Prof. Dr. Mehmet Şenoğlu — Brain, Nerve and Spine Surgery
The most important part of the conversation I have with patients for whom I recommend cervical disc surgery is, most of the time, not the operation itself but the part where the risks are explained. Because a good surgical decision rests not only on an honest answer to the question “will this operation help?” but also to the question “how much risk does it bring me?”
In this article, I want to explain the risks of cervical disc surgery as clearly and as unexaggeratedly as possible. My aim is not to frighten you; it is to make sure you have real information in hand when you decide. Because the well-informed patient is the patient who gets the best outcome.
Let me set the frame from the start: cervical disc operations today are routinely performed surgical procedures with a high success rate, and rates of serious complications are low. However, “low risk” and “no risk” are not the same thing.
Before We Discuss the Risks: The Decision Has Two Sides
Skipping this is the most common error in reasoning.
When assessing the risks of an operation, one must also place the risks of not having that operation on the other side of the same scale. Cervical disc surgery is recommended not only to relieve pain, but most often to prevent permanent nerve damage.
Especially if there is pressure on the spinal cord (cervical myelopathy) — that is, if findings such as loss of dexterity in the hands or unsteadiness in walking have appeared — waiting can also carry a serious price.
For this reason, the right question is not “Is surgery risky?” but “In my situation, which risk is the wiser one to take?”
General Surgical and Anesthesia-Related Risks
These apply to every operation:
- Bleeding: In neck surgery it is generally small in amount; rarely, a collection of blood (hematoma) can develop in the neck in the postoperative period. Because it can make breathing difficult, patients are monitored closely in the early period.
- Infection: At the wound site or deeper; the rate is low, and preventive antibiotics are given.
- Anesthesia-related risks: These vary according to cardiac, pulmonary, and general health status; the preoperative anesthesia assessment exists precisely for this.
- Blood clots (thrombosis/embolism): The risk increases in patients who remain immobile for long periods; early mobilization is the most effective protection.
Risks Specific to the Neck Region
The neck is a region where the blood vessels, the esophagus, the windpipe, and the nerves going to the vocal cords are all intertwined. For this reason, some risks are specific to this operation.
Difficulty Swallowing (Dysphagia)
This is a relatively common side effect in operations performed from the front of the neck (ACDF). It is due to the esophagus being gently retracted to the side during the operation and to swelling developing in the tissues.
The good news: in the great majority it is temporary. It generally resolves on its own within days to a few weeks. In the first days, eating soft foods is sufficient. It is rare for it to be permanent.
Hoarseness
This is due to the nerve going to the vocal cords (the recurrent laryngeal nerve) being affected during the operation. This too is generally temporary. Permanent hoarseness is rare.
I recommend that patients who use their voice professionally (singers, teachers, presenters, and so on) discuss this subject separately with their surgeon before the operation.
Cerebrospinal Fluid Leak (Dural Tear)
This can occur where the membrane surrounding the spinal cord (the dura) has thinned or is adherent to the herniation. It is noticed during the operation and repaired; sometimes additional bed rest or, rarely, a second procedure may be needed.
Nerve Root and Spinal Cord Injury
This is the risk patients fear most, and I understand that fear. Temporary numbness or weakness in the arm can be seen due to nerve root damage. Permanent paralysis, meanwhile, is the most feared but rarely seen complication; in studies it is generally reported at below 1%.
This risk is somewhat higher in patients who already have pressure on the spinal cord before the operation.
Horner’s Syndrome
Due to involvement of the sympathetic nerve chain in the neck, slight drooping of the eyelid and constriction of the pupil on the same side can be seen. It is rare and generally temporary.
Risks Related to Implants and Fusion
In cervical disc operations, the space of the disc is frequently filled with a cage and the vertebrae are fused. This brings its own specific risks.
Failure of the Fusion (Pseudarthrosis)
This is the bone not fusing as expected. It can lead to persisting pain or to implant problems; sometimes a second operation may be needed.
Its biggest trigger is smoking. I particularly recommend that every patient for whom a fusion is planned quits smoking; this is the strongest risk factor you can directly control.
Implant Displacement or Screw Problems
The cage or the plate shifting from its position is rare, but possible. The risk increases in patients with poor bone quality (osteoporosis).
Adjacent Segment Disease
The discs immediately above and below the fused level bear more load over time; this can accelerate wear at those levels. Years later, a new complaint or a second operation may become necessary.
For this reason, in suitable patients a disc prosthesis that preserves movement is considered as an alternative.
Recurrence: The Herniation Coming Back
The herniation can recur at the same level or at another one. Ways to reduce the risk: quitting smoking, weight control, paying attention to ergonomics, and keeping up the exercises recommended after surgery.
Not Achieving the Expected Result
This is not a technical complication, but it is a real risk and needs to be discussed.
The area in which cervical disc surgery is at its strongest is relieving pain radiating into the arm due to nerve compression. In this type of pain, the results are generally very satisfying.
In contrast, in chronic neck pain due to years of wear, expectations of surgery should be more measured. Surgery makes room for the nerve; but it does not return your spine to the state it was in at the age of twenty.
Furthermore, one needs to know that in a nerve that has been under compression for a long time and has become damaged, the numbness or weakness may not fully resolve even after the operation. Surgery most often halts the progression; it does not always fully restore what has been lost. This is why making the decision to operate in good time is so important.
