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Anterior Cervical Discectomy w/wo Fusion w/wo plating

Procedure Description

An anterior cervical discectomy is performed to decompress a nerve root or  the spinal cord, within the neck.  Generally, a transverse (across) or vertical incision (up and down) is made, on the right or left side of the neck.  The surgeon then dissects through a number of tissue planes, and creates a path down to the front of the spine.  The route is between the trachea and esophagus on the medial side (towards the middle) and the carotid artery and jugular vein on the lateral side.  The surgeon then removes the disk between two vertebral bodies.  After this is accomplished, the surgeon will often remove another ligament, known as the posterior longitudinal  ligament, in order to visualize the covering of the spinal cord and nerve root.  Aside from the initial exposure, this is often done under the microscope.  Once the disk is removed, and the spinal cord and nerve roots decompressed, the surgeon will decide whether or not to perform a fusion.  If so, the surgeon will use either bone from the bone bank or will harvest bone from the patient's hip, to use in between the vertebral bodies, to act as a framework through which the patients own bone will grow, thus accomplishing the fusion.  After the bone graft is in place, the surgeon may elect to place a titanium plate over the interspace, thus bridging the two vertebral bodies.  After doing so, and after satisfactory x-rays are taken, the surgeon will close, sometimes using a drain for any residual bleeding which may occur.  Hospital stays after surgery may generally range from 1 to 2 days.

 

Procedure Risks

Anterior cervical discectomy is a frequently performed procedure.  Even though the risks of complications are relatively low, there are risks.  These can be broken down into two categories, 1) those related to the operative site, and 2) those related to the risks of anesthesia. 

Risks related to the operative site: 

Surgical Exposure:  There may be injury to the trachea (windpipe), esophagus (swallowing apparatus), carotid artery (supplying blood to the brain), or jugular vein (significant amounts of blood can be lost).  There may also be injury to a nerve traveling to the larynx (voice box).  These injuries may result in difficulty with swallowing, or hoarseness with speech.  If the carotid artery is injured, a large stroke may ensue. 

Spinal Cord/Nerve Root injuries: If there is any injury to the spinal cord or nerve roots, the consequences may involve loss of sensation, increased burning sensation, paralysis, weakness, loss of bowel, bladder, sexual function.  There may be a spinal fluid leak, which could occur after a tear of the covering of the spinal cord or nerve root.   Control of the diaphragm responsible for breathing, eminates from the upper cervical spinal cord.  If this area is damaged, the patient may need a permanent tracheostomy (hole in the windpipe), to provide a diversion of the route air takes to enter the lungs. 

Bone Graft Problems:  The bone graft, either from the patients own bone, or from the bone back, has the potential of not fusing, resulting in a mobile joint.  Persistent neck pain may occur.  The graft could break, slip out of place to the front of the spine, resulting  in pressure on the trachea and esophagus, or it could dislodge back in to the spinal cord, resulting in paralysis.  If bone bank bone is used, there is a very small risk of infection (hepatitis or AIDS).  If fusion fails, another surgery may be needed.  Risks of non-fusion are greater for smokers. 

Instrument Failure:  If a titanium plate is used, screws are placed in the vertebral bodies above and below the disk space being fused.  While generally quite safe, certain complications can occur.  There can be mechanical complications, related to breakage of the plate or screws.  If the screws back out of the bone, they can press on or erode into the esophagus or trachea.

General Risks:  These include such general difficulties, such as bleeding, infection, stroke, paralysis, coma and death.  The scar on the neck may be tender, or may heal in an unpleasant manner.  There is also the possibility that the surgery may not relieve the symptoms for which the procedure was performed.  The problem for which the surgery was performed may recur, requiring additional surgery in the future.  In addition, although every attempt is made to protect all areas of the body from pressure on nerves, skin and bones, injuries to these areas can occur, particularly with prolonged cases.

Risks of Anesthesia: Blood clots in the legs, heart attacks, reaction to the anesthetic, reaction to blood transfusion, if it given.

 

Post-operative care:

You may be required to wear a firm cervical collar postoperatively.  There shall be no bending, twisting, or heavy lifting for several weeks after surgery.  Physical therapy may or may not be implicated.  Your doctor will gradually ease your work restrictions, depending on your progress. 

Remember to keep the wound dry and clean.  Notify your surgeon of any drainage or temperatures greater than 101 Fahrenheit.

You may experience some continuing incisional pain and occasional spasms in the back of your neck from time to time.  Any numbness which you had in your hands prior to surgery may continue as well.  There are several steps you can take which will help speed your recovery as well as give you the best chance for a successful outcome.

  1. Immediately upon discharge, contact our office and set up an appointment for staple removal is one has not already been set up.
  2. Wear the collar given to you by your surgeon.  It should be worn continuously except when showering or shaving, unless instructed otherwise by your surgeon.
  3. Do no drive until cleared with your physician.
  4. Avoid riding in a car more than 50 miles.
  5. When shaving, avoid tilting your neck back.  When washing your hair, do it in the shower and not in the sink.
  6. Begin an exercise program of walking to gain strength.
  7. Lift nothing heavier than one pound (one quart of milk).
  8. No jogging, weight lifting, or other heavy exercise for now.
  9. Do not raise your arms above your head.
  10. You may shower with the incision covered.
  11. You may engage in sexual relations.
  12. In doing any activity in which you notice an increased amount of neck, shoulder or arm pain, STOP.  Your body is telling you that you are doing too much.
  13. If you notice any swelling, redness or opening of the incision, notify your surgeon immediately.
  14. If you develop hoarseness, difficulty swallowing, fever or a stiff neck, notify your surgeon immediately.
  15. If you have any questions, please do not hesitate to call your surgeon.
  16. Take your temperature at 4:00 PM daily until clips/sutures are removed.
  17. Take your medications as prescribed by your physician.
  18. It takes 6-18 months for a nerve to heal.  You may have numbness, tingling, creepy crawly sensations or fleeting pain during this time.

 

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