Anterior Cervical Discectomy and Fusion
Anterior cervical discectomy and fusion is a procedure used to relieve pressure placed on the nerves, nerve roots and/or spinal cord in the neck. Typically, what is pressing on the nerve roots or the spinal cord is a disc herniation and/or bone spurs. The procedure involves removing the bone spurs and/or disc material that is compressing the nerves and then placing a piece of bone graft where the disc was located in order to promote healing of the bones and biologically weld them.
INDICATIONS FOR CERVICAL DISCECTOMY AND FUSION
The most common reason to have an anterior cervical discectomy and fusion is due to pain in the arms associated with numbness and/or tingling and/or weakness that has not responded to typical conservative measures such as physical therapy and/or chiropractic treatment and/or epidural steroid injections. In cases when there is significant compression on the spinal cord rather than the nerve roots, patients can have arm pain, numbness and weakness and also difficulty with their balance, coordination of their hands and rarely bowel and bladder dysfunction. In such cases, surgical treatment may be needed more urgently.
THE PROCEDURE
The procedure is done under general anesthesia. It is done through a small incision in the front of the neck. The front of the spine is exposed and any disc material and/or bone spurs that are pressing on the spinal cord and/or nerve roots are removed. Once the nerve roots and/or spinal cord are decompressed a bone graft is placed between the two vertebra and typically a plate and screws are placed for extra support and stability to help ensure that the bones heal and fuse together properly. The procedure can be done at multiple levels, depending on how many levels need to be decompressed to relieve pressure on the nerves.
RECOVERY
Most patients are able to be discharged from the hospital the day after their procedure. Typically a soft collar is used but some patients may need a more rigid collar depending on how many levels are fused. Most patients are up and walking the day of surgery. A drain is placed and removed the first day after surgery. Patients can typically return to work within two to six weeks after surgery. This depends on the physical nature of the patient’s employment.
RISKS
There are risks as with any surgical procedure. These include infection, bleeding, spinal fluid leak, hoarseness of voice (typically transient), swallowing difficulty (typically transient), failure of the bone to heal and/or instrumentation loosening, blood clots, nerve damage. A potential risk that is inherent to any sort of spinal fusion surgery is failure of the bones to heal appropriately and for the bone graft to fuse. If this should occur additional surgery may be required. One of the well known risk factors for the bones not healing and/or fusing is smoking, and this patients are highly encouraged to stop smoking prior to and after their procedure.
