Herniated Disc (anterior cervical discectomy and fusion)

One of the most common conditions of neck pain is a herniated disc. The disc is a soft jello-like structure made of tissue known as cartilage. Discs lies between the vertebra in the spine and act as a cushion to absorb impact as well as to allow for the various motions of the neck.

A herniated disc occurs when a portion of the disc ruptures and interferes with the spinal cord and nerves. In the most common scenario, the herniated disc will pinch a nerve. A pinched nerve in the neck causes neck pain that radiates into the shoulder blade and into the arm. Sometimes pain can also be accompanied by a numbness sensation to the arm/hand and weakness of the arm.

The treatment of a herniated disc involves medications, physical therapy, and injections. Your doctor will usually prescribe nonsteroidal anti-inflammatory medications and a mild narcotic for pain. Most symptoms of a herniated disc should resolve or significantly improve within 4–6 weeks.

If pain persists, then your doctor will order an MRI which will show the herniated disc. If the symptoms do not respond to conservative treatment, your doctor may refer you to a surgeon. The surgery for a herniated disc is called anterior cervical discectomy and fusion (ACDF). The surgery involves removing the disc to relieve the pressure on the nerves and spinal cord. A bone plug is put in place and covered with a titanium plate to stabilize the vertebra. The bone plug will fuse to the adjacent vertebra.

Cervical Spondylosis (ACDF, cervical laminectomy)

As a disc degenerates, there is generally bone spur formation where the disc and vertebra meet. These bone spurs, also known as osteophytes, can interfere with spinal cord or nerve roots leading to symptoms such as neck pain and arm pain/weakness/numbness.

The treatment options are medications, physical therapy, steroid injections, and finally surgery. An anterior cervical discectomy and fusion is generally the favored approach.

Another approach is the cervical laminectomy. This approach is performed in cases where the cervical facet joints are enlarged due to arthritis and compress the spinal cord/nerves. The goal of a cervical laminectomy is to remove the bone spurs and ligaments that are interfering with the spinal cord and nerves. Unfortunately, the removal of the bone spurs and ligaments can often lead to immediate or delayed instability of the spine that could lead to further pain and disability.

To prevent immediate or future instability a fusion and instrumentation procedure usually accompanies the cervical laminectomy. Screws and rods are used to stabilize the spine and bone is placed in and around the joints to strengthen the spine.