Minimally Invasive Procedures

Percutaneous cervical discectomy

Treatment of a painful herniated cervical disc is contemplated only when other measures have failed to relieve the patient’s pain. These measures include, rest, medications, physical therapy and occasionally injectional therapy, wherein pain relieving medications are injected to the site of nerve irritation or compression.

Patients with a cervical disc herniation may present with burning pain along the shoulders and arms. This is usually due to irritation of the spinal nerve as it exits the spine either by direct disc compression or inflammation. This is because a segment of disc is “herniated,” meaning migrated from its normal location or swollen beyond its normal location. Alternatively, patients with cervical disc herniation may present with neck pain, low neck pain or a low lying headache, depending on the location of the herniated cervical disc. Here the disc itself is painful, rather than compressing adjacent nerves.

Percutaneous cervical discectomy is a minimally invasive procedure for the treatment of neck pain or cervical nerve pain due to herniated disk. “Percutaneous” means that the procedure is performed through a tiny skin incision. For a cervical discectomy, a small needle is placed into the disc, from just to the side of the neck, from the front. The surgeon can feel the vertebra of the cervical spine with deep palpation, or hand pressure. At the same time, the surgeon uses his hands to push important structures, like the trachea, esophagus, carotid artery and jugular vein, out of the way. This allows a safe passageway into the disc. A wire is placed through the needle and a cannula, or surgical access tube, is placed over the wire. Once at the disc devices are placed through the cannula to remove the diseased disc and decompress the nerves. Occasionally overgrown bone, called osteophytes, caused by arthritis has to be removed through the cannula. The procedure is guided by a scope placed through the cannula and by x-rays. In either case, the surgeon watches the images on a screen while he or she performs surgery.

A true percutaneous cervical discectomy relies on mechanically decompressing the nerves of the cervical spine. This means that impinging bony overgrowth or disc is physically removed using tiny instruments passed through the cannula. However, energy based ablation may be a complimentary procedure and is often performed after the discectomy. This is called laser thermodiscoplasty and involves placing a laser probe into the disc and using laser energy to liquefy residual degenerated disc and ablate, or burn, the nerves within the disc that can cause pain.

Contrary to traditional cervical disc surgery, percutaneous cervical discectomy usually involves only a small band aid and a single suture to the front of the neck. Because the herniated disc is approached in a minimally invasive fashion, important natural structures are not disturbed. In traditional cervical disc surgery the surgeon accesses the disc from behind, necessitating the removal of bone, ligaments and muscle. This is not necessary through the percutaneous approach. Patients may, in almost all cases, go home the same day. Postoperative care will consist of rest and physical therapy.