The following 3 situations may lead to surgery:
1. Persistent disabling arm pain with failure of non-operative treatment over approximately 6 weeks.
2. Progressive weakness in the arms.
3. Cervical myelopathy, which is characterized by difficulty with balance and walking, over-active nerve reflexes, trouble with delicate finger movements such as buttoning buttons, and issues with bowel and bladder function.
The most common surgery to address cervical radiculopathy is an anterior cervical discectomy and fusion (ACDF). This surgery consists of a small incision on the front of the neck, removing the herniated disc, taking pressure off the nerves or spinal cord, and fusing the affected level with a plate and screws. In most cases the surgeon uses magnifying eyeglasses or a microscope in order to perform this surgery through a small incision.
If the radiculopathy is not caused by bone spurs and is located in just the right position, it may be possible to perform a posterior cervical foraminotomy to take pressure off the nerve. The advantage of this approach is avoiding a fusion.
An artificial cervical disc replacement is a newer surgery that theoretically preserves motion at the affected level. Long term studies that compare this technique with the gold standard fusion are currently in process.
Most patients stay overnight in the hospital after these surgeries. The wound is quite tender for the first few days after surgery, and most surgeons send patients home with prescription narcotic medications. You can typically get out of bed and walk within an hour or two after surgery is completed. Many patients who have sedentary office jobs can return to work within 2-4 weeks, while those who have jobs requiring heavy lifting will often need to be out of work for 3 months.
Most patients experience at least 80% improvement in arm pain. Arm weakness and numbness and tingling are less predictable, and patients can expect approximately a 50% improvement.