Personal Factors That Increase Risk
The same operation does not carry the same risk in every patient. The main factors that raise it:
- Smoking (it impairs fusion and wound healing)
- Uncontrolled diabetes
- Advanced cardiac and pulmonary conditions
- Osteoporosis (bone loss)
- Obesity
- The need for a multi-level operation (the risk increases compared with a single level)
- Previous surgery in the same region (because of scar tissue)
- Advanced spinal cord compression already present before the operation
- Advanced age — but here what is decisive is not calendar age, but general health status
How Are the Risks Reduced?
What the Surgical Team Does
- The surgical microscope and microsurgical technique: They make structures smaller than a millimeter visible.
- Intraoperative neuromonitoring: Spinal cord and nerve function is monitored electrically throughout the operation; when a risky point is approached, the system gives a warning. It is one of the strongest reassurances against the fear of paralysis.
- Imaging and navigation support: They ensure that work is being done at the correct level.
- Detailed preoperative assessment: Heart, lungs, blood tests, anesthesia consultation.
What You Can Do
- Quit smoking — this is the single most effective step.
- Get your blood sugar and blood pressure under control before the operation.
- Report all the medications you use, especially blood thinners.
- Follow the postoperative recommendations: early movement, exercise, ergonomics.
- Ask your questions. Do not let anything you do not understand pass by.
Questions You Should Ask Your Surgeon
I am glad when my patients bring this list with them:
- Which method will be used in my case, and why? (ACDF, disc prosthesis, posterior approach…)
- How many levels will be operated on?
- What is my risk profile — not general statistics, but in my situation?
- Will neuromonitoring be used?
- What happens if I do not have the operation? What do I lose if I wait?
- What will the recovery process be like, when can I return to work?
- What will we do if hoarseness or difficulty swallowing occurs?
- How many times a year do you perform this operation?
Asking these questions is your right, and a good surgeon is not troubled by them.
After the Operation, for Which Symptoms Should You Seek Help Immediately?
After discharge, in the following situations go without losing any time to your doctor or to the nearest emergency department:
- Difficulty breathing, rapidly increasing swelling in the neck
- Newly starting or increasing loss of strength in an arm or leg
- Serious difficulty swallowing, being unable to take fluids
- Discharge from the wound site, increasing redness, fever
- Severe and progressively increasing neck pain
- Unsteadiness in walking, increasing loss of dexterity in the hands
- Disruption of bladder or bowel control
Frequently Asked Questions
Below, I have gathered the most frequently asked questions on this subject along with brief answers. These answers are for general information; the information that applies to your specific situation is the one given by the doctor who examines you.
What are the risks of cervical disc surgery?
The main risks are: bleeding, infection, temporary hoarseness and difficulty swallowing, cerebrospinal fluid leak, nerve or spinal cord injury (rare), failure of the fusion, implant problems, adjacent segment disease, recurrence of the herniation, and general anesthesia-related risks. Serious complications are uncommon.
Does cervical disc surgery cause paralysis?
Permanent paralysis is the most feared but rarely seen complication; in studies it is generally reported at below 1%. Thanks to neuromonitoring and microsurgical techniques, this risk has decreased markedly. In patients with spinal cord compression before the operation, the risk rises somewhat.
Will there be hoarseness and difficulty swallowing after the operation?
In operations performed from the front of the neck (ACDF), these complaints are relatively common, but they are for the great majority temporary; they resolve within days to a few weeks. Eating soft foods in the first days is sufficient. It is rare for them to be permanent.
What increases my surgical risk?
Smoking, uncontrolled diabetes, advanced cardiac and pulmonary conditions, bone loss, obesity, the need for a multi-level operation, previous surgery in the same region, and advanced spinal cord compression all increase the risk. Some of these can be improved before the operation.
If screws and a cage are placed, will my neck not move?
Because there is more than one mobile level in the neck, fusing one or two levels does not markedly restrict your daily movements. Furthermore, in suitable patients, a disc prosthesis that preserves movement is an alternative.
What is adjacent segment disease, and will it definitely happen?
It is the discs neighboring the fused level bearing more load over time, and wear at those levels accelerating. It does not occur in everyone; it can develop over the years, and in some cases additional treatment may be needed. The disc prosthesis is an option developed to reduce this risk.
If I do not have the operation, does that mean I am taking no risk?
No. In a picture that requires surgery, waiting is also risky. Especially if there are findings of spinal cord compression (loss of dexterity in the hands, unsteadiness in walking), delay carries the risk of permanent nerve damage. The decision should be made by weighing both sides together.
Will my pain go away completely after the operation?
For pain radiating into the arm due to nerve compression, the results are generally very good. However, in chronic neck pain that has spread over years, expectations should be more measured. In addition, in a nerve that has been under compression for a long time, numbness or weakness may not fully resolve; this is why deciding in good time is important.
What can I do before the operation to reduce the risks?
The most effective step is quitting smoking. In addition, getting your blood sugar and blood pressure under control, reporting all your medications to your doctor, completing all preoperative assessments, and choosing an experienced team at a well-equipped center markedly reduce the risk.
Disclaimer (Legal Notice)
The information contained in this article has been prepared for general informational purposes only and in no way replaces a medical examination, diagnosis, or treatment. The rates shared above are approximate values based on the general literature; your personal risk profile may differ from them. The necessity of cervical disc surgery, the method to be applied, the risks, and the recovery process vary greatly according to the type of the herniation, the number of levels, whether or not there is spinal cord compression, bone quality, and the person’s general state of health, and can only be determined by a doctor who evaluates you. For the decision to operate and for the risks, always discuss matters in detail with the surgeon who examines you. If the emergency symptoms mentioned above are present, go to the nearest healthcare facility without delay.