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Cervical Disc Surgery - Neck Disc Surgery
Orthopedics and Traumatology

Cervical Disc Surgery - Neck Disc Surgery

About This Department

 
Orthopedics

Cervical disc surgery frees a nerve or the spinal cord from a worn neck disc. Most pinched neck nerves settle without it.

In a population study of 561 people with a pinched nerve in the neck, 90 percent were free of symptoms or only mildly affected five years later, and 26 percent had surgery along the way. Surgery relieves arm pain faster, protects a compressed spinal cord, and in two-level disease a disc replacement halved later surgery at neighboring levels compared with fusion over ten years. Send your MRI and a note on your symptoms, and our spine team will tell you whether surgery fits.

90%
Pinched neck nerves symptom-free or mildly affected at five years
9% vs 18%
Adjacent-level surgery at 10 years, disc replacement against fusion
4.8%
Moderate or severe swallowing difficulty six months after anterior surgery
Free
Review of your MRI before you book
Free consultation

Six discs cushion the bones of the neck. With age, they dry out and bulge, the bones around them grow spurs, and the openings for the nerves narrow. A disc can also rupture suddenly and press on a nerve root or on the spinal cord itself.

Symptoms of a cervical disc problem

Neck pain on its own rarely needs surgery. Two patterns do.

A pinched nerve, radiculopathy

Which nerve, which fingers
Pain shoots from the neck through the shoulder blade and down the arm, with tingling or numbness in particular fingers and weakness in particular muscles. The pattern tells the surgeon which nerve root is trapped, and the MRI has to match it before any operation.

This table scrolls sideways on a narrow screen. Swipe or drag to see every column.

Neck nerve roots and where they show
Nerve root Pain and numbness Weakness
C5 Shoulder and outer upper arm Lifting the arm sideways
C6 Thumb and index finger Bending the elbow, lifting the wrist
C7 Middle finger, the commonest Straightening the elbow
C8 Ring and little finger Grip and fine finger movements

Pressure on the spinal cord, myelopathy

When a disc or bone spur squeezes the spinal cord, the signs come slowly and without much pain. Clumsy hands, trouble with buttons and handwriting, numb fingers, an unsteady walk and, late on, bladder problems. Myelopathy tends to worsen step by step, and lost cord function does not always return, so surgery comes earlier.

See a spine surgeon the same week, or go to emergency
Sudden weakness in an arm or leg, new difficulty walking, loss of bladder or bowel control, or rapidly worsening clumsiness of both hands. These point to pressure on the spinal cord.

Treatment without surgery first

For a pinched nerve without weakness, six to twelve weeks of anti-inflammatory medicines, physiotherapy and, where needed, a steroid injection around the nerve come first, because most attacks settle on their own.

During the median duration of follow-up of 4.9 years, recurrence of the condition occurred in 31.7%, and 26% underwent surgery for cervical radiculopathy.
Population study of 561 patients, Brain, 1994
Surgery or physiotherapy for a long-lasting pinched nerve
Persson and colleagues in Sweden randomized 81 patients with long-lasting arm pain and a compressed nerve root to surgery, physiotherapy or a soft collar. At four months the surgical group had less pain, less numbness and better strength. A year later pain and numbness had evened out, and some strength measures still favored surgery over physiotherapy.

This table scrolls sideways on a narrow screen. Swipe or drag to see every column.

What happened to 561 people with a pinched neck nerve
Finding Result
Commonest nerve root C7, then C6
Caused by a disc protrusion alone 21.9 percent
Caused by spurs, disc or both 68.4 percent
Recurrence over five years 31.7 percent
Surgery over five years 26 percent
Free of symptoms or mildly affected at the end 90 percent

When surgery helps

Reasons to operate

Surgical decompression for the treatment of cervical spondylotic myelopathy was associated with improvement in functional, disability-related, and quality-of-life outcomes at one year of follow-up for all disease severity categories.
AOSpine North America study, 278 patients, Journal of Bone and Joint Surgery, 2013
Matching MRI
The scan shows compression at the level that explains your symptoms.
A fair trial of treatment
Six to twelve weeks without lasting relief, for a pinched nerve.
Nerve tests if unclear
Nerve conduction studies separate a neck nerve from carpal tunnel or ulnar nerve trouble at the elbow.
Surgery
For arm pain that will not settle, weakness that is progressing, or any sign of myelopathy.

Faster relief, similar at one year

Pain improved faster in the surgery group but after one year no differences were seen.
Persson and Lilja, randomized trial of 81 patients, Disability and Rehabilitation, 2001

What it means for you

Weighing speed against waiting
Surgery buys months of relief sooner and a firm answer for weakness. Waiting gets many patients to the same place within a year, with no operation. We lay both out and let pain, work and the strength of the arm decide. For myelopathy the balance tips firmly toward surgery, since the AOSpine study saw improvement at every level of severity and lost cord function does not reliably return.

