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Anterior cervical discectomy and fusion

Overview of surgery

Anterior cervical discectomy and fusion involves removal of the cervical (neck) disc and osteophytes to take away the compression of the spinal cord or nerve roots or both. The space remaining after removal of the disc is filled with bone graft or cage. A plate with screws may be used to provide further stabilisation. This surgery is indicated for those who have a) No relief of arm pain with non-operative forms of treatment; b) Increasing numbness and weakness in the arms and hands; c), significant or worsening weakness in the arms and hands at presentation and d) myelopathy (spinal cord dysfunction)

Steps of the surgery:

  • The surgery is performed under general anaesthesia, with the patient lying on the back
  • The spine is exposed through a 2.5 to 5 cm incision on the skin in the front of the neck. The spine is exposed by moving the muscles and blood vessels aside. The involved intervertebral disc(s) is removed using special instruments and the pressure on the nerve roots and spinal cord is relieved
  • The resultant gap is filled with bone graft (from the pelvic bone) or a spacer (cage) made from a plastic material called PEEK or titanium. A titanium plate with screws may be used to provide further stability to the spine
  • The incision (cut) is closed with dissolvable sutures. A drain tube will remove the blood that collects at the surgical site. A urinary tube may be used to drain the bladder.

The Success rates and the outcomes:

This surgery is associated with a high success rate (>90%) in terms of relief of the arm pain. If muscle weakness and numbness was present prior to surgery, it usually improves over a period of time. If myelopathy (spinal cord dysfunction) was present before surgery, the extent of recovery is less predictable. However, surgical decompression will usually stop the deterioration and provides the most favourable opportunity for recovery.

Your pathway to recovery:

  • Following surgery, the patient will be moved to the recovery room where a neck collar is provided to ensure comfort and to prevent excessive neck movements. Adequate pain relief and intravenous fluids will be provided. When the patient is comfortable, he/she will be transferred to a high dependency ward for an overnight stay for more personalized attention. Most patients will be encouraged to walk the day after surgery with the neck collar after removing the urinary tube. Normal diet is usually advised either in the evening after the surgery or the next morning
  • The duration of stay in the hospital may extend from 2-4 days depending on comfort and ability to walk and the surgeon will decide on the date of discharge.

Complications

Allergic reactions to medications and conditions like pneumonia, stroke or heart attack, though rare and not directly caused by the surgical treatment, may have serious consequences.

Surgical complications can include bleeding, infection, spinal fluid leak, injury to the veins and arteries near the spine, injury to the spinal cord and nerves and its surrounding protective layer (dura). Injury to the spinal cord or the nerves during surgery can result in varying degrees of muscular paralysis, alteration of normal sensations and loss of bowel and bladder control which may be permanent or may recover over a period of time. An injury to the covering layers of the nerves (dura) can result in a leak of spinal fluid and may rarely require a repeat surgery.

Injury to the trachea (windpipe), oesophagus (food pipe) or the vocal cord nerve may occur during surgery. Damage to the vocal cord nerves may result in a hoarse or weak voice. The bone graft may not heal and fuse the spine (non-union) and rarely the bone graft may become dislodged, requiring further surgery.

A 1-5% incidence of post-operative wound infection is possible despite antibiotics given before and after surgery. Superficial infections can be treated with antibiotics, while deep infections may require a wound wash-out under anaesthesia. The presence of an infection in any other region (urinary bladder, chest and skin) immediately prior to surgery, increases the risk of post-operative infection, so inform your surgeon about this.

Deep vein thrombosis (DVT - clotting of blood in your calf muscles) and pulmonary embolism (clot migrating to your lungs) are uncommon after an elective spine surgery, particularly when you are out of bed and walking within 24 hours after surgery. We do not routinely use medications to prevent DVT; however, if you have had an episode of DVT in the past, let your surgeon know.