Posterior Cervical Microdiscectomy
Some spinal surgeons may prefer the posterior approach (from the back of the neck) for a cervical discectomy. This approach is often considered for large soft disc herniations that are lateral to (to the side of) the spinal cord.
The principal advantage of the posterior approach is that a spine fusion is not required after removing the disc. The principal disadvantage is that the disc space cannot be opened with a bone graft to give more space to the nerve root as it exits the spine. Also, since the posterior approach leaves most of the disc in place, there is a small chance (3% to 5%) that a disc herniation may reoccur in the future.
After a small incision is made in the midline of the back of the neck, the paraspinal muscles are elevated off the spinal level that is to be approached. An X-ray is then done to confirm the surgeon is at the correct level of the spine. For disc removal, a high-speed burr is used to remove some of the facet joint so the nerve root can be identified. A surgical microscope is then used for better visualization. The disc will be directly under the nerve root, which needs to be gently mobilized (moved to the side) in order to free up the disc herniation.