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
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.
related to the operative site:
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.
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.
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
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.
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.
Anesthesia: Blood clots in the legs, heart attacks,
reaction to the anesthetic, reaction to blood transfusion,
if it given.
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
upon discharge, contact our office and set up an appointment
for staple removal is one has not already been set up.
- 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.
- Do no drive
until cleared with your physician.
- Avoid riding
in a car more than 50 miles.
- When shaving,
avoid tilting your neck back. When washing your hair,
do it in the shower and not in the sink.
- Begin an exercise
program of walking to gain strength.
- Lift nothing
heavier than one pound (one quart of milk).
- No jogging,
weight lifting, or other heavy exercise for now.
- Do not raise
your arms above your head.
- You may shower
with the incision covered.
- You may engage
in sexual relations.
- 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.
- If you notice
any swelling, redness or opening of the incision, notify
your surgeon immediately.
- If you develop
hoarseness, difficulty swallowing, fever or a stiff neck,
notify your surgeon immediately.
- If you have
any questions, please do not hesitate to call your surgeon.
- Take your
temperature at 4:00 PM daily until clips/sutures are removed.
- Take your
medications as prescribed by your physician.
- It takes 6-18
months for a nerve to heal. You may have numbness,
tingling, creepy crawly sensations or fleeting pain during