Cervical Disc Herniation: To Operate or Not?

Q: Cervical Disc Herniation: To Operate or Not?

Hello： Whether to perform surgery for cervical disc herniation compressing the nerves depends on： 1. <br>The urgency of the situation, such as if there is already paralysis or weakness; 2. <br>The effectiveness of conservative treatments, such as medications and physical therapy;

Cervical intervertebral disc herniation..?

Hello Dr.
Lai: I visited for arm numbness and pain last November, and it was found that I have a herniated disc at the C5 and C6 vertebrae.
At that time, I underwent traction therapy and acupuncture, which helped a bit, but I did not fully recover.
Then in July of this year, the symptoms recurred, and the numbness and pain were more severe than before.
I have had X-rays and an MRI, and I consulted two doctors—one recommended surgery, while the other said it was not necessary.
I am in a dilemma and unsure whether to proceed with the surgery, as I am also very concerned about potential complications.
That is my question.
Thank you!

Ms. Zhang, 50~59 year old female. Ask Date: 2022/09/30

Dr. Lai Zhaokang reply Neurosurgery

Hello: Whether to perform surgery for cervical disc herniation compressing the nerves depends on: 1.
The urgency of the situation, such as if there is already paralysis or weakness; 2.
The effectiveness of conservative treatments, such as medications and physical therapy; if these have not been effective; 3.
MRI imaging that clearly shows nerve compression and damage, where surgical decompression could improve symptoms.
This involves 1.
Objective assessment of the degree of compression on MRI; 2.
The patient's subjective experience of symptoms; 3.
The surgeon's experience and judgment.
I usually advise patients: if the imaging shows compression and you can tolerate it, then continue with your life as is.
However, if you want to improve your quality of life, then consider surgery.
For me, the surgery is not difficult.
Whether there are complications depends on the surgical method, materials used, the patient's constitution, and the surgeon's skill.
Generally speaking, cervical spine surgery performed by an experienced surgeon should go smoothly.
Wishing you health and safety.
By Dr.
Lai Chao-Kang, Chief of Spine Surgery, Changhua Hospital.

Reply Date: 2022/09/30

More Info

Cervical disc herniation is a condition that occurs when the soft inner material of a spinal disc protrudes through a tear in the tougher exterior, potentially pressing on nearby nerves. This can lead to symptoms such as pain, numbness, or weakness in the arms or hands, as you have experienced. The decision to operate or not can be complex and depends on several factors, including the severity of your symptoms, the degree of nerve compression, and your overall health.

In your case, it seems that you have already undergone conservative treatments such as traction and acupuncture, which provided some relief but did not completely resolve your symptoms. The fact that your symptoms have worsened suggests that the herniation may be affecting your quality of life and daily activities.
When considering surgery for cervical disc herniation, doctors typically evaluate the following:
1. Severity of Symptoms: If your symptoms are severe and significantly impact your daily life, surgery may be recommended. This is especially true if you are experiencing persistent pain, weakness, or numbness that does not improve with conservative treatments.

2. Duration of Symptoms: If you have had symptoms for an extended period (usually more than six weeks) without improvement, surgery might be considered.
3. Neurological Deficits: If there are signs of nerve damage, such as muscle weakness or loss of reflexes, surgery may be necessary to prevent permanent damage.

4. Response to Conservative Treatment: If you have tried various non-surgical treatments without success, this may indicate that surgery is a viable option.

5. Imaging Results: MRI and X-ray findings can help determine the extent of the herniation and whether it is compressing the spinal cord or nerves.

The two opinions you received from different doctors reflect the variability in treatment approaches for cervical disc herniation. Some physicians may lean towards conservative management, especially if the herniation is not causing significant neurological deficits. Others may recommend surgery sooner, particularly if there is a risk of worsening symptoms or if the herniation is severe.

Regarding your concerns about potential surgical complications, it is important to discuss these with your surgeon. Common risks associated with cervical spine surgery include infection, bleeding, nerve damage, and complications related to anesthesia. However, many patients experience significant relief from their symptoms after surgery and can return to normal activities.

Ultimately, the decision to undergo surgery should be made collaboratively with your healthcare provider, taking into account your specific circumstances, preferences, and the potential risks and benefits of the procedure. It may also be helpful to seek a third opinion or consult with a spine specialist who can provide further insight into your condition and treatment options.

In conclusion, if your symptoms are severe and affecting your quality of life, and if conservative treatments have not provided adequate relief, surgery may be a reasonable option to consider. However, it is crucial to weigh the potential benefits against the risks and to have a thorough discussion with your healthcare provider to make an informed decision.

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