For patients whose pain does not improve with non-surgical treatments, surgery may be necessary. Disc replacement may be performed with an anterior (front) cervical discectomy is the most common surgical procedure to treat damaged cervical discs or to alleviate nerve pinching. Its goal is to relieve pressure on the nerve roots or on the spinal cord by removing the ruptured disc (disc herniation).

After a skin incision is made, only one thin vestigial muscle needs to be cut, after which anatomic planes can be followed right down to the spine. This procedure is usually done under microscopic visualization. The limited amount of muscle transection or dissection helps to limit postoperative pain.

Sometimes the space between the vertebrae are left open. However, in order to maintain the normal height of the disc space, the surgeon may choose to fill the space with a bone graft, which results in fusion of the disc space. Alternatively, the disc space can be replaced with a device that allows sparing of motion (disc replacement).

The general procedure is:

1. Surgical approach
• The skin incision is about one inch and horizontal and can be made on the left or right hand side of the neck.
• The thin platysma muscle is then split in line with the skin incision and the plane between the sternocleidomastoid muscle and the strap muscles is then entered.
• Next, a plane between the trachea/esophagus and the carotid sheath can be entered.
• A thin layer of fibrous tissue that covers the spine can easily be dissected away from the disc space.
  
  
2. Disc removal
• A needle is then inserted into the disc space and an x-ray is done to confirm that the surgeon is at the correct level of the spine.
• After the correct disc space has been identified on x-ray, the disc is then removed by first cutting the outer annulus fibrosis (fibrous ring around the disc) and removing the nucleus pulposus (the soft inner core of the disc). The dissection is often performed using an operating microscope to aid with visualization of the canal.
• Dissection is carried out from the front to back to a ligament called the posterior longitudinal ligament. This ligament can be gently removed to allow access to the spinal canal to remove any osteophytes (bone spurs) or disc material that may have extruded through the ligament.
  
  
3. Placement of prosthetic disc
• The disc space is prepared by making sure that the endplates are parallel. Trial spacers and shavers are used to prepare the space. A burr may also be used.
• The appropriate sized spacer is placed, making sure to place it in the midline of the disc, with good fill of the disc space from front to back.