Summary The goal of surgery for a cervical herniated disc is to remove the damaged disc and ensure that the nerve root and/or spinal cord is decompressed.
Posterior cervical discectomy A small incision is made in the midline of the back of the neck. The para-spinal muscles are elevated off the spinal level that is to be approached. An x-ray is done to confirm that the surgeon is at the correct level of the spine. A high-speed burr is used to remove some of the facet joint, and the nerve root is then identified under the facet joint. An operating microscope is then used for better visualization. The disc will be directly under the nerve root, which needs to be gently mobilized (moved to the side) to free up the disc herniation. There is usually a plexus (network) of veins over the disc that can obstruct visualization if they bleed.
Foraminotomy A foraminotomy is a decompression surgery that is performed to enlarge the passageway where a spinal nerve root exits the spinal canal. The term foraminotomy is derived from the medical term for a hollow passageway—foramen. The latter half of the term foraminotomy—otomy—means to open. The procedure can be performed as a day stay surgery, but most patients stay in hospital for 1-2 nights. General anesthesia is utilized and the surgery is performed through an incision of 2-4 cm. Usually a small window is made on one side of a spinous process, at the junction of the lamina and facet joint, through the removal of some bone and ligament to allow visualization of the involved root. Using a high speed drill and microinstruments, once the nerve root affected is identified, the whole out of which the nerve passes is enlarged. The nerve root is then gently elevated and if there is a disk bulge this is palpated. If identified, the disk bulge is incised and typically a tiny piece of disk is removed. The whole disk is not removed. The operation is then complete and after placing cortisone over the nerve root, closure is effected, typically, with dissolving sutures for skin. Typically this takes 1-2 hours to perform.
Total Removal of Tumor Surgery is performed in order to improve patient outcome, reduce the risk of paralysis and reduce pain, tumors of the bony spinal column may require resection and stabilization. Spinal Tumor surgery is generally indicated in case there is a localized tumor which can be removed with minimum damage to nerve and spinal cord. There is persistent neurological deficit and pain which is unresponsive to non operative treatment Surgery may include resection or excision of tumor.
Indications Discectomy & Foraminotomy - Nerve root compression (Spinal stenosis, Degenerative disc disease, a bulging or herniated intervertebral disc, bone spurs, spondylosis) - If the pain lasts longer than 6 to 12 weeks, or if the pain and disability are severe and unresponsive to nonsurgical treatments
Tumor removal The surgery will depend on symptoms. - Back pain often radiating to other body parts - Difficulty walking - Loss of sensation or muscle weakness - Loss of bowel/bladder function - Scoliosis - Desturction of vertebral body - Paralysis of varying degree