Do I Need Surgery for My Herniated Cervical Disc? Expert Insights

Do I need surgery to replace my cervical intervertebral disc due to a herniated disc?

Hello Doctor, I am a patient with hypotonic cerebral palsy.
Last March, I suffered a fall that resulted in herniated discs at cervical levels 4 to 6.
Initially, I experienced increased difficulty controlling my legs, worsened balance, numbness in my hands while lying down, hand congestion when tilting my head back, and involuntary hand tremors.
I have been undergoing rehabilitation, traction, acupuncture, and massage therapy for over a year.
I had surgery to repair an atrial septal defect when I was six years old.

1.
Yesterday, an improper head turn caused my hands to tremble involuntarily again (this is the only symptom).
Given my current situation, do you think I still need surgery to replace the artificial disc, or can I recover through rehabilitation?
2.
Is there a possibility of complications after replacing the artificial disc? Will my sensations and neck movements feel abnormal afterward? What might happen if I fall again in the future?
3.
When I consulted with a doctor, they mentioned the risk of thrombosis during surgery.
How can I prevent thrombosis from occurring during the operation?
4.
Are there any other risks associated with the surgery?
Thank you for taking the time to answer my questions in detail.
I wish you success in your work.

007, 30~39 year old female. Ask Date: 2020/10/16

Dr. Zhang Junwei reply Neurosurgery

Your question is too complex.
Certain conditions require imaging studies and a personal physical examination to provide an answer.
It is recommended to consult a neurosurgery outpatient clinic for evaluation.

Reply Date: 2020/10/16

More Info

When considering surgery for a herniated cervical disc, particularly in the context of your specific medical history and symptoms, several factors must be taken into account. Your situation is complex due to your history of cerebral palsy and previous heart surgery, which may influence both your recovery and the risks associated with surgical intervention.

1. Current Symptoms and Surgical Necessity: Given that you have been experiencing significant symptoms such as difficulty controlling your legs, balance issues, and numbness in your hands, it is crucial to assess whether these symptoms are directly related to the herniated discs at C4-C6. The fact that your symptoms have worsened after a sudden movement suggests that there may be ongoing nerve compression or irritation. Surgery, such as a discectomy or artificial disc replacement, may be necessary if conservative treatments (like physical therapy, traction, acupuncture, and massage) have not provided sufficient relief. A thorough evaluation by a spine specialist, including imaging studies like an MRI, can help determine the extent of nerve involvement and whether surgical intervention is warranted.

2. Risks of Artificial Disc Replacement: While artificial disc replacement can alleviate pain and restore function, it is not without risks. Potential complications include infection, nerve damage, and the possibility of the artificial disc failing or causing adjacent segment degeneration (where the discs above or below the replacement wear out faster). Post-surgery, some patients report changes in sensation or neck movement, but many experience significant improvement in their symptoms. It is essential to discuss these risks with your surgeon, who can provide insights based on your specific case.

3. Preventing Blood Clots During Surgery: The risk of blood clots (deep vein thrombosis or DVT) is a concern with any surgical procedure, especially in patients with limited mobility. To minimize this risk, surgeons often recommend measures such as early mobilization post-surgery, the use of compression stockings, and possibly anticoagulant medications. Discussing your concerns with your surgical team will help them tailor a plan to reduce your risk of clot formation.

4. Other Surgical Risks: Besides blood clots, other risks associated with cervical spine surgery include anesthesia complications, prolonged pain, and the possibility of needing additional surgeries in the future. Each patient's risk profile is unique, especially considering your medical history. Therefore, a detailed discussion with your healthcare provider about the potential benefits and risks of surgery is essential.

In conclusion, the decision to proceed with surgery for your herniated cervical disc should be made collaboratively with your healthcare team, considering your symptoms, the effectiveness of conservative treatments, and your overall health status. If surgery is deemed necessary, understanding the risks and benefits will help you make an informed decision. Always feel empowered to seek a second opinion if you feel uncertain about the recommended course of action. Your health and quality of life are paramount, and addressing these issues proactively is crucial for your well-being.

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