The first thing to make clear is that the vast majority of hernias do not need surgery. There will be times when the cervical hernia is causing injury around you and you need to intervene. In these cases there are several options. I am going to comment them although logically it is up to the surgeon to decide and perform the most appropriate in each situation.
The common link between all the surgeries we are going to comment on is the removal of the disc. With this gesture we eliminate the cause that is compressing the nerve root. The next step to take is where there are differences:
– There is the possibility of doing nothing else. You can remove the herniated disc and do not put anything in its place. There are surgeons who defend it although it is not usually done because of the risk of altering the normal curve of the neck when losing height the area of the disc. In my professional experience I have never seen him do it.
– The most common is to perform an arthrodesis, ie eliminate mobility in the segment operated by fixing it. Classically, it has been performed by providing bone graft between the two vertebral bodies. In making this gesture, the two vertebral bodies remain glued and form a block of bone where there is no mobility.
Cervical hernia surgery
Today the graft is attached by placing a plate with screws to hold the position while the bone grabs. This plate is screwed to the vertebral bodies as you can see in the photo. This is what we would call an arthrodesis with a bone graft. The bone graft is usually taken from our own body, from the iliac crest (where the pelvis begins in our back). The bone graft with the passage of weeks sticks to the two vertebrae. This process takes about three months.
– An evolution to the previous system is the implantation of an intersomatic box. This is nothing more than a device that gets where the disk was.
This has the advantage of not having to take the graft of the iliac crest. Instead of the bone these devices are placed. They are hollowed in such a way that the bone can grow through it and end up consolidating as in the previous case. They also have a few “teeth” to attach to the vertebral bodies and prevent them from moving out of place while the bone strengthens.
– There are systems that associate a box and a plate to make it more stable and decrease the risks of the box moving.
– There is a modern option when you do not want to immobilize the segment. They are the disc prostheses. These prostheses are placed between the vertebral bodies and allow mobility in the operated segment.
It would become a piece that imitates the function that made the disk. This option has existed for a while and has been developed for a reason. When an arthrodesis is done, mobility is eliminated in a segment and this causes the upper and lower segments to suffer an overload to assume the lost mobility. Over the years, these suffer more wear and can give problems. The prostheses of disc give a good initial result but, being so recent, no studies of what happens with the passage of the years.
I have reviewed above the types of surgery that exist to treat cervical hernia. Of each type of device there are different brands with their different characteristics, I have limited to the concepts. The surgeon will be in charge of applying the most appropriate system for our particular case.