Hi Dr. Moza. I've got a problem... disc herniation to be specific. I tried the physical therapy and medication route and I didn't get much relief. Unfortunately, I think it's time for surgery. What are my options?

I'm sorry to hear that your pain hasn't been managed by the more-conservative methods you've attempted. As you know, not all patients with this type of pain require surgery. In fact, more than 95 percent find symptom relief through non-surgical therapies like exercise, medication, physical therapy and chiropractic care. Other methods include ACDF treatment, which includes therapeutic and rehabilitation methods to ease the pain sensation without surgeries.

Before I answer your question, let me give our readers a primer on the topic. The tissues between the bones in your neck are called intervertebral discs. The discs are composed of a soft gel-like center and a tough outer lining. The intervertebral disc creates a joint between each of the bones in the spine that allows them to move. When the outer lining that surrounds a disc tears, the soft center can squeeze out through the opening, creating a herniated disc.

Neck pain and the symptoms caused by a herniated disc are common problems for many adults. The neck is composed of many different anatomic structures, including muscles, bones, ligaments and joints. Each of these structures has nerve endings that can detect painful problems when they occur.

A herniated disc in the neck can cause neck pain, radiating arm pain, shoulder pain and numbness or tingling in the arm or hand. The quality and type of pain can vary from dull, aching and difficult to localize to sharp, burning and easy to pinpoint. Pain in the arms as well as in the neck is usually the first sign that the nerve roots are irritated by a problem in the neck. Symptoms such as numbness, tingling and especially weakness in the muscles of the arms are warning signs that the problem may be more serious. Weakness in the arms is a definite sign that one should see a doctor about neck pain immediately.

In your case, you may need to have an anterior cervical discectomy and fusion (ACDF) surgery. Traditionally, a procedure called a spinal fusion (anterior cervical discectomy) has been the gold standard for surgically treating degenerative conditions in the cervical spine. Using bone grafts and instrumentation such as metal plates and screws, this procedure fuses, or creates a bond between, two or more adjacent vertebrae. This will ideally stabilize the spine and provide pain relief. Many patients have achieved excellent results with anterior cervical discectomy.

However, a potential disadvantage associated with this type of spine surgery is the loss of motion and flexibility in the treated vertebral segment. Fortunately, there are a variety of treatment options, such as artificial disc replacement, that help provide relief and keep you active.

No matter what option you choose, what I would suggest definitively is to select a surgeon who specializes in minimally-invasive treatments. Significantly-smaller cuts mean less damage to the tissue; less risk of infection; and less time to recover.

I'd be happy to help you decide if surgery is the right call for you. Give my office a ring and we'll set up an appointment.

Kapil Moza, MD FACS
Diplomate, American Board of Neurological Surgery
Dr. Moza's Santa Clarita office is conveniently located in Valencia. 805-497-3622