Anterior Cervical Decompression and Fusion
Why is this surgery done?
The surgery is usually done for degenerative conditions of the spine involving bone spurs or disc herniations that compress and/or damage the nerves of the spine. It can also be done for other conditions of the spine, including fracture, joint instability and infection. As long as they have not had other complicated surgeries or radiation involving the neck, most patients are good candidates for this type of approach, assuming a more extensive surgery is not needed to solve the problem.
How is anterior cervical decompression and fusion done?
First an incision is made on the front of the neck just off to the right or left of the trachea, depending on the surgeon’s preference and your anatomy. Then we dissect through the tissues of the neck carefully until we identify the front of the cervical spine just behind the trachea and esophagus. We make sure we are in the right location using x-rays. We then remove the disc starting superficially, then deeper in the joint space until we work all the way through the joint and enter the spinal canal where the bone spurs or disc herniation compress the nerves. We remove the compressive pathology very carefully, as the nerves that are in that area are very delicate.
After we get all of the pressure off of these delicate nerves, we reconstruct the joint using an implant of cadaver bone or a cage made of synthetic materials. A metal plate and screws then are secured to the front of that part of the spine so that the bones of that segment will heal/fuse and remain stable. The wound is closed with stitches under the surface that dissolve after the skin has healed.
What are my risks? What are common complications?
This is one of the safest and most well-tolerated spine surgeries we perform; in fact, most patients can go home the same day. This is because major complications after the surgery are extremely rare. It is very uncommon to have major difficulties with this and almost always these issues lesson after a number of weeks.
Pain in the back of the neck and at the operative site are mild to moderate and controlled with oral pain killers. Many patients report difficulty swallowing after surgery. This could range from very minor to quite significant, making it difficult to swallow solid food. There is a small risk of hoarseness after surgery that could be permanent in an extremely small number of patients.
There are other structures in the neck, such as blood vessels, that could be damaged and lead to a wound hematoma (collection of blood under the skin), significant bleeding or stroke. When we take pressure off the delicate nerves during surgery, there is a very small chance that nerve damage could occur, causing weakness/paralysis, nerve pain, numbness or loss of bowel or bladder control. Other very rare complications include infection, delayed wound healing or spinal fluid leak.
As with any surgery, there is always a risk of general anesthesia. These risks are extremely unlikely with this procedure and include heart attack, stroke, pneumonia or even death.
Most patients who have the surgery are very satisfied with their results, but some patients feel that their pain was not relieved to their satisfaction. It is also possible for the bone fusion to heal poorly or for the screws to break or dislodge, which could lead to chronic pain or need for reoperation. The fusion of the joint will cause a small reduction in neck flexibility. This can cause strain on nearby joint spaces in the neck.
What do I need to know before surgery?
In order to heal properly, you should be mindful of your health and nutrition leading up to this surgery. Eating healthy, nutritious foods and avoiding of processed foods and refined sugar are best. It is good to have your house and affairs in order prior to this surgery so that you can best comply with the postoperative restrictions. This would include having your home as clean as possible and placing necessary items within easy reach. We restrict twisting, bending and lifting, as well as housework and driving, and this should be kept in mind. You will not need round-the-clock supervision but it is best to have someone close who can help with these daily needs. Also, certain medications such as blood thinners and anti-inflammatories will need to be stopped prior to surgery.
General discharge instructions
- After you return home and are fully mobile, you may remove the support hose worn on your legs.
- Keep your dressing in place for two days after you return home. Sometimes under the dressing will be Steri-Strips, which are small adhesive strips across the surgical incision. Leave these Steri-Strips on the incision and allow them to fall off naturally. This usually occurs within two weeks. If after two weeks the Steri-Strips have not fallen off, you should remove them.
- After removing the dressing, your incision can be open to the air. It is important for a family member to examine your incision each day for one week after surgery to monitor it for any changes as the healing process continues.
- Your surgeon will give you a cervical collar for comfort. However, wearing the collar may not be required. Your surgeon will clarify the instructions for wearing your collar. You may discover that wearing it while riding in the car is helpful, for example.
- If your surgeon gives you a rigid neck brace, specific instructions about its required and optional uses will be reviewed with you before you leave the hospital.
- Do not drive for at least the first two weeks after surgery.
- Do not lift anything heavier than 10 pounds until you’ve had your first follow-up appointment.
- Do not do things that put strain on your neck, such as laundry, sweeping, vacuuming, shoveling or yard work. Use good body mechanics when you move.
- Do not smoke.
- Avoid nonsteroidal anti-inflammatory drugs like Celebrex, Motrin, ibuprofen, Advil and Aleve.
What should I expect while recovering?
You may have significant pain behind your neck, between your shoulder blades and around the surgical incision for the first few days and weeks after your surgery. You may experience some persistent arm pain, numbness and tingling after surgery because your nerve roots requires time to recover. You may also experience neck discomfort and stiffness after surgery. To help you manage your pain, when you leave the hospital you will be given a prescription for pain medication.
Pain from surgery will change as you heal, and this fluctuation is normal and to be expected. As your healing progresses, consider these pain management techniques to help you gain control of your pain level.
- After acute surgical pain has improved, you should gradually discontinue use of the prescribed pain medication, which is often a narcotic. Prolonged use of such prescription narcotics will reduce your body’s production of natural pain-fighting chemicals. When this medication is used for an extended period of time, you may develop a tolerance to it, resulting in the need for higher levels of pain medication.
- Once the pain begins to ease and you no longer need the prescription pain medication, Tylenol and Tylenol-based products are safe to use. However, you should avoid nonsteroidal anti-inflammatory drugs, such as Celebrex, Motrin, ibuprofen, Advil or Aleve. While each of these is important for a variety of pain control needs, they can prevent bone fusion. These medications can be safely resumed 3 – 6 months after your surgery.
- Ice may be used for discomfort as needed.
Possible physical therapy exercises
After leaving the hospital, physical therapy is not necessary for most patients. Your best therapy is walking, which increases blood flow in the body and assists in the healing process. Try walking on a structured basis, beginning slowly at first and progressing on a regular basis as your pain begins to lessen.
If your recovery is slower, you may need additional therapy after surgery. If needed, physical therapy will be discussed with you at your follow-up appointment.