Anterior cervical decompression + fusion surgery
This procedure is performed to alleviate nerve pinching (cervical disc herniations), and allows the offending disc to be surgically removed.
Fusion surgery (fusing one bone to another) is often done to prevent motion at a vertebral segment. Decreasing the motion at a painful motion segment should decrease the pain at that segment.
Anterior cervical fusions are commonly done in conjunction with an anterior cervical discectomy. Theoretically, fusing the two vertebral segments together after removing the disc prevents the spine from falling into a collapsed deformity, jacking open the disc space (kyphosis). Fusions are also done to treat cervical instability due to:
To achieve a fusion, a bone graft is used to connect two bones together. The patient’s own bone will grow and incorporate the graft bone as its own. This process creates one continuous bone surface and eliminates motion at the fused joint. The bone graft is usually taken from the patient’s pelvis.
What happens before surgery?
Following diagnosis at an outpatient appointment, patients would need to have an MRI scan done either through the hospital or at an outside MRI scan unit (if you have your own scan it is vital that you bring with you on the day of surgery). Prior to formal admission, patients will be called to attend a ‘preassessment clinic’, where they will be examined by a member of the orthopaedic medical team, have blood tests and an up-to-date x-ray taken (and, in some cases, a heart trace).
What's the operation like?
It will be done under general anaesthesia. The anterior approach (from the front of the neck) will be the preferred because it provides good access to the spine through a relatively uncomplicated pathway.
After a skin incision is made, only one thin vestigial muscle needs to be cut, after which anatomic planes can be followed right down to the spine. The limited amount of muscle transection or dissection helps to limit postoperative pain. Surgery is carried out in 2 phases.
1. Surgical approach
- The skin incision is horizontal and can be made on the left or right hand side of the neck
- The thin platysma muscle is then split in line with the skin incision and the plane between the sternocleidomastoid muscle and the strap muscles is then entered
- Next, a plane between the trachea/esophagus and the carotid sheath can be entered
- A thin fascia (flat layers of fibrous tissue) covers the spine (pre-vertebral fascia) which can easily be dissected away from the disc space
2. Disc removal
- A needle is then inserted into the disc space and an x-ray is done to confirm that the surgeon is at the correct level of the spine
- After the correct disc space has been identified on x-ray, the disc is then removed by first cutting the outer annulus fibrosis (fibrous ring around the disc) and removing the nucleus pulposus (the soft inner core of the disc)
- Dissection is carried out from the front to back to a ligament called the posterior longitudinal ligament. Removal of any osteophytes (bone spurs) or disc material is carried out that may have extruded through the ligament.
- The bone graft is inserted between the cervical vertebrae; usually the bone graft is packed into a ‘cage’ which in turn is inserted into the neck
What risks are associated with fusion surgery?
Although cervical discectomy/fusion is a very good operation to relieve shoulder and arm pain (with or without weakness or numbness/tingling), there are potential uncommon risks, which may include:
- Nerve root damage (rare)
- Damage to the spinal cord (about 1 in 10,000- extremely rare)
- Graft dislodgment
- Damage to the trachea/esophagus (Retraction of the esophagus may produce temporary difficulty with swallowing (1 to 2 weeks)
- Continued pain
- Temporary hoarseness (the small nerve that supplies the vocal cords, recurrent laryngeal nerve, may not function for weeks after surgery because of retraction during the procedure, but tends to recover)
There is little chance of a recurrent disc herniation because most of the disc is removed with this type of surgery.
What is the recovery like?
After fusion surgery, a patient can expect to:
- Be in bed for the first 24 hours
- Possibly have a urinary catheter, which would usually be removed after 1-2 days once you're mobile
- Have a neck collar that should be worn religiously for the first six weeks!
- Refrain from solid food for the first day in order to avoid food sticking in the food-pipe
- Be given pain killers, either through a vein, or intramuscularly, or as tablets
- Be seen by their doctor and nurse following surgery; routine observations such as vital signs and arm movements will be recorded. Blood test and x-rays will also be carried out
- Mobilize the day after surgery if comfortable and alert
Following discharge from hospital, you will be given an appointment to come to outpatient for review; you may also be given a separate appointment to be seen by a district nurse who will check on your wound and remove skin clips
Return to treatments and operations.