Disorders of discs in the cervical spine can occur suddenly or cause chronic neck and shoulder pain with and without radiation in the arms. Protrusions or exudations of intervertebral disc material are referred to as intervertebral disc protrusions. The spinal cord and nerve roots are mechanically impacted by intervertebral disc material in the spinal canal and can be permanently damaged with resulting pain, paraesthesia or neurological deficits.

The images are from a 40-year-old patient, who experienced sudden neck and arm pain with weakness occurring while stretching the left arm. The pain radiates into the middle finger of the left hand. He is an electrical engineer who has been unable to work for a few days, despite the use of painkillers and starting physiotherapy. The examinations and a MRI image of the cervical spine show the herniated disc (orange arrow) with compression of the nerve root, which correspond to the patient’s symptoms.

There are different surgical treatment methods. The aim of every treatment is to remove the dislodged intervertebral disc material that constricts the nerve root and causes pain and arm weakness as quick as possible, i.e. decompress the nerve root. Since the structures on the cervical spine are small, a surgical microscope or magnifying glasses with a headlight system is used.

The patient decides to undergo surgery via anterior (front) access to completely remove the defective disc. The disc space is then filled with a placeholder (cage) and fixed with a metal implant (plate). Alternately, artificial discs (intervertebral disc prostheses) are also available. The movement of the affected segment is thus maintained.

Our patient has decided for the operation with plate fixation (anterior cervical discectomy and fusion (ACDF)) as shown. He can leave the hospital after a few days and continue his regular work without any arm pain. The strength in his left arm also recovers completely after a few weeks.