For patients whose pain does not improve with non surgical treatments, surgery may be necessary. Depending on the location of the herniated disc, the surgeon may make an incision either in the front or back of your neck to reach the spine. The technical decision of whether to perform the operation from the front of the neck (anterior approach) or the back of the neck (posterior approach) is influenced by many factors including the exact location of the disc herniation and the experience and preference of the surgeon. With either approach, the disc material is removed from the nerve, usually with good results. While an anterior cervical discectomy is the most common treatment for disc herniation, a posterior (back) cervical approach can be performed to alleviate nerve pinching. A laminotomy (partial removal of the lamina) and foraminotomy (opening of the foramen where the nerve exists) can be done for disc herniation if the herniation pinches the nerve root or if there is pressure on the nerve from overgrowth of bone (a bone spur or osteophyte). This procedure cannot be used to effectively remove the compression of the spinal nerve or spinal cord caused by a midline disc herniation. General Procedure
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Surgical approach
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The skin incision is made on the back of the neck.
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The muscles are dissected off of the spine.
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Deep retractors are placed.
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Bone removal
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After the correct disc space has been identified on x-ray, a keyhole is made in the lamina and part of the facet is removed.
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The pressure on the nerve caused by bony overgrowth is removed.
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The nerve may be retracted and the disc removed. The dissection is often performed using an operating microscope.
Advantage of Foraminotomy vs. Anterior Cervical Discectomy
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Foraminotomy does not require fusion
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Allows for treatment of serveral spinal motion segments (multilevel foraminotomy)
Disadvantage of Foraminotomy vs. Anterior Cervical Discectomy
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Increased incidence of neck pain with foraminotomy over anterior cervical discectomy
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Cannot decompress a central disc herniation with foraminotomy
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