A bulged or herniated cervical disc occurs when the fibrous outer layer of an intervertebral disc forms tears. Under the mechanical stresses from adjacent vertebrae, the softer interior of the disc pushes through the defect and forms an outward bulge. This becomes a problem when the bulge pushes onto the nearby spinal roots or spinal cord resulting in pain and other neurological symptoms.
Nonsurgical Treatments
Conservative therapy is usually the first line of treatment for a bulged cervical disc, according to the Mayfield Clinic, a Cincinnati neurosurgery practice. These therapies include rest, massage, physical therapy, exercise, chiropractic manipulation, and pain management. Medicines such as nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen; analgesics; muscle relaxants; and steroids can be used to effectively manage symptoms. Also, Cedars-Sinai suggests that corticosteroid injections into the affected area can relieve pain, as can the use of back braces, activity modification, stress management and electrotherapy. The rate of success with conservative therapy is over 95 percent and patients can return to normal activity in about six weeks. When such conservative therapies fail to provide the desired results or when symptoms progress, surgery is usually indicated.
Anterior Discectomy
The anterior or frontal approach is the most common surgical technique for treating a bulged cervical disc, the Mayfield Clinic notes. This is because the muscles and other soft tissues are easier to safely separate so that uninterrupted access to the disc can be gained. Also, the disc is more exposed from the anterior aspect compared to the posterior approach. Discectomy involves removing the disc and usually filling the space left behind with bone grafts. This will create fusion between the vertebrae in order to avoid the pathology of two rubbing bones and to provide stability. Usually metal hardware is used to stabilize the two opposing vertebrae.
Posterior Discectomy
The less often used posterior discectomy is preferred when the bulged disc has fragmented into smaller pieces which push on spinal nerves, according to eOrthopod. This approach involves making an incision on the back of the neck. The spinal muscles are dissected to expose the back of the spine. Pieces of the bone covering the spinal nerve is removed and special instruments are used to remove the disc pieces. The cavity containing the spinal nerve is also enlarged to prevent future compression. Bone spurs are also carefully removed at this time. Since the disc is not usually removed entirely, the vertebrae may not require stabilization, but if they do metal hardware can be used.
Minimally Invasive Discectomy
Discectomy can be performed using a minimally invasive procedure. The approach is from the posterior aspect, according to the Mayfield Clinic. In this technique a small incision is made on the back of the neck. Dilators, or small expansion tubes are inserted to enlarge a tunnel leading to the cervical vertebrae. Once accessed, bone is removed to expose the area of the disc and the nerve root. Using an endoscope or a surgical microscope and special tools, the bulge is removed. The advantage of this technique is less trauma than a traditional discectomy.
Artificial Disc Replacement
Using the anterior approach, artificial intervertebral disc arthroplasty can be performed. According to BlueCross BlueShield Association, this new technique uses an artificial disc to replace the degenerated disc. The advantage of this technique is that the artificial disc preserves the natural motion between the vertebrae. It also does not require fusion and it may prevent disc disease in adjacent levels.
