Anterior Cervical Decompression Fusion

Surgery :: Anterior lumbar interbody fusion :: Lumbar Disc Replacement
Posterior Cervical Spine Surgery :: Spinal Deformity Surgery :: Lumbar Decompression and Fusion
Lumbar Discectomy :: Surgical Risks :: FAQ

Anterior Cervical Spine Surgery

What is a disc prolapse?

This is also referred to as a slipped disc or disc herniation and usually occurs between the ages of 25-50 years. The jelly-like central portion of the disc (nucleus pulposus) tears through the surrounding layers (annulus pulposus) and is displaced into the spinal canal, compressing the nerves extending from the spinal cord.

Disc prolapse symptoms occur as a result of compression on the spinal cord or the nerves going to the arms. Pain in the arms that increases on coughing and sneezing is a symptom of disc herniation. Numbness, the sensation of pins and needles, and muscular weakness in the arms and hands may also be present. When the prolapsed disc compresses the spinal cord (myelopathy), it can cause difficulty in walking, clumsiness of the hands and problems with urinating. The presence and severity of these symptoms vary from person to person.

Who needs surgery?

Surgery is reserved for those with:

• No relief of pain with non-operative forms of treatment;
• Increasing numbness and weakness in the arms and hands; or
• The presence of myelopathy, which indicates the need for early surgery.

About the surgery

Anaesthesia: The surgery is usually performed under general anaesthesia, with the patient lying on the back.

Procedure: The surgeon makes a 2.5 to 5 cm incision in the skin in the front of the neck. The spine is exposed by retracting the muscles and blood vessels. The bulged disc is removed using special instruments and the pressure on the nerve roots and spinal cord is relieved. After the removal of the disc, the resultant gap is filled with a spacer (cage) made from a plastic material called PEEK and filled with an artificial bone graft substitute called VITOSS and OP-1. A titanium plate with screws is then used to fix the spine. A drain tube will remove the blood that collects at the surgical site. Skin sutures: Dissolvable sutures are used to close the skin. These will dissolve as your wound heals, however, the ends of the suture on either end of the incision will need to be cut on your first visit to the surgeon's office (7-10 days after surgery).

After the surgery

In the recovery room: Following surgery, you will be transferred to the recovery room and may feel some pain at the operated site when you wake up. A patient-controlled analgesia (PCA) pump will be provided, which releases a small dose of pain medication every time you press the button thereby putting you in control of your pain. You will be given intravenous fluids to keep you hydrated and a urinary catheter will empty your bladder. A neck collar will be provided to prevent excessive neck movements and to keep you comfortable. When the medical staff in the recovery room is confident that you are comfortable, you will be transferred to your room.

In the ward: You will be allowed to drink sips of fluids after surgery and gradually progress to a full diet. The day after surgery, the drain tube, urinary catheter and pain pump will be removed and you will be encouraged to walk wearing a brace to support your spine. You will stay in the hospital for 1-3 days and your surgeon will decide when you can go home.

Pain relief: Although we expect that you will be in pain or discomfort, we recommend that you take regular pain relief following surgery. Medications will be provided to reduce your pain after surgery and at home for the first 1-2 weeks. If pain persists after discharge please seek advice from Spine Service or your General Practitioner.

Skin sutures: Dissolvable sutures are most often used to close the skin. These will dissolve as your wound heals, however, the tip of the suture on either end of the incision will need to be cut on your first visit to the surgeon's office 7-10 days after surgery.

What to expect following surgery

Pain: You will feel discomfort and pain at the operative site immediately after surgery. You will be given pain medications; however, the soreness and stiffness in your back and/or limbs will continue for some time. Please ensure you take regular pain relief.

Tingling / Numbness: A degree of tingling and/or numbness in your limbs may be experienced after surgery and may take some time to subside.

Drains: Some patients may return to the ward with a drain tube near the surgical site to help prevent any collection of fluid at the operation site. The drain is usually removed in 24 to 48 hours.

Drips: You will have a small plastic needle (cannula) to receive fluids and antibiotics during and after surgery. The cannula will be removed when you are drinking sufficient fluids and after the doctor has stopped the prescribed antibiotics.

Catheter: A catheter will be inserted into your bladder under anaesthesia to drain you bladder during and immediately after surgery. This catheter will keep you comfortable, so you will not have to get out of bed to go to the toilet on the first day. The catheter is usually removed the day after surgery.

Calf compressors: Following your surgery, you will have inflatable compressors on your calves to reduce the risk of deep vein thrombosis (DVT). You may also be given a pair of anti-thrombotic stockings.

Coping with the Blues: It is not uncommon for patients to feel a little depressed or emotional after your surgery. The doctors and nurses will help you through this vulnerable phase.

Diet: You will be Nil by Mouth initially allowed only sips of fluid and crushed ice to suck. Once bowel sounds are present, you will start on a post-operative diet and gradually increase to a full diet. To avoid constipation, you should include plenty of roughage, cereals, fruit & vegetables in your diet. You should also aim to drink 2-3 litres of fluid daily.

Bowels: It is common not to have bowel movements for the first few days. Once you have started on a full diet, you will be given medications to help with bowel movements.

Are there any risks involved in disc surgery?

All surgical procedures are associated with a risk of complications and all risks should be discussed with your surgeon. The risks may be associated with the anaesthesia given or the surgical procedure per se. Surgical complications can include bleeding, infection, spinal fluid leak, injury to the veins and arteries near the spine or injury to the spine's nerve tissue or its surrounding protective layer.

Injury to the spinal cord or the nerves may occur during surgery and can result in complete paralysis of all four limbs or paralysis of certain muscles in the arms or legs, with loss of normal sensation. Loss of bowel and bladder control can also occur following injury to the nerves. An injury to the covering layers of the nerves (dura) can result in a leak of spinal fluid and this may occasionally require a repeat surgery. Great care is taken to ensure the accurate placement of the screws, including the use of intra-operative fluoroscopy (x-rays).

Although antibiotics are given before and after surgery, there is a 1-5% incidence of wound infection. Superficial mild infections can be treated with antibiotics, while deep infections may require a wound wash-out under anaesthesia. If you have had an infection in any other region (urinary bladder, chest and skin) immediately prior to surgery, you may be at a higher risk of post-operative infection in the spine, so let your surgeon know.

Venous thrombosis (DVT: clotting of blood in your calf muscles) and pulmonary embolism are uncommon after an elective spine surgery, particularly when you are out of bed and walking within 24 hours after surgery. We use calf compressors and TED stockings to prevent the clotting of blood in legs; we do not routinely use medications. However, if you have had an episode of DVT in the past, let your surgeon know.

There are certain warning signs you should look for after surgery that may indicate a problem, such as excessive bleeding, redness or discharge from the wound, fever, weakness or numbness of the legs, or problems urinating. If you notice any worrisome symptoms, notify your surgeon at once.

Talk to your surgeon

This is a brief overview and does not include all the known facts about your condition and the surgery. Feel free to seek any clarifications from your surgeon and his or her team. It is important for you to obtain a clear understanding of your condition, the surgery and the potential risks and benefits before you sign the consent form.

Frequently Asked Questions - FAQ