The operations

ACDF, disc replacement and foraminotomy

Anterior cervical discectomy and fusion, ACDF
Through a three-centimeter crease in the front of the neck, the surgeon moves the windpipe and gullet aside, removes the whole disc and any spurs under the microscope, and fills the space with a spacer that the bone grows into over months, with or without a small plate. The neck loses movement at that level, and the levels above and below take more load.

Disc replacement

Cervical disc arthroplasty
The same approach, with a moving metal and plastic disc in place of the fusion spacer. It keeps motion at that level and suits younger patients with soft disc herniations and healthy facet joints.

Ten years of two-level results

Results of 2 large randomized trials suggest similar-to-improved patient reported outcomes for multilevel CDA versus ACDF maintained out to midterm to long-term follow-up of 5-10 years, with lower rates of revision surgery at index and adjacent levels and lower rates of serious adverse device-related events.
Long-term evidence review, International Journal of Spine Surgery, 2020

A disc replacement needs the right neck.

  1. One or two levels.
  2. No instability and no severe arthritis in the small facet joints at the back.
  3. Good bone density.
  4. Compression from soft disc rather than thick bony bars behind the vertebrae, which a fusion handles better.
Dysphagia after anterior cervical spine surgery is a common early finding.
Prospective study of 249 patients, Spine, 2002
Day of surgery
Walking within hours.
Days one to two
Home.
Two to six weeks
Desk work and driving return once you can turn the head freely to check traffic over each shoulder, and short walks build up daily while the throat settles and the wound heals.
Three months
Lifting and sport, after an X-ray shows the fusion or disc settled.
Swallowing and voice after surgery
In a prospective study of 249 patients, some swallowing difficulty was reported by 50.2 percent at one month, 17.8 percent at six months and 12.5 percent at one year, but only 4.8 percent had moderate or severe trouble at six months. Women and operations on several levels carried more risk. A hoarse voice from the nerve to the vocal cords persisted in 1.3 percent at one year.

The stay in Istanbul

One or two nights in hospital. Then five to seven days in Istanbul, until the wound check. Fitness to fly follows that check, and a short aisle-seat flight with a walk every hour causes the neck no harm. A posterior foraminotomy, done through the back of the neck for a single trapped nerve, follows the same timeline. A companion can sleep in your room, our coordinators speak English, Arabic, French, Russian, Serbian, Romanian and Spanish, and follow-up after you return home runs through them with an X-ray at six weeks and three months reviewed by our surgeon. The cost depends on the number of levels and on fusion or disc replacement, and the estimate after the free review lists each item.

For the free review, send these.

  1. Your neck MRI, original images on disc or by link, less than six months old.
  2. Neck X-rays, including bending forward and back if you have them.
  3. Nerve conduction results, if done.
  4. A short note on the pain, which fingers are numb, any weakness and the treatments tried.

Cervical disc surgery FAQ

Will my pinched neck nerve get better without surgery?
In most people, yes. In a population study, 90 percent were free of symptoms or only mildly affected at five years.
Is disc replacement better than fusion?
For suitable patients, two large trials found similar or better results with disc replacement over five to ten years, and fewer repeat operations at neighboring levels.
Will I have trouble swallowing after surgery?
Mild swallowing discomfort in the first weeks is common and fades. At six months, 4.8 percent in one study still had moderate or severe trouble.
How long will I stay in Istanbul?
Five to seven days for most single- and two-level operations.
Can I travel home with a collar?
Yes. Most patients need a soft collar for comfort only, and the coordinator arranges an aisle seat and help at the airport.

References

  1. Radhakrishnan K, Litchy WJ, O'Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy: a population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994;117(Pt 2):325-335.
  2. Persson LC, Moritz U, Brandt L, Carlsson CA. Cervical radiculopathy: pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar. A prospective, controlled study. European Spine Journal. 1997;6(4):256-266.
  3. Fehlings MG, Wilson JR, Kopjar B, et al. Efficacy and safety of surgical decompression in patients with cervical spondylotic myelopathy: results of the AOSpine North America prospective multi-center study. Journal of Bone and Joint Surgery (American Volume). 2013;95(18):1651-1658.
  4. Goldstein ZH, Boody B, Sasso R. Two-level anterior cervical discectomy and fusion versus cervical disc arthroplasty: long-term evidence update. International Journal of Spine Surgery. 2020;14(s2):S36-S40.
  5. Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine. 2002;27(22):2453-2458.

Editor's note

Written by the Biruni Hospital medical editorial team. Reviewed by Assoc. Prof. Dr. Necdet DEMİR, Orthopedics and Traumatology.

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