Cervical Disc Herniation Treatment Options
Pain from a cervical disc herniation can typically be managed without surgery. It often resolves on its own with anti-inflammatory medications, physical therapy, and steroid injections. However, when the pain is severe and cannot be managed with conservative measures or in cases of loss of neurologic function, there are good surgical options.
Conservative non-surgical treatments
- A cervical collar is occasionally recommended to provide support and stabilize the neck for a short period of time, allowing it to rest and heal.
- Over-the-counter nonsteroidal anti-inflammatory (NSAIDs) pain relievers such as ibuprofen or acetaminophen can reduce inflammation and pain. When these do not provide enough pain relief, prescription strength NSAIDS, muscle relaxants and oral steroids may be necessary for short-term use.
- Physical therapy involves exercises to improve strength and flexibility and reduce pain in the neck. Cervical traction reduces pressure on the nerves. Massage therapy, ultrasound and electrical muscle stimulation may also be beneficial.
- If the pain is severe, an epidural steroid injection can help reduce inflammation and promote healing. Cervical epidural steroid injections deliver anti-inflammatory medications directly to the area around compressed nerves.
- Activity Modification involves refraining from strenuous activities, and modifying daily activities to avoid movements that cause or worsen symptoms.
When conservative measures fail to alleviate the symptoms, or when the condition is severe or worsening, surgical treatment may be recommended. The goal is to relieve symptoms by decompressing the spinal cord and nerves by removing the herniated disc.
- Anterior Cervical Discectomy and Fusion (ACDF): This is a common surgical procedure for treating cervical disc herniation. Your Dallas Neurosurgical and Spine surgeon removes the herniated disc and any bone spurs from an incision in the front of the neck, relieving pressure on the nerve roots or spinal cord. The space left by the removed disc is often filled with a bone graft or cage, and the adjacent vertebrae are typically fused together using a plate and screws.
- Anterior Cervical Corpectomy and Fusion (ACCF): This is a similar surgical procedure to an ACDF, but involves removal of a portion of the vertebrae in addition to the adjacent discs to decompress the spinal cord and nerves, followed by the placement of a bone graft or cage in the empty space. The graft can be obtained from the patient, a donor, or using a synthetic substitute. It promotes bone growth and fusion of the adjacent vertebrae for stability. Metal plates and screws are often used to ensure immediate stability and maintain correct spinal alignment.
- Artificial cervical disc replacement (ACDR): Also known as total disc replacement (TDR), this is a type of arthroplasty. It’s a surgical procedure that involves replacing a damaged disc in the cervical spine with an artificial disc. This is a newer procedure that involves removing the damaged disc through a small incision in the front of the neck, and replacing it with an artificial disc. The goal is to maintain or restore more natural neck motion and potentially prevent adjacent segment disease.ACDR tends to be recommended for younger, active individuals who have single-level cervical disease (i.e., only one disc is problematic). This is because one of the main advantages of ACDR over fusion techniques, such as Anterior Cervical Discectomy and Fusion (ACDF), is the preservation of normal neck movement. However, ACDF is still a very common procedure and is often used in patients with multi-level cervical disease or other factors that make ACDR less suitable.
- Posterior Cervical Laminoforaminotomy: In this procedure, the surgeon approaches from the back of the neck, removes a portion of the vertebra (lamina) and/or the facet joint to reach and remove the herniated disc.Posterior Cervical Laminoforaminotomy is less invasive than other types of spinal surgery, and it preserves more of the normal spinal anatomy. However, it’s typically used for conditions affecting one or two levels of the cervical spine. For more extensive conditions, other procedures may be more appropriate.
All surgical procedures carry potential risks and complications, such as infection, nerve damage, spinal fluid leak, and issues related to general anesthesia. Always consult with your Dallas Neurological & Spine healthcare provider to discuss the best treatment options for your specific circumstances.
The best surgical procedure for each patient is determined by a multitude of factors, including the patient’s age, health, lifestyle, occupation, and patient preferences in addition to the symptoms and imaging findings. Contact Dallas Neurological & Spine to schedule a consultation to receive a thorough evaluation and all your treatment options. Our goal is to perform the least invasive, most effective procedures available tailored to your needs. We have offices in Plano, Frisco, and Dallas and offer virtual visits as well.