MANAGEMENT OF CERVICAL DISK PROBLEMS
By John C. Mullan, M.D., F.A.C.S.

Damaged or worn-out cervical disks are a common problem. A cervical disk may bulge out and press on the spinal cord or a nerve root. This is called a cervical disk herniation. A cervical disk may also wear out and flatten. This is called cervical disk degeneration.  Osteophytes (bone spurs) may form on the bones near worn out cervical disks and may put pressure on the spinal cord or nerves. The narrowing of the spaces in the spine for the spinal cord and nerves is called stenosis. Both bulging cervical disks and osteophytes can cause stenosis. Cervical disk problems may cause neck pain, arm pain, arm and leg weakness and numbness.

The most common test for cervical spine problems is the MRI scan. The MRI scan isn't a perfect test though and you made need other tests such as the EMG (electromyogram) or myelogram to accurately diagnose your condition.

Many times cervical spine problems can be treated without surgery.Medications can be used to treat your pain and reduce inflammation. You may be asked to restrict your activities.  Physical therapy, possibly including traction, heat, ultrasound, massage and strengthening or range of motion exercises, may help. You may be offered a trial of an epidural steroid injection.

Your neurosurgeon may advise you that surgery is recommended. This recommendation is usually made because you are not responding to other treatments or because your condition is too severe to treat without surgery. Your neurosurgeon will explain to you how your surgery is likely to affect your symptoms. It is important to remember that your symptoms may not go away completely after your procedure. Make sure that your neurosurgeon understands your expectations and that you understand your prognosis.

During cervical disk surgery your surgeon may remove all or part of a damaged disk and may make more room for your spinal cord or nerve roots by removing osteophytes. An operating microscope is used to minimize the size of the incision and to maximize the safety and accuracy of the operation. You may be offered a cervical microdiskectomy. In this procedure your neurosurgeon will make a small incision in the back of your neck and remove the damaged portion of the disk that is pressing on a nerve. Many cervical disk problems can't be reached from the back of your neck because the spinal cord is in the way. If this is the case you will be offered an anterior cervical diskectomy and fusion. In this operation a small incision is made in the front of your neck and the disk and any osteophytes are removed.  The empty disk space is then prepared for a fusion and will heal with bone. Titanium or other materials may be added to help the bone heal.

Surgery does have limitation and there are risks including problems with swallowing, persistent hoarseness, failure of bony fusion to occur, bleeding, infection and damage to the nerves or spinal cord. Your neurosurgeon will explain the specific risks of your surgery.

Most patients undergoing cervical disk surgery are discharged from the hospital the morning after their surgery. You will be informed of your restrictions and given an estimate of when you can return to normal activities and work. You may be asked to wear a neck brace or attend physical therapy but many times these are not required. Your first check-up after surgery is usually 4 weeks after you leave the hospital.

This brief article cannot completely cover the management of cervical disk problems but I hope you have found it informative. Your neurosurgeon will be happy to answer your questions during your consultation.