Innovative Approach in Neck Hernia Surgery: Disc Prosthesis

Among the causes of neck pain that negatively affect daily life, neck herniation is characterized by complaints such as pain that sometimes radiates from the neck to the fingertips, as well as numbness and weakness. In recent years, there has been a new approach to the surgical treatment of neck herniation. Disc prostheses, which are used particularly in patients requiring surgery and have the ability to mimic the natural movements of the neck, stand out as a noteworthy treatment method due to their advantages. For more details on this topic, we consulted Prof. Dr. Mehmet Çağlar Berk, Director of the Neurosurgery Department at Anadolu Health Center Hospital. What kind of method is the disc prosthesis used for neck herniation, can it be applied to every patient, and what are its differences from classical neck hernia surgery? All your questions related to these topics will be answered in this article...

How Does a Herniation Occur?

Neck pain is a common issue, especially among people who work at desks. This pain can sometimes indicate a herniated disc in the neck, which is the most mobile part of our spine, with symptoms such as pain that may radiate down to the fingers, numbness, and weakness. If persistent, recurring pain that does not improve with simple over-the-counter painkillers begins to restrict daily life, it is important to consult a specialist for a definitive diagnosis without delay. The sections between the bones that make up our spine, known as "discs," help maintain the distance between the bones while also providing the spine with a certain degree of flexibility, movement, and load-bearing capacity. Our spine is capable of all neck movements thanks to these discs. The disc can be likened to a small cushion. The outer part of the disc is covered with cartilage-like tissue, while the inner part is jelly-like and consists of water, collagen, and other protein compounds. However, this structure can lose its elastic properties due to age-related loss of protein and water. This negatively affects the load-bearing capacity and flexibility of each disc in our neck. The result is, as you might guess, a hernia. Over time, the inner structure of the disc protrudes outside, leading to herniation. Herniations typically occur in the neck and lumbar regions; when the protruding structure contacts the nerves, it manifests with symptoms such as pain, numbness, tingling, and weakness. While neck herniation is rarely seen in children, it primarily occurs in individuals aged 30-50, and degenerative issues like rheumatism and osteoarthritis become more prominent as one ages.

Causes of Neck Herniation

Age-related decrease in the flexibility and load-bearing capacity of the discs.

• Heavy lifting and abrupt neck movements.
• Trauma from traffic accidents and falls, spinal injuries, and unexpected impacts.
• Postural problems caused by the frequent use of smart technologies in modern life.

Diagnosis and Treatment Process

For diagnosis, the patient's account of their symptoms and detailed examinations are crucial. Key questions include when the symptoms started, how frequently they occur, their severity, and which movements or positions exacerbate or alleviate the complaints. Listening carefully to the patient is essential for accurate diagnosis and the best treatment decision. MRI is utilized to reveal the spine, discs, spinal cord, and nerve tissues in detail for diagnosis, and in some cases (if there are suspicions of fractures, cracks, or conditions like rheumatism), a CT scan and X-rays may also be requested. X-rays taken in various positions are particularly used to assess the limits of neck movements and whether there is any restriction in movement. Additionally, in the diagnostic process, for some patients (for example, those suspected of having diabetes or other diseases affecting the nervous system), EMG tests, which measure nerve conduction, are a useful method to differentiate whether the nerve involvement stems from a neck herniation or another issue.

It is possible to discuss both non-surgical and surgical options in the treatment of neck herniation. Non-surgical treatment options include painkillers and muscle relaxants, injections targeted at the area of nerve compression, physical therapy, and chiropractic treatment. Among surgical options, disc prostheses have gained particular attention in recent years due to their advantages.

What is the Role of Disc Prosthesis in Neck Herniation?

The goal of surgical treatment for neck herniation is to relieve the mechanical pressure on the nerve root and provide comfort to the nerve root. When this pressure is alleviated in the early stages, it prevents potential chronic and even permanent changes that could occur in the nerve tissue later on. If treatment is delayed, even if the patient eventually undergoes surgery, they may not benefit from the operation due to nerve damage caused by the delay. Therefore, it is crucial to determine the most appropriate treatment for each patient, including when and how it should be performed.

In surgical treatment, there are approaches that can be performed from the front or back of the neck. Surgeries performed from the back involve microsurgical techniques to widen the canal through which the nerve tissue exits, indirectly relieving the pressure caused by the herniated disc on the nerve. In classical surgery performed from the front of the neck, the disc between two vertebrae is completely removed, allowing access to the herniated section to relieve the nerve. After cleaning the protruding section, a bone piece taken from another part of the patient's body (usually the hip) or plastic/metal cages are used to fill the gap between the two vertebrae. Following this, it is necessary to wait for 2-3 months for the two vertebrae to fuse completely. After this type of surgery, the range of motion in the neck decreases by 10-20 degrees for each operated level. Although this loss generally does not create issues in daily life, over time, due to increased load and stretching at the levels above and below the operated area, the risk of developing a neck herniation increases. This condition is medically referred to as “adjacent segment disease.” The risk of this occurring is 2.9% for each year of life following classic fusion surgeries performed at a single level. Fusion at multiple levels further increases this annual risk. Therefore, regardless of how successful the cervical fusion surgery is, there is a high likelihood of requiring a second surgery sooner or later.

Today, in neck herniation surgery, cervical disc prostheses are preferred methods that aim to preserve natural movement capability without restriction in the early stages and to prevent what we call “adjacent segment disease.” These prostheses are made from special plastics and ceramic alloys that are well-accepted by the body and do not cause any allergic reactions, as well as lightweight and highly durable materials like titanium.

Recently, Prof. Dr. Mehmet Çağlar Berk and his team have been performing neck herniation surgeries with a high success rate using cervical disc prostheses at Anadolu Health Center. Patients have the opportunity to recover quickly and return to their daily lives after surgery. Additionally, surgeries performed with cervical disc prostheses that maintain the natural movements, flexibility, and load-bearing capacity of the neck also help preserve the health of the discs above and below the treated area.

How Long Does the Surgery Take?

The placement of the disc prosthesis used to address neck herniation is completed with a surgery lasting 1 to 1.5 hours. Patients typically stay in the hospital for only one day and are discharged the next day. During the first 1-2 weeks after surgery, patients are advised to rest and avoid strenuous neck movements. After this period, patients can return to their normal daily life and activities without any restrictions. Since there is no need for restriction of neck movements even in the early post-operative period, patients do not require a hard neck brace, which is often used after other surgical methods. This also provides additional comfort and convenience for patients.

Is the Disc Prosthesis Permanently Retained in the Body?

Cervical disc prostheses are permanent and durable, so there is no need for their removal or replacement in the future. They do not interfere with the natural movements of the neck and protect other healthy discs, so they do not cause any restrictions in daily life for the patient.

Is it Used for Lumbar Herniation as Well?

Prosthetic applications are also available for lumbar herniation, but they are not yet as commonly used as in neck herniation.

Is it Applicable to Every Patient?

Cervical disc prostheses are currently the most preferred treatment method. However, sometimes—though rarely—the patient’s neck anatomy may not be suitable for a disc prosthesis. In this case, other treatment methods appropriate for the patient may be considered.