Treatment depends on the symptoms and cause of the cervical disc herniation, but generally, non-surgical management is first-line treatment, designed to decrease inflammation around the disc, improving physical function, and managing pain.
For an acute cervical disc herniation that happens after an injury, most patients will improve with non-surgical management including:
Resting the neck and avoiding activities that worsen pain in the short term after an injury are helpful in managing pain, and preventing more inflammation around the herniated disc.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as Aleveâ or ibuprofen, or acetaminophen or Tylenolâ may be helpful in improving pain.
If pain is persistent, a short course of oral steroids or muscle relaxants may be prescribed, in particular if the patient is having muscle spasms.
Some patients find relief with applying heat or ice to their neck.
Physical therapy also may be helpful in improving range of motion and restoring neck muscles strength to prevent further injury.
When pain medicine, heat, ice and oral steroids, and physical therapy are unsuccessful, patients may benefit from a spinal steroid injection done under X-ray fluoroscopic guidance.
Typically, with conservative therapy, most patients improve in about 6 weeks. If symptoms continue to persist despite conservative management, then a minimally invasive surgery can be considered.
Surgical management is meant to fix the disc protrusion or to create more space around the spinal cord or nerve roots to alleviate symptoms. All surgical procedures are performed using general and local anesthesia. Chicago spine surgeon Dr. Kern Singh recommends these surgical procedures for a herniated cervical disc.
Anterior cervical discectomy and fusion (ACDF)
In an ACDF, Dr. Singh makes a small incision, less than one inch long, at the front of the neck, gently pushes aside the muscles and removes the herniated disc and any bone spurs. He then places a bone graft or plastic spacer in place. A synthetic bone graft helps to fuse the vertebrae above and below for stability. A metal plate may also be used for stability. Patients can typically leave the surgery center the same day. Most patients do not need a cervical fusion, and in general, Dr. Singh recommends motion preservation with a cervical disc replacement instead of fusion in almost all situations. Nevertheless, in those situations where the disc degeneration is extremely advanced Dr. Singh is adept in providing a minimally invasive outpatient anterior cervical fusion.
In a cervical disc replacement, Dr. Singh makes a small incision, less than one inch long, at the front of the neck. Then he removes the damaged and herniated disc and replaces it with an artificial disc made of titanium and plastic (very similar to implants used in a total hip or knee replacement). Patients go home the same day. Compared to the ACDF, cervical spine motion is maintained because there is no fusion of the vertebrae with a plate or screws.
A cervical endoscopic foraminotomy is a minimally invasive surgical technique that is used to relieve pressure on spinal nerves in the neck by widening the neural foramen. The procedure involves two incisions smaller than the size of a pen tip. One incision is used to place a small camera similar to those used in knee and shoulder arthroscopy. The other incision is used to use small instruments smaller than 5mm to remove the bone spurs. The procedure is outpatient meaning you go home the same day of surgery. This technique has a high success rate for reducing arm pain (radiculopathy). While a cervical foraminotomy can be performed using an open technique (large incision in the back of your neck), endoscopic foraminotomy offers significant benefits that make it a preferred technique in qualified hands such as Dr. Singh’s. It is safe and effective for patients with arthritic bone changes and herniated discs in the neck.
After surgery, no neck brace is required even in the rare instance of a cervical fusion. Dr. Singh will provide each patient with complete post-operative recovery instructions including wound care. Patients typically experience an immediate improvement of arm pain with gradual improvements in numbness and weakness over several weeks.
Patients can expect some postoperative pain or discomfort at the surgical site. Dr. Singh may prescribe pain medications to manage any discomfort during the initial healing process. Activities will be restricted for a few weeks to promote healing. Full recovery can take a few weeks to months.
Dr. Kern Singh, MD is an internationally renowned spine surgeon specializing in outpatient minimally invasive and motion-preserving techniques and endoscopic spine surgery at Midwest Orthopedics at RUSH and Professor in the Department of Orthopedic Surgery at RUSH University Medical Center in Chicago, Illinois. Dr. Kern Singh is one of the nation’s Top 100 spine surgeons and beloved by his patients for his compassionate care and excellent outcomes. He welcomes nationally and internationally – based patients.
