Prof. Dr. Nurullah Ermiş
Cervical Disc Herniation Surgery
Cervical Disc Herniation Surgery Nedir?
A cervical herniated disc occurs when the intervertebral discs between the neck vertebrae rupture due to aging, trauma, or excessive mechanical stress, allowing the nucleus to protrude and compress the nerve roots traveling to the arm or to directly compress the spinal cord. The C5–C6 and C6–C7 levels are most frequently affected. Because the nerves at these levels supply the shoulder, arm, forearm, and fingertips, compression typically produces arm pain, tingling, numbness, and grip weakness. In multi-level or central herniations, direct pressure on the spinal cord — known as cervical myelopathy — can occur, presenting with fine motor difficulty in the hands, gait disturbance, and balance problems that require urgent evaluation.
Prolonged computer and smartphone use, forward-head posture, sedentary office work, and poor ergonomics significantly increase the risk of cervical disc disease. Although the condition is most commonly seen in the 35 to 55 age group, severe cases are encountered in patients in their 30s as well. Diagnosis is established through clinical examination and neurological testing, followed by MRI to determine the level, size, and degree of canal stenosis caused by the herniation; electromyography (EMG) is used to identify which specific nerve root is affected.
Prof. Dr. Ermiş performs cervical disc surgery through a cosmetic incision of approximately 3 cm made on the front of the neck, working under the operating microscope. After the diseased disc is completely removed, disc height and the natural cervical curve are restored using a titanium or PEEK cage, fully decompressing the nerve and spinal cord. In cases where preserving range of motion and minimizing stress on adjacent segments are priorities, a mobile artificial disc (TDR — Total Disc Replacement) is preferred over fusion.
Decision-making in cervical disc disease is based not only on MRI findings, but also on whether the patient has progressive arm weakness, signs of spinal cord compression, dexterity loss, gait imbalance, and night pain that disrupts sleep. The number of affected levels, spinal alignment, bone quality, and the presence of osteophytes or severe foraminal stenosis are all essential in choosing the correct technique.
Recovery after cervical spine surgery also requires a structured postoperative plan. Pain control, early mobilization, posture correction, ergonomic changes for desk work, and gradual neck-muscle reactivation all contribute to long-term success. The goal is not only to remove pressure from the nerve or spinal cord, but also to help the patient return safely to daily life, work, and screen-based activities without recurrent symptoms.
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- Burning pain radiating from the shoulder into the arm, forearm, and fingertips
- Tingling, numbness, and grip weakness in the fingers
- Difficulty with fine motor tasks such as buttoning clothes, holding a pen, or using a keyboard
- Marked restriction in neck movement, neck stiffness, and inability to turn the head fully
- Nighttime arm and neck pain that wakes the patient
- Balance problems in the legs, gait difficulty, or a scissoring walk pattern (indicating spinal cord compression)
- Hand stiffness, loss of strength, and reduced willingness to use tools
Tedavi Yöntemleri
ACDF — Anterior Cervical Discectomy and Fusion
ACDF (Anterior Cervical Discectomy and Fusion) is the most frequently performed surgical technique for cervical disc disease worldwide and has well-established long-term outcomes documented in extensive clinical studies. Surgery begins with an approximately 3 cm cosmetic horizontal or slightly oblique incision on the front of the neck; because the incision is concealed within a natural skin crease, the postoperative scar is barely visible. Through this incision, the major vessels and nerves of the neck are gently mobilized to expose the anterior surface of the spine, and the diseased disc is completely removed under the operating microscope. A titanium or PEEK cage is then placed into the disc space to restore disc height and cervical lordosis, and a titanium plate is fixed anteriorly with screws. This constructs a stable fusion, provides controlled restriction of segmental motion, and permanently decompresses the nerve root and spinal cord. For a single-level procedure, operative time is 60 to 90 minutes and hospital stay is 1 to 2 days.
TDR — Total Disc Replacement (Artificial Disc)
Total Disc Replacement (TDR) is a modern alternative to fusion that is particularly preferred in young to middle-aged active patients with single-level disc disease in whom preserving neck range of motion and reducing adjacent-segment stress are priorities. After discectomy, instead of a cage, a mobile artificial disc prosthesis — composed of cobalt-chromium alloy or ceramic components with a polyethylene interface — is implanted. This prosthesis replicates the function of the natural disc, preserving neck flexion, extension, and rotation. Because TDR maintains motion at the treated level, it has the potential to prevent early degeneration of adjacent discs that would otherwise be subjected to increased load transfer following fusion. Published prospective randomized trials support that, in appropriately selected patients, TDR provides comparable clinical outcomes to ACDF at 7 to 10 year follow-up and reduces the rate of adjacent segment disease.
Sıkça Sorulan Sorular
Can a cervical herniated disc improve with exercise?
In mild cases, neck stretching and strengthening exercises, physical therapy, and ergonomic adjustments can significantly reduce pain; when symptoms have been present for fewer than 6 weeks and there are no neurological deficits, conservative management is the first-line approach. However, if radiating arm pain persists beyond 6 to 8 weeks, grip or arm strength is reduced, or signs of spinal cord compression are present, exercise therapy alone is insufficient, and specialist evaluation with imaging is necessary.
Is neck surgery dangerous?
In experienced hands with appropriate technology, the complication profile of ACDF is very favorable. Transient hoarseness may occur in 2 to 5% of patients and swallowing difficulty in 3 to 5%; the vast majority resolve completely within a few weeks to months. Permanent nerve injury or vascular complications are extremely rare. The operating microscope, intraoperative neuromonitoring, and modern implants all contribute to minimizing these risk rates.
Which is better: a cage or an artificial disc?
This decision is individualized based on the patient's age, activity level, number of affected segments, bone density, status of adjacent segments, and surgical anatomy. As a general principle, TDR tends to be preferred in patients under 40 who are active and have single-level disease with healthy adjacent segments, while ACDF is more commonly selected for those over 50, multi-level involvement, or where bone quality is a concern. Both techniques have well-supported long-term safety and efficacy profiles.
Is a neck brace required after surgery?
For a standard single-level ACDF, most surgeons recommend a soft collar for only a few days to two weeks primarily for comfort. In multi-level procedures or cases with poor bone quality, this may extend to four weeks. Prolonged immobilization weakens the cervical musculature and is therefore not recommended; targeted muscle activation and early mobilization have a positive effect on recovery.
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