Cervical disc protrusion, or disc herniation, occurs when the fibrous outer layer of the cervical disc develops defects pathologically and for unknown reasons. Within the disc is contained a more gelatinous material required to absorb the compressive forces produced by adjacent vertebrae. With degenerative disc disease, the softer inner material can protrude through the defect and impinge on nearby neural tissues. This is the source of pain and other symptoms.
Noninvasive Treatments
The Mayfield Clinic states noninvasive or conservative treatments for cervical disc protrusion are usually considered before using surgery. There are a number of such treatments, which include massage, rest, exercise, physical therapy, chiropractic and pain management. Medicines including nonsteroidal anti-inflammatory drugs, muscle relaxers, analgesics and steroids can treat symptoms. Additionally, corticosteroid injections into the spinal column can relieve pain, and back braces, stress management, electrotherapy and modifying activities can be employed, according to Cedars-Sinai. With such therapies, over 95 percent of people return to their normal activities in six weeks. However, when these fail or if symptoms get worse, surgery is usually recommended to remove the cervical disc, either partially or entirely.
Anterior Discectomy
The most common approach to reach the cervical disc is from the front, or anterior aspect of the neck. The muscles and other tissues in this approach are easier to move aside to gain access to the vertebrae. In addition, the anterior approach exposes the disc more thoroughly. Complete discectomy entails removing the entire disc and filling in the space with grafted bone chips. The graft encourages the opposing vertebrae to fill the intervertebral space with new bone cells. Ultimately, the two vertebrae fuse together, stabilizing the area and preventing pathology from the two bones rubbing together. Usually screws, plates and rods can be employed to help stabilize the vertebrae.
Posterior Discectomy
The posterior approach to the disc is less often used for treating cervical disc protrusion, according to eOrthopod, and is usually required when the disc has broken into small pieces. An incision is made on the back side of the neck, and the spinal muscles are separated, exposing the posterior spine. Any pieces of bone over the spinal nerve are removed, and then specialized instruments are used to extract pieces of disc material. Also, the space around the spinal nerve is made larger to prevent compression in the future. Bone spurs also are removed. The vertebrae may or may not require fusion and hardware stabilization.
Minimally Invasive Discectomy
Minimally invasive discectomy is approached is from the posterior surface, according to the Mayfield Clinic. A relatively small incision is created in the neck through which dilators, or small tissue expander tubes, are inserted. These create a tunnel that leads to the bulged disc area. Bony obstructions are removed, and the disc is exposed. With the aid of a surgical microscope or endoscope and specialized instruments, the bulging material is removed. This technique offers the advantage of being less traumatic than traditional discectomy.
Artificial Disc Replacement
When artificial intervertebral disc arthroplasty is used, the anterior approach is taken. BlueCross BlueShield Association says this technique employs an artificial disc to substitute for the diseased disc. The advantages of this technique are that natural movements between vertebrae are preserved with the artificial disc. Also, since fusion is not required, disc degeneration at other levels may be prevented.
