One of the Region’s Top Spine Surgeons Explains Two Surgical Procedures to Repair Herniated Disc and Relieve the Associated Pain and Discomfort
Patients suffering from herniated disc can rest more easily knowing that there are state-of-the-art procedures performed by highly respected New York-area spine surgeon Ezriel Kornel, MD that can mean relief from the debilitating condition.
Dr. Kornel, a neurosurgeon with offices in Manhattan and White Plains, is a partner in Brain and Spine Surgeons of New York, and is an Assistant Clinical Professor of Neurosurgery at Weill Cornell Medical Center in New York. He is one of the foremost practitioners of minimally invasive surgery and an expert in cervical spine surgery.
Because of Dr. Kornel’s particular interest in cervical spine surgery, he is one of the first neurosurgeons in the New York metropolitan area to replace damaged cervical discs with the newly introduced artificial discs. Recently Dr. Kornel outlined two distinct surgical approaches to repairing herniated disc within the spine. The bones in the spine are cushioned by sponge-like discs, which act as shock absorbers. When discs become damaged, they can press on the nerve in the spinal column and result in pain, numbness or weakness.
Dr. Kornel explains that there are two approaches to eradicating a herniated disc and restore a patient to sound spine health: surgical fusion; and surgical disc replacement, also referred to as surgical arthroplasty.
“When do we operate on a cervical disc? When there is a herniation of the disc, which means that the disc is compressing the nerve or spinal cord in the neck,” Dr. Kornel explains. When a herniation occurs, the disc pushes into the spinal canal. “There is a mechanical problem there; discs do not slip into place. Once they’re out, they’re out.” Either they shrink on their own, or they have to be removed. “When they’re removed, one of the main ways in which we do that is to go through the front of the neck, because the discs are in the front of the spine” Dr. Kornel explains. The vertebral bodies are in the front, “which are the building blocks of the spine,” he says, “and in-between we have the discs. The discs are like a soft-boiled egg with a gelatinous center. And there is a thick outer fibrous ring that holds them together. When a disc becomes damaged it becomes more like a hard-boiled egg and the center becomes tougher; the outer part becomes weaker.”
When the disc herniates, Dr. Kornel points out, it pushes out of the disc bases itself and can compress the nerve where it comes out of the spine or compress the spinal cord, which is sitting in the spinal canal between the lamina and the vertebral bodies and discs. “To get to that disc we have to go through the front of the spine. We make an incision along the skin crease in the front of the neck. Usually one side or the other; I prefer to go from the left side. You have to move the trachea and esophagus over to one side gently to get to the front spine, and move the muscles and the carotid artery over to the other side in order to have a portal or small opening to visualize the disc.”
There are a variety of techniques to remove the disc, Dr. Kornel explains. “The one I prefer is to cut into the surface of the disc, remove the portion of the surface and then use a high-speed drill to drill out the remainder of the disc. Then I use a microscope to see the back end of the discs to see the important structures — the spinal cord and the nerve. I want to make sure not to damage the nerve or the spinal cord. Once the disc is out, I flatten out the edges of the end plates, which are the portions of the vertebral bodies against the discs themselves, so that I can perform either a fusion or an arthroplasty.”
Dr. Kornel explains the rudiments of spinal fusion surgery: “We put something in place of the disc that a person’s bone can then grow through so that ultimately it’s bone bridging to bone” he says. “That means that there’s no movement anymore at that disc level because it’s all one solid structure, from vertebrae to vertebrae. The advantage to that is that there is no further disc to be herniated, and the patient will not have any further nerve or spinal cord compression once that fusion has occurred.”
With cervical fusion, Dr. Kornel places an interbody device, or a ‘cage’ sandwiched between two vertebrae. “Once we put that in, it is locked into place by small plates that slide into the cage, then into the bone, and then lock into place so it can’t move and it maintains the alignment of the vertebrae,” he shares. “There is a big channel in the middle, and we can use pieces of the patient’s own bone that we can obtain when we’re removing the disc into there.” A specially prepared sterile donor bone paste, or allograft, can be used that promotes and stimulates the patient’s own bone to grow through the region. “Ultimately you’ve got a peg of bone going through from one vertebrae to the other; that’s a fusion. And that means your vertebrae do not move at that particular segment, and the symptoms of the herniated disc are relieved.”
Replacement with an artificial disc is the second option for repairing cervical herniation. “What I particularly like to do now in the appropriate patient is to put in an artificial disc, or what we call an arthroplasty,” Dr, Kornel explains. “When we remove the disc, which is in the same manner as we do with the fusion, rather than put in a cage as in fusion, we put in the artificial disc.” The advantage to this option is that it permits movement. “Why is movement important? Primarily because it reduces the stress on the discs that are adjacent to the disc that has been damaged, and those discs now do not have to do all the work,” he says. “The artificial disc can then still do some of the work, and hopefully limit the likelihood of further damage to subsequent discs.” It doesn’t guarantee that there won’t be other discs damaged, however. “There are many factors that go into disc degenerating and herniating,” he adds, “but certainly if you can reduce the stresses on that disc, it does decrease the likelihood of further disc problems.”
Is there a downside to opting for the artificial disc? It can fuse, Dr. Kornel says. “That’s unusual, but it can happen. “But if it does happen, then you’re really no worse off than if you had a fusion to begin with. These artificial discs have been shown to hold up very well, and in fact it is extremely rare that they would have to be removed and replaced or fused.” The times when artificial disc replacement might not be the best course of action, Dr. Kornel notes, “is when the joints of the spine are already damaged with arthritis and may have already fused themselves, in which case there isn’t any movement there anyway, or there is so much arthritis that the movement is very limited to begin with; then there is no point in putting in an artificial disc because you won’t have sufficient movement to allow that artificial disc to be functional.”
In terms of recovery time, the artificial disc procedure has been shown to offer a slightly quicker recovery than with the cervical fusion option. “In either operation I don’t feel the patient needs to wear a neck brace or a collar,” Dr. Kornel says. “Certainly with an artificial disc patients can begin to move more normally a bit faster. Both result in relief of neck pain and relief of pain related to pressure on the nerve. And both are very effective in relieving symptoms and allowing patients to get back to a normal routine of life. The artificial disc does give us a bit more possibilities that other discs will not be damaged in the future. It’s still important,” he concludes, “to do appropriate neck exercises and work on maintaining proper alignment and posture of the spine to prevent problems down the line.”