Discal Cervical Hernia
Discs are structures between every two vertebrae that serve as cushion for loads supported by the spine. When the discs degenerate due to age or repeated effort, they could get out of their normal place, which is known as a herniated disc.
When they are not in their right place, they may apply pressure to nerve structures and be accompanied by sensory disturbances in arms as "pins and needles" (paresthesia), a cork-like feeling (hypoesthesia), or pain (radiculalgia) in the arm or hand. The reflexes are usually diminished. In more advanced stages some loss of strength in an upper limb’s muscle group may appear.
What is the operation about?
It depends on each case, and sometimes on the experience of each surgeon, to choose a posterior or anterior technique. Anterior surgery is the most frequent and is performed through the skin folds of the neck’s right and front halves. The goal of this operation is to remove the herniated disk or the osteophytes.
After the disc is removed, a full prosthesis of the disc (to keep the physiologic motion of the spine) or a biocompatible intervertebral cage (anterior arthrodesis when these vertebrae need to be restrained) are often placed. Posterior approach surgery is done through a major incision in the neck’s midline, the back of one or more vertebrae is resected (laminectomy), so compression is removed from nerves or the spine.
When is the intervention indicated?
The treatment with medication and rest is the solution in most cases. After the acute phase, the rehabilitation treatment is indicated. However, when the herniated disc is very large, there is nerve damage or it does not improve with medical treatment or rehabilitation, surgical treatment may be necessary.
What are the risks, complications and possible sequelae?
Often, temporary discomfort in the neck and pain when swallowing appear. These drawbacks subside within a few weeks and are easily controlled with treatment. More rarely, problems may occur with pieces that are placed between the vertebrae, infections from the wound or derived from the application of general anaesthesia. The most serious complications described above, albeit exceptional, are those of injured areas near the cervical spine (spinal cord, esophagus and trachea), and may range from greater or lesser nerve injury to be a cause of death (exceptionally). A book by the Spanish Society of Neurosurgery has been published with most possible (but not likely) complications.
Transient radicular deficit (1.2-19%)
Persistence of radicular syndrome or aggravation (0.4%)
Surface wound infection (0.9-6.8%)
Meningitis (casual complication)
Abscess (casual complication)
New spinal cord injury (0.2.-4%) or worsening of the pre-existing spinal cord injury (0.5-3.3.%)
Recurrent nerve injury (0.2.-4%)
Generally, the patient is hospitalised in the Intensive Care Unit (ICU) for the first 12 hours after the surgery for stricter monitoring. After 24 hours the patient may get up with a cervical collar. Usually, the patient is discharged 48-72 hours after surgery, which could be delayed depending on their condition. In the discharge report, which patients receive before leaving, the intervention will be described and relative rest, wearing a cervical collar and the use of painkillers will be recommended.
What happens at the moment of hospital discharge?
When the Head Practitioner handling your case decides the discharge, you will receive a clinical report detailing the characteristics of your illness, the type of intervention performed and the treatment to be followed at home. Then you will be sent to the Neurosurgery Outpatients department to carry out an evolutionary follow-up of your case.
Advice after the intervention
The postoperative recovery period lasts four to six weeks after the intervention. During this time you should try to keep physical and mental rest, avoid trips and journeys, and take the measures listed below:
FIRST TWO WEEKS
Not too long ago patients who underwent surgery for a cervical disc herniation stayed in the hospital for one and sometimes two weeks. Fortunately, surgical-anesthetic advances currently allow an early discharge (usually 48-72h). This should not make you believe that when you go home everything is over. You must accept that you will continue the period of hospitalisation at home for a few more days. Take the medication exactly as prescribed by your surgeon. If you are receiving any other treatment for any other disease, you should continue to do so unless you are told otherwise. Ask your surgeon regarding surgical wound care (they will depend on the type of suture used). You can shower, with assistance, trying not to touch the dressing of the wound unless told otherwise. Skin sutures should be removed seven days after surgery, although sometimes reabsorbable sutures that do not require stitches are used.
The cervical collar, which is usually soft, must be worn at all times, except during periods when you are lying down and awake. To sleep, it will be needed that you put it on, in order to prevent sudden involuntary movements. Try not to keep a fixed posture of your head during these two weeks – for instance, watching television for a long time or reading a book – to avoid muscle overload that can be painful.
It is recommended to progressively increase the pace of your normal routine till you reach the point of going out for walks. From the second week, walk every day for brief periods of time (15 minutes), progressively increasing the distance. Do not travel by car or other means of transport during these two weeks (except to go to the health centre or visit the doctor).
THIRD AND FOURTH WEEK
By the third week you will feel pretty recovered. You may still have pain in the wound or perhaps some residual symptoms – in the form of tingling or lack of sensitivity – persist in the arm(s), or you may notice pain in the cervical region when moving. Keep in mind that complete healing requires between 4 and 6 weeks. Be patient. The wound must be completely healed and will not require any dressing but, if you wish, you may place a piece of gauze over the scar to avoid rubbing with your clothes. Start leaving home and walking increasingly long journeys, always on flat terrain and with sports shoes.
Keep the collar on whenever you get out of bed and go for a walk. You can remove it when you are sitting or awake in bed. It is mandatory that you use it if you are in a motor vehicle, although it would be better to avoid riding in a vehicle at all unless you go for a medical consultation. The total time you will have to wear the soft collar will depend on the type of intervention. In cases of disc prosthesis placement, where the preservation of movement is desired, the time will be 1 or 2 weeks. In the case of a cervical arthrodesis with intersomatic box, the minimum time will be 4 weeks. At the end of the fourth week you should go to the doctor’s office for a review.