Anterior Cervical Discectomy and Fusion for Radiculopathy
Why am I in pain?
The most likely cause of your pain is compression of a spinal nerve by a combination of a prolapsed disc and overgrown bony spurs within the spinal canal, which together cause compression of the exiting nerve root.
You will drift off to sleep under general anaesthesia in a safe and controlled fashion by an anaesthetist. Whilst you are under anaesthesia you will not feel any pain, nor will you be aware of time passing. Having cleaned your neck in a sterile fashion, an incision about 1 inch long in the skin on the left front part of your neck will allow us to create a working channel between the oesopaghus (“gullet”) and the trachea (“wind-pipe”) on one side, and the great vessels (jugular vein and carotid artery) on the other side. The bones of the neck are then visualised, with the disc between the bones being removed. Further bony spurs may then be removed. We can confirm then that the spinal cord & exiting nerve root has been successfully decompressed. An interbody spacer (or cage) is then placed securely in the space where the disc used to be. Once a securing plate has been put in place over the two bones surrounding the newly implanted plastic cage, the wound will be stitched up, and the anaesthetist will allow you to wake up in a safe manner. The procedure itself will take approximately one and a half hours, but your stay in the operating room environs may be a little longer than this.
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.
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 the nerve root, 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?
The vast majority of patients with arm pain experience significant relief of their arm symptoms and pain. Patients with predominantly neck pain experience less impressive pain relief.
Are there alternatives to surgery?
Alternatives to anterior cervical discectomy and fusion would include physiotherapy, nerve root injections & 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. Herniated discs causing nerve root compression will eventually dessicate (dry up & shrivel, thereby occupying less volume, and exerting significantly less pressure on your nerve root), so if you are willing to put up the pain, you can reasonably choose to avoid this procedure. I cannot ascertain how much pain you are in - you are the only one that appreciates how much pain you are in!
Will I be paralysed if I don't undergo surgery?
No. As things stand, your spinal cord is not being damaged. If you elect to not undergo surgery, you ought to inform me if your symptoms change or worsen significantly. Such changes may represent a larger prolapse of disc putting new pressure on your spinal cord, necessitating urgent surgery.
How long will my expected hospital stay be?
You will be admitted to 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 - you may need to get some skin-clips removed by your GP. 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 – you’ll be advised of this after the surgery. 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 a 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 it's 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 will have further imaging tests or therapies arranged if required. 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.