Some spinal surgeons may prefer the posterior approach (from the back of the neck) for a cervical discectomy. This approach is often considered for large soft disc herniations that are lateral to (to the side of) the spinal cord. The principal advantage of the posterior approach is that a spine fusion does not need to be done after removing the disc. The principal disadvantage is that the disc space cannot be opened with a bone graft to give more space to the nerve root as it exits the spine. Also, since the posterior approach leaves most of the disc in place, there is a small chance (3% to 5%) that a disc herniation may reoccur in the future.
1. The general procedure for the posterior cervical decompression (microdiscectomy) surgery is:
2. Surgical approach: 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.
Disc removal: 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 bleeding occurs.
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