Anterior Cervical Discectomy an Fusion Surgery as an Outpatient?
It can be frightening to discover that the only treatment left for your spinal condition is an anterior cervical discectomy and fusion. More than likely, your condition has progressed to a point that other treatment options are no longer viable.
During surgery, a small piece of bone is removed from the hip and placed in the disk space in the neck. Surgery is performed from the front of the neck through a very small incision. Initial recovery allows you to return home the same day.
Anatomy
The cervical spine contains seven vertebrae that begin at the skull and join with the thoracic section of the spine. The vertebrae are bony portions of the spine. Each vertebrae fits over top of each other. The spinal cord consists of nerves covered in three layers of tissue called meninges and runs from the brain stem to the end of the spine. The cartilage disk material lies between each vertebra. The cartilage is spongy, and it allows flexibility between the bones.
Conditions
Degenerative disc disease develops when the disk material dries out allowing some of the nucleus material to ooze into the disc space. In addition, bone spurs, (bony projections) can grow into the disk area, narrowing the space. The condition can cause severe pain, numbness and weakness.
A bulging herniated disc, also known as a herniated nucleus polypus or HNP, occurs when the disc material bulges and ruptures through the wall, putting pressure on the spinal cord and its nerves.
Surgery Candidate
Surgery is a last resort, but a necessary one when other methods have not corrected the condition. Patients may require surgery if they have more pain in their arms then their neck, have been diagnosed with HNP or degenerative disc disease, experience numbness in the arm and hand, and have been treated with physical therapy and pain medications without relief.
Surgery and Results
Anterior cervical discectomy and fusion are performed while the patient is in the supine (back) position. The head is slightly lowered back to move the neck forward. A small incision is made in the neck and the disc is removed. The bone that was retrieved from the hip is placed in the open disk space. The bone is reinforced by plates and screws. