Anterior Cervical Discectomy and Fusion
Information about your procedure:
The intervertebral disc is the structure between the vertebrae (bones of the spine), which acts as a spacer and a shock absorber.
Following your consultation with your spinal surgeon, you have been diagnosed with having a cervical disc protrusion resulting in nerve root compression and arm pain. Occasionally, the disc protrusion can also cause spinal cord compression resulting in weakness in your legs.
In general, if a patient’s arm pain due to a cervical disc protrusion is going to get better, then it will do so in about 6–12 weeks.
However, if the symptoms have not resolved following conservative measures (physiotherapy, medication or injections), surgery may be necessary.
About the procedure
The operation is carried out under general anaesthetic, through an incision in the front of the neck. After other structures have been moved aside, the disc material is removed and the implant, containing bone graft, is placed in the space created. The implant is stabilised in the disc space by a small blade.
Risks and complications
Risks include the following:
Damage to the nerve root and the outer lining which surrounds the nerve roots (dura). This is reported in < 5% of cases. This could result in neck or arm pain, weakness or numbness, leaking from the wound, headaches or, very rarely, meningitis.
Bleeding in the wound and swelling around the windpipe (laryngeal oedema), which could result in difficulty breathing or swallowing. You must inform your consultant if you are taking blood-thinning tablets, such as warfarin, aspirin or clopidogrel.
Deep wound infections may occur in < 1% of cases. These can be difficult to treat with antibiotics alone and sometimes patients require more surgery.
Bony non-union. This can occur in up to 5%.
Ongoing neck and arm pain.
Implant movement can occur in up to 2%, with 1% requiring re-operation.
Damage to the trachea (windpipe) or oesophagus (food pipe). This is reported in less than 1% of cases.
The nerve that supplies the vocal cords sometimes does not function after surgery because of retraction during the procedure. This could cause temporary or rarely some permanent hoarseness of the voice. Retraction of the oesophagus can produce temporary difficulty with swallowing.
Very rarely but and in extreme circumstances there may be damage to the spinal cord with paralysis and loss of control to the bladder and bowel. This can occur through bleeding into the spinal canal after surgery. If this was to occur, every effort would be made to reverse the situation by returning to theatre to wash out the haematoma. Sometimes, however, paralysis can occur as a result of damage or reduction of the blood supply of the nerves or spinal cord and this is unfortunately not reversible.
What to expect in hospital
Immediately after the procedure you will be taken on your bed to the recovery ward where nurses will monitor your blood vital signs. Once back on the ward and when you are fully awake you will be allowed to get out of bed. You will have a plastic tube (drain) coming from the wound, that will prevent any blood collection in the wound. This will be removed on the ward the next day and removal is not painful. A sore throat is normal after surgery.
You will normally be discharged home with simple analgesia 2-3 days after your operation. Please arrange for either a friend or relative to collect you from the hospital, as driving yourself or taking public transport is not advised for 48 hours after the anaesthetic. A responsible adult should remain with you overnight. You will walk as comfort allows from the day after the surgery.
In general, you may return to work after 4 weeks provided that you are comfortable. We will provide a sick note at your request on the day of the procedure.
Follow-up in 2 weeks for wound check.