This is a microscopic technique carried out through a small transverse incision at the front of the neck. It is almost always done on the right side, even if symptoms are on the left, because there is less chance of retracting on one of the nerves to the vocal cord. The surgeon then makes a small channel down to the spinal column in a natural plane between blood vessels and the gullet (oesophagus). Once X-rays are taken to confirm the correct level, the disc and any bony spurs at the back (osteophytes) are removed with fine instruments and a high speed drill. Once the spinal cord and nerve roots are thoroughly decompressed there are a number of options:

• The disc space can be left empty. If the problem has been a simple soft disc herniation in a young patient at one level, this is a reasonable option. In such cases the cervical spine is perfectly stable and the disc space will simply heal by scarring or fuse by itself.
• The disc space can be fused using a titanium cage filled with artificial bone and held in place with a plate and screws. This is an excellent time-honoured technique in patients with degenerative disease who have single or multilevel problems. Postoperatively there is usually less muscular neck discomfort and there is no need for a collar.
• A prosthetic (artificial) disc may be inserted.

An aesthetically pleasing closure of the wound is accomplished with deep absorbable stitches, and steristrips on the skin. Most patients do not require a drain. Discharge from hospital is usually on the first or second post-operative day.