Patients who do not benefit from conservative treatments such as pain relievers and physical therapy may require surgery. The aim of the surgery is to remove the part of the disc that is pressing on the nerve. This is done through a procedure called a discectomy and is a delicate surgery (microdiscectomy), usually performed under a microscope.
A hernia is entered through a skin incision made in the front or back of the neck. The decision to operate anteriorly (anterior approach) or posteriorly (posterior approach) is influenced by many factors, such as the location of the disc herniation, the surgeon's experience, and the patient's preference. This method is performed together with fusion or prosthesis applications. It is also known as closed surgery among the people. This is used to relieve pressure on the nerve roots and spinal cord and relieve symptoms. Microdiscectomy is a minimally invasive method and in some patients, the surgical scar disappears completely in the long term.
Anterior cervical discectomy and fusion (ACDF): This method is a minimally invasive method. The surgeon also makes a small incision in the front of the neck and removes the herniated disc. A graft (usually made of bone or synthetic material) is then placed between the two vertebrae to support the disc space. Modern grafts have the property of spontaneously fusing to the lower and upper vertebrae and do not need to be supported by plates, screws or cages attached to the spine as before. In both approaches, the portion of the disc that is pressing on the nerve is removed and usually produces good results. In the anterior approach, most of the disc will need to be removed to reach the herniated disc, which will usually require a fusion. The biggest disadvantage of fusion surgery is the disappearance of movement in the fusion region. Single level discectomy does not pose a significant disadvantage in terms of neck mobility. This is because the lost mobility of this segment is compensated and tolerated by other intact levels. However, the increased movement and workload applied to the upper and lower segments will cause abrasion, neck hernia and pain in these areas. Thanks to the developing technology today, it is formed by removing the disc instead of fusion. Removable prostheses can be placed in the space.
Cervical prostheses; It allows the spine to maintain its pre-operative flexibility in all directions. Prostheses are not suitable for every patient. Ideal candidates are patients who are relatively younger, whose facet joints have not degenerated, and whose disc heights have been preserved. Whether the prostheses are suitable for the patient or not is decided by evaluating each patient as a case on its own. This relieves pressure on the nerve roots and reduces symptoms. Since the herniated disc cannot be completely removed in this method, the chance of success is lower than the anterior approach and the risk of recurrence is higher. These three methods are some of the most commonly used neck hernia surgery methods. To determine the surgical method, the patient's condition and symptoms should be evaluated by the specialist. When choosing the surgical method, it should be evaluated how many discs herniated and complained about, whether there is ossification in the herniated disc, whether there is stenosis in the spinal canal due to spinal calcification, whether there is spinal cord crush (myelomalacia).
What it takes
Most patients are walked the same day after surgery and are able to go home after a while, sometimes less than 24 hours. You can return to your normal daily activities (toilet, dressing, cooking, going up and down stairs) within a day or two after the surgery. It is not desirable to go out of the house for the first five days, but it is necessary to be active at home. After 5 days, there is a control examination and if there is no problem in the wound, shower and bath are released. After the 5th day, the patient can go out of the house. It is desirable to use a neck brace for the first ten days. It can drive and fly short distances. The patient can return to desk jobs after 10 days if he/she wishes. For strenuous work, the patient is asked to return to work a little later. Patients with severe weakness before surgery may need a comprehensive postoperative rehabilitation and physical therapy program to fully return to their daily activities. is essential. Some spine exercises speed up recovery.
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