I saw a surgeon this week for neck pain that has plagued me for years. Nothing I’ve done has helped (acupuncture, massage, physical therapy, chiropractic adjustments). It looks like the disc and bone around it is disintegrating. The surgeon is suggesting removing the damaged disc in a procedure she calls diskectomy. After thinking about it, I’m wondering how that will help. Without any disc there won’t it just be one vertebra bone rubbing against the one next to it?

Degenerative disc disease and other age- or trauma-related changes to the neck are referred to as cervical spondylosis. This is a common problem in adults that becomes more prevalent the older we get. In fact, MRIs and X-rays taken in normal groups of adults over the years show a 14 per cent rate of abnormalities before the age of 40.

The number of people affected by neck degeneration increases to 28 per cent after age 40 up to 89 per cent after age 60. The people in these studies did not have any symptoms indicating there was a problem. But for those who do develop severe pain and other symptoms (e.g., arm pain, numbness and tingling down the arm), treatment is recommended.

Conservative (nonoperative) care such as what you tried is first. But if that doesn’t work, then diskectomy (removal of the disk) may be suggested. The surgeon rarely just removes the disc as the only step in the treatment. Usually, the surgeon removes the diseased or damaged disc and any bone spurs that might be causing problems. This part of the procedure is called decompression.

Then the spine is surgically stabilized. This involves fusion of the two vertebrae on either side of the disc that was removed. A metal plate is attached to the front (anterior) side of the spine. A metal cage filled with bone graft material may be placed in the space where the disc once was. The bone graft is used to help speed up the stabilization process.

The entire procedure is referred to as an anterior cervical diskectomy and fusion or ACDF. More recently, ACDF has been replaced with a different surgical approach. The development of a total disc replacement (TDR) has been introduced. Disc replacement does not require bone grafts and preserves neck motion. Not all surgeons perform this procedure and studies are being done to compare the results between fusion and disc replacement.

In time with continued long-term follow-up, the results of fusion (ACDF) versus nonfusion (total disc replacement) surgery will be fully known. The hope is that the number of patients who experience problems after either procedure will decline as surgical techniques continue to improve and advance.