FAQs


Why is surgery often done through the front of the neck

Dr. Moe R. Lim
Chapel Hill, NC
The cervical discs are located in the front of the spine and surgery through the front of the neck allows easier and safer access to remove the entire disc. Also, incisions in the front of the neck are less likely to get infected and heal with a less noticeable scar.
Dr. Mark R. McLaughlin
Princeton, NJ
Surgery is usually performed in the front of the neck for cervical disc herniations because it is a more direct decompression of the nerves and spinal cord. Sometimes the disc can be removed from the back of the neck, but in my experience it requires more manipulation of the nerves and may cause more pain in the recovery period.
Dr. Theodore A. Belanger
Charlotte, NC
The discs that are often the target of surgery are located in the front of the spine. The spinal cord, which is very delicate, lies behind the discs, and makes it more difficult to reach the discs while avoiding injury to the spinal cord. Also, patients tolerate surgery from the front a little better than from the back, and the resulting scar is much more cosmetically appealing.
Dr. W. Christopher Urban
Glen Burnie, MD
There are several advantages to using an anterior (front) approach to the cervical spine. First, it allows for a safe and thorough decompression of the spinal cord and nerve roots. A large majority of disc herniations and bone spurs occur in front of the spine and are accessible through an anterior approach. Another reason is that an anterior approach is biomechanically superior in terms of restoring spinal alignment. The bone that is used for the fusion helps to restore disc height and widen the bony tunnels that contain the nerve roots. Finally, an anterior (front) approach can be performed through a small incision that typically heals well and is less painful than a posterior incision.
Dr. Brett Taylor
St. Louis, MO
There are a number of procedures described to safely and effectively treat neck pathology. The anterior approach is the more common technique to deal with spinal pathologies related to cervical herniated discs. This route is an extremely safe procedure. It does place certain structures at risk and is associated with problems swallowing and vocal problems after surgery. In general, the neck procedures performed through the front of the neck offer less postoperative pain in comparison to surgery performed through the posterior aspect of the neck or the back of the neck. Many spinal surgeons feel that the anterior surgical approach is the most direct route to address the problems of disc herniations.
Dr. Sebastian Lattuga
Rockville Centre, NY
Surgery for cervical disc disease is optimally done through the front of the neck. I feel it is the safest and least painful for the patient. Only a small incision is made which results in quicker healing time and less post operative discomfort.
Dr. Kevin Yoo
Escondido, CA
Approaching the spine through the front of the neck is the easiest and, more importantly, safest route by which to reach a herniated disc.
Dr. Jeffrey C. Wang
Los Angeles, CA
Most of the elements which will cause nerve compression stem from the anterior portion of the neck. To address these in the most efficient and easiest way, surgery is often done through the front to eliminate the problems directly.
Dr. Timothy C. Ryken
Iowa City, IA
I prefer the anterior approach, if possible, as there is less post-operative discomfort and there is less risk of abnormal motion during positioning.
Dr. Rick Sasso
Indianapolis, IN
There are a number of reasons that the operation is done from the front. First is that's where the problem is. Usually, the pressure on the nerve the pressure on the spinal cord is from the front, and so it makes much more sense to take the pressure off the spinal cord where the pressure is on the spinal cord. If we went from the back, we'd actually have to move the spinal cord and nerve root over to take the pressure off it. And it's much, much safer that way in regard to neural structures. Number two - actually, the approach from the front is much less invasive than it is from the back. We don't have to cut any muscles when we go from the front. It's a very bloodless procedure going in from the front, and it's basically the standard way that we take pressure off the nerves. In fact, it can be done on an outpatient basis now.
Dr. Robert S. Pashman
Los Angeles, CA
The anterior (front) approach is preferred because the muscles in the front of the neck naturally part and offer direct access to the disc while the spinal cord is protected by the vertebrae.
Dr. Joseph Alexander
Winston-Salem, NC
Many of the degenerative conditions affecting the spine cause pressure on the spinal cord or the spinal nerves from the front portion of the neck. Although it sounds unusual if one is not familiar with the anatomy of the neck, it is actually relatively straightforward to approach the spine from the front of the neck. The structures in the front of the neck can be gently displaced to one side, allowing the surgeon to access the discs directly. Because there is relatively little dissection of muscle, there is only mild post-operative pain in many cases. However, not all surgeries are best done through the front of the neck. Once again, it is necessary to individualize each patient's care in light of his or her own unique anatomy and symptoms.
Dr. Jeffrey Goldstein
New York, NY
The majority of problems that cause pinching of the nerve or pinching of the spinal cord come from the front of the neck. Although the spine is in the back of the neck, the spinal cord sits behind the spine and the disks. So approaching from the front of the neck allows you to get directly to the problem and remove that inciting problem whether it's a ruptured disc or bone spur and it's also a surgery that's sometimes more easily tolerated. It doesn't require any stripping of the muscles or of bone. It works through tissue rather than destroying tissue.
Dr. Daniel Resnick
Madison, WI
Surgery is performed through the front of the neck because this provides a broad exposure of the disc space and allows us to remove disc from the front of the spinal cord and their roots which is where it is located. This approach allows us to remove disc without having to manipulate the spinal cord or nerve roots nearly at all.
Dr. Douglas Slaughter
Mesa, AZ
Surgery is done through the front of the neck because the disc is often the cause of the pain and/or neurologic dysfunction. Reaching it from the back is dangerous secondary to the spinal cord's being in the path of getting to the disc.
Dr. Sean Salehi
Chicago, IL
It allows for a better decompression of the spinal cord and nerve roots. It also causes less post operative pain. A posterior operation is reserved for soft disc herniation or decompression of the spinal cord over many segments.
Dr. Paul Saiz
Mesa, AZ
The safest route to the front of the spinal cord is anteriorly. The surgeon typically does not want to manipulate the spinal cord, which increases the risk of paralysis. Any posterior procedure where the surgeon is attempting to get to the front of the spinal cord will invariably involve manipulation of the spinal cord. Because of this, anterior surgery is the mainstay for decompressing the neck.
Dr. David S. Baskin
Houston, TX
Advances in surgical techniques now permit surgeons to tailor the surgery to the specific anatomy of the problem. Believe it or not, this surgery is much less painful than surgery that is performed via the back of the neck. The reason that surgery is often performed from the front is that many of the disc herniations and bone spurs that occur and cause problems can be more safely and completely removed from the front of the neck, as this is where they are located. We have learned that when patients have a problem in the front of the neck, they have a better result with an operation from the front of the neck.
Dr. B. Theo Mellion
Carbondale, IL
The majority of problems that cause pinching of the nerve or pinching of the spinal cord come from the front of the neck, which can not be approached from the back. Approaching from the front of the neck allows you to get directly to the problem and remove that inciting problem whether it is a ruptured disc or bone spur. It is also a surgery that is sometimes more easily tolerated because it does not require any stripping of the muscles off of bone, does not require any removal of bone, and is approached through normal tissue planes.
Dr. Dennis G. Crandall
Mesa, AZ
Many of the problems in the cervical spine can be better addressed through the front of the neck, leaving the neck muscles in the back undisturbed. This allows for a quicker rehabilitation of the neck muscles after the fusion heals.
Dr. Randy Davis
Glen Burnie, MD
The easiest and safest way to approach a patient with a degenerative disc (or bad shock absorber) is through the front of the neck. The disc can safely be removed without touching the spinal cord area. Surgery through the front of the neck can also be done by splitting muscles without cutting muscles. Surgery through the front of the neck has the ability to restore normal curvatures and alignment of the spine, which is difficult to do when surgery is done through the back of the neck.
Dr. Allan Levi
Miami, FL
Surgery done through the front of the neck is often advantageous as the incision and dissection avoids cutting muscles and thus tends to be less painful. In addition, a surgery done in the front of the neck allows the surgeon to access disc material positioned in front of the spinal cord. Posterior procedure often requires removing disc material while working around the spinal cord or nerve roots.
Dr. Mark Testaiuti
Haddonfield, NJ
If you recall the anatomy page, the discs are best removed this way because the spinal cord is not manipulated and the disc can be accessed and both nerve roots decompressed. Complete disc removal cannot be done solely from behind.
Dr. Kambiz Hannani
Los Angeles, CA
The front of the neck gives your surgeon easier access to the discs and bones that are compressing your nerves or spinal cord. The best approach is determined by a patient’s symptoms and the anatomy of the problem as shown on MRI scans and X-rays.
Dr. Brian Subach
Atlanta, GA
The spine is very close to the skin at the front of the neck so it is very easy to reach problems which arise from the front of the spine such as disc herniation.

The commentary above recounts the experiences of these physicians. Medtronic invited them to share their stories candidly. Keep in mind that results vary; not every patient's response is the same. Talk with your doctor to learn more about any products that are mentioned above.

It is important that you discuss the potential risks, complications and benefits of spinal surgery with your doctor prior to receiving treatment, and that you rely on your doctor's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.

Published: May 04, 2007
Updated: April 19, 2010