Anterior Cervical Discectomy and Fusion for Myeloradiculopathy
Why am I in pain?
Everything you need to know
What are the potential benefits of this procedure?
The primary benefit of anterior cervical discectomy and fusion is to provide a significantly more rapid relief of radicular arm pain, in patients who have failed more conservative treatment options. It also provides a relief of pressure off of the spinal cord in patients who are myelopathic (difficulty walking/difficulty with fine motor tasks/clumsy weak arms & legs).
What are the potential risks of this procedure?
The main risks particularly associated this procedure are wound infection, failure of your symptoms to improve, worsening of your symptoms despite the pressure being taken off of your spinal cord, a recurrence of your symptoms, damage to the spinal nerves with resultant weakness of your legs or arms, paralysis due to spinal cord damage, or damage to your bladder and bowel continence. A more extensive list of risks is detailed on the consent form. The risk of requiring further surgeries at other levels adjacent to the operated level is approximately 25% over 10 years. Smoking in the 12 months prior to surgery, or in the 3 months after your surgery, increases your chances of experiencing a failed fusion, which may cause persistent neck pain requiring further surgery.
Will my symptoms be reversed?
In myelopathic cases, the function of this surgery is to hopefully prevent you from deteriorating any further. Some patients find that their fine motor skills are improved after this surgery; a greater proportion of people, however, find that they're no better (though no worse either!), whilst a third category unfortunately deteriorate further despite MRIs showing the cord has been decompressed and the surgery being carried out in a safe fashion. I cannot say into which category you will fit, but if there is evidence of pressure on your spinal cord on the MRI, I do recommend you undergo this procedure.
Are there alternatives to surgery?
Alternatives to anterior cervical discectomy and fusion would include physiotherapy, nerve root injections, and epidural injections by a pain management specialist. These are successful in alleviating the pain temporarily, but will not remove the bony spurs or ligamentous overgrowth. Pressure on the spinal cord causes permanent irreparable damage, and as such, if you choose to not undergo surgery in the setting of cord compression, you are liable to experience progressive weakness of your arms and legs at a date in the future. You are also at an increased risk of spinal cord damage in the event of being in a car accident or falling.
How long will my expected hospital stay be?
You will be admitted to the hospital on the morning of surgery, and will be discharged home within 3 days. You will need to get somebody to drive you home from the hospital on the day of discharge. You will experience soreness when swallowing, and a rather sharp pain between your shoulder blades - these discomforts will last between 2 and 3 weeks on average.
How long will my expected recovery take?
The stitches used to close the wound are dissolvable, but you may need to get superficial skin-clips removed. You will have a stiff sore neck for the first 3 weeks after this procedure, but by the time you are reviewed in the clinic this should be significantly better. Typically an improvement in your arm or hand pain will be the first benefit you will notice after this procedure, next an improvement in any "pins-and-needles", and lastly an improvement in any numbness (this may take a number of months or may in fact persist permanently). You may require a long course of physiotherapy -this will be discussed at your follow-up visit. The scar will fade to a dull white mark over the next 12 months. You should not use any anti-inflammatories for the first 3months after this procedure - use of such products will delay the fusion process, and could cause a persistence of movement at the operated level. Such unwanted movement can be a source of a lot of pain, and may indeed require further surgery.
How long before I return to work?
Desk-work people are advised to refrain from returning to full-employment for 6 weeks. Housewives (and house-husbands!) need a similar period of time to recover also. People with flexible work hours, and those that can complete their duties whilst standing upright may return to work after 3 weeks. People who return to work too early have been shown to experience a greater degree of long-term neck pain. Physiotherapy exercises should commence after 6 weeks. Hard or foam collars should not be worn.
How long before I return to sports?
Athletes can usually return to gymnasium and track training in approximately 10 weeks, though each case will need to be judged on its individual merits, taking factors such as the athlete's age, particular athletic activity, and body habitus into account. Should your MRI reveal evidence of spinal cord damage already, it is advised that you not participate again in contact sports.
When will I need to be seen in the clinic again?
You will be reviewed in the clinic after 6 weeks, and possibly again 3 months later to confirm that your recovery has proceeded satisfactorily. You will have been given a regime of neck muscle exercises by the physiotherapy department. It is important that these exercises become as regular a part of your daily routine as brushing your teeth!
Tell me what worrying symptoms I need to look out for whilst I'm recovering.
Should you experience any unusual symptoms or signs either prior to your surgery or during your subsequent recovery period, you must contact our office line immediately. Should that not be possible, we would advise you to seek immediate medical advice from a registered medical practitioner. Urinary or faecal incontinence, urinary retention, constipation, difficulty breathing or completing sentences, new-onset numbness or leg weakness, a painful calf or thigh (especially if red or swollen) are all reasons to call us immediately, or to go to your local hospital emergency department.
Always tell your surgeon if you are taking Aspirin, Disprin, Plavix (Clopidrogel), Warfarin, Dipyridamole (Persantine), Asasantin, Aggrenox or if your medical condition has changed in any respect in the period of time prior to your procedure.