
Surgical treatment may be suggested to treat pain that has not responded to non-operative treatment or if there is severe neurologic deficit such as bowel or bladder incontinence or progressive weakness in vital muscle groups. With the exception of the presence of severe neurologic deficits, the decision to proceed with surgery is a quality of life decision.
Surgical options for a cervical disc herniation are listed below. These surgical options often include a combination of surgical treatments (i.e. decompression, fusion, instrumentation). For a detailed explanation of the individual treatments, please visit the Surgical Treatments section of the web site.
- Anterior Cervical Decompression and Fusion with Instrumentation
This is the most common surgical treatment for disc herniation. The procedure involves removal of the disc including its compression on the nerves or spinal cord. Sometimes part or the whole vertebral body needs to be removed (corpectomy) to remove the compression on the spinal cord. The resulting void is filled with bone (either from the patient or a bone bank) to fuse the motion segment. The motion segment is held together with instrumentation (plate and screws).
- Anterior Cervical Decompression and Fusion without Instrumentation
For one level fusion, the fusion rates are high without instrumentation, and therefore some surgeons prefer not to use the plate and screws.
- Anterior Cervical Foraminotomy
With this procedure, only the part of the disc that is compressing the nerve to the arm is removed from the front of the neck. This procedure is not indicated if the spinal cord is being compressed.
- Posterior Cervical Foraminotomy
With this procedure, only the part of the disc that is compressing the nerve to the arm is removed from the back of the neck. This procedure is not indicated if the spinal cord is being compressed.
- Minimally Invasive Procedures
Posterior or anterior cervical foraminotomy can be performed through tubes. Anterior decompression and fusion procedures have also been performed through tubes. Laser disc removal has also been performed with mixed results.
- Anterior Cervical Decompression without Fusion or Instrumentation
Many older studies have shown very good results with complete removal of the disc without fusion or instrumentation. More recent studies have suggested that patients may develop increased neck pain and possible deformity when fusion is not performed.
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