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Spine Conditions

Cervical Herniated Disc Treatment Options

The treatment options for a herniated cervical disc are designed to relieve pain, improve mobility, and prevent further injury to the spine. Depending on the severity of the symptoms, the degree of nerve compression, and the patient’s overall health status, these treatments can be broadly categorized into non-surgical (conservative) and surgical methods.

Most cases of cervical herniated discs will resolve within the first four weeks without any intervention. Acute cervical nerve pain caused by a herniated cervical disc is managed with non-surgical treatment. 75%-90% of patients will improve with conservative management. However, in the presence of strength deficits, numbness, balance or gait changes, or urinary or bowel control issues, expedient surgery may be the most appropriate course of treatment to optimize the prognosis for neurological recovery.

Non-surgical treatment includes:

  1. Medications
    • Pain relievers: Over-the-counter (OTC) pain medications like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain.
    • Muscle relaxants: These may be prescribed to relieve muscle spasms.
    • Nerve pain medications: Medications such as gabapentin or pregabalin can be effective for nerve-related pain.
    • Oral corticosteroids: A short course might be used to reduce inflammation and pain for severe acute pain.
  1. Epidural steroid injections are a common alternative to surgery. They are administered under fluoroscopy and are for patients whose symptoms are not effectively managed with noninvasive treatments. They help reduce inflammation and nerve irritation. Dr. Ball also works with an excellent consultant network of pain management specialists who offer other interventional pain procedures.
  2. Physical therapy is typically recommended after a short period of rest and immobilization. It involves tailored exercises to help strengthen neck muscles, improve posture, and increase flexibility, thereby reducing the pressure on the herniated disc.
  3. Cervical immobilization to treat acute neck pain involves the use of a cervical collar.
  4. Cervical traction may help relieve pain and stress on affected nerves.
  5. Manual therapy, including massage, chiropractic adjustments, or osteopathy, may offer symptomatic relief for some patients.

Surgery may be considered if conservative treatments fail to improve symptoms after some time, usually 6 to 12 weeks, or if there is significant weakness, loss of function, or severe pain.

Surgical options include:

Anterior Cervical Discectomy and Fusion (ACDF)

This is the time-tested traditional surgical treatment option for a herniated cervical disc when there is severe or progressive neurological damage and significant pain that does not respond to non-surgical treatments. It involves removing the herniated disc (discectomy) to relieve pressure on the nerve roots or spinal cord and then fusing the bones with a graft of bone or synthetic materials. Plates and screws may be used to stabilize the spine.

ACDF is indicated for patients with symptomatic cervical herniated discs that have not improved with conservative treatment, especially when accompanied by nerve compression symptoms such as pain, numbness, and weakness in the arms.

Cervical Artificial or Total Disc Replacement (ADR or TDR)

In this procedure, which is becoming the gold standard surgically, instead of fusing the vertebrae after removing the herniated disc, the surgeon inserts a motion-restoring artificial disc into the surgically decompressed, vacated disc space. The artificial disc is designed to mimic the form and function of the natural disc, preserving motion at the operated level of the spine.

ADR may be considered for patients with cervical disc herniation causing nerve compression symptoms who have not found relief with non-surgical treatments. It is particularly suited for patients where preserving neck motion is desirable and who do not have conditions that would necessitate fusion, such as significant spinal instability or multi-level disc disease.

Posterior Cervical Discectomy

This approach involves removing part of the herniated disc that is compressing a nerve root from the back of the neck. Posterior cervical discectomy is indicated for certain cases of cervical disc herniation, especially when the herniated disc is located more laterally (to the side). It might be more accessible from the posterior approach without requiring the removal of too much bone or other tissue and does not require any pressure or retraction on the spinal cord.

The choice among these surgical options depends on several factors, including the location and severity of the disc herniation, the presence of other cervical spine issues, the patient’s overall health, and personal preferences regarding recovery and outcome expectations.

Recovery times and post-operative care vary between procedures, depending on factors like the patient’s health and lifestyle, the specific technique used, and the presence of complications. Post-surgical rehabilitation typically involves physical therapy to strengthen the neck muscles, improve flexibility, and support a quicker return to normal activities.

The decision to proceed with surgery is taken after a thorough evaluation and discussion between the patient and the healthcare provider, considering the potential benefits and risks of the procedure. Contact Dr. Hieu Ball to schedule a consultation to learn more about your treatment options.

Contact Dr. Hieu Ball to schedule a consultation at his San Ramon. He offers a full range of treatments for neck pain. Dr. Ball offers state-of-the-art patient-centered care for patients with neck, mid-back, and low-back problems. He received his orthopedic and spine surgery residency and fellowship training at Harvard Medical School and UCLA-affiliated institutions. Education included training at Massachusetts General Hospital, Brigham and Women’s Hospital, and Boston Children’s Hospital. Dr. Ball is a double fellowship-trained orthopedic spine surgeon. He received a pediatric spine fellowship at Boston Children’s Hospital and a second adult spine fellowship at UCLA. Dr. Ball offers minimally invasive spine care, and many procedures often may be performed on an outpatient basis in an ambulatory surgical center setting.

References

  • Sharrak S, Al Khalili Y. Cervical Disc Herniation. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.¬†Available from: https://www.ncbi.nlm.nih.gov/books/NBK546618/
  • Yoon WW, Koch J. Herniated discs: when is surgery necessary? EFORT Open Rev. 2021 Jun 28;6(6):526-530. doi: 10.1302/2058-5241.6.210020. PMID: 34267943; PMCID: PMC8246101.
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Dr. Hieu Ball

  • Double fellowship-trained orthopedic
  • Orthopedic surgery residency at Harvard Medical School
  • Over 20 years of spine surgery experience
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