Cervical disc herniation, also known as “neck herniation,” occurs when the contents of the  discs between the vertebrae shift toward the area containing the spinal cord or nerve roots. Cervical disc herniation often presents with neck pain, radiating pain down the arm, numbness in the arms, and changes in sensory, motor, and reflex function, resulting in a condition known as radiculopathy. In approximately a quarter of patients, myelopathy may develop, which involves impaired blood supply to the spinal cord and structural changes in the spinal cord itself. This condition manifests with symptoms of spinal cord damage, such as weakness in the arms and legs, sensory loss, difficulty walking, and urinary incontinence. Although non-surgical treatment options are available for cervical disc herniation, the decision for surgery is made after a thorough examination of each patient. Non-surgical treatment options include rest, cervical collar use, painkillers and muscle relaxants, transforaminal injections, and facet joint injections.

In cases of myelopathy, which results from impaired blood supply to the spinal cord, the problem is typically more related to spinal canal stenosis rather than disc herniation. In cervical spinal stenosis, pain is often not the primary symptom, so neurological signs may go unnoticed by the patient until they become more advanced. Therefore, a thorough neurological examination is essential for all patients.

The goal of surgical treatment is to remove the herniated disc and alleviate pressure on the nerve. This surgery is typically performed through an incision made at the front of the neck. During the procedure, both the spinal cord at the midline and the compressed nerve channels on the sides leading to the arms are decompressed. Additionally, any bony spurs, known as osteophytes, along the edges of the vertebrae are shaved down.

Fusion and Stabilization

Following decompression, fusion of the vertebrae is a commonly used procedure. An implant filled with material that accelerates the fusion process is placed in the space where the disc was removed. This implant not only accelerates the fusion but also helps preserve the height of the disc space and restore the natural curvature of the neck. A metal plate is then placed at the front of the spine and secured with screws to stabilize the vertebrae.

In cases of spinal stenosis and myelopathy, decompression surgery may be performed from the front (anterior), back (posterior), or both sides, depending on the severity and location of the stenosis. After decompressing the nerve and spinal cord structures, an implant is placed to support the cervical vertebrae and ensure proper fusion in the correct alignment.

Surgical Approach
Surgery may be planned from the front of the neck (anterior), back (posterior), or both, depending on several factors. Surgeons evaluate points of compression in the spinal cord or nerve roots and determine the level of compression. They also assess issues like impaired blood flow in the spinal cord and myelomalacia (spinal cord damage) as well as the alignment of the cervical vertebrae. The presence of kyphosis, a forward curvature, is particularly important for planning the surgery.

Anterior Surgery
For an anterior approach, an incision is made at the front of the neck, providing access to the spine through the esophagus, trachea, and carotid arteries. Disk and vertebral segments pressing on the nerve root are removed. Bone fragments from the removed vertebrae are placed into an implant, which is then inserted between two vertebrae. These vertebrae are secured together with a metal plate and screws.

Posterior Surgery
There are two main techniques for posterior surgery:

1. Laminectomy + Stabilization
   In posterior surgery, the spine is accessed through the muscles at the back of the neck. Based on radiological and neurological findings, screws are inserted at specified levels and connected with a metal rod for stabilization. The bone called the lamina, which forms the back of the spinal canal, is thinned and removed, creating a partially open canal that relieves pressure on the spinal cord.

2. Laminoplasty
   In laminoplasty, the lamina on one side is completely cut, and the opposite side is partially thinned. This allows the posterior spinal elements on the cut side to be lifted like a hinge. Once the spinal cord is decompressed, mini plates and screws are used to secure and widen the canal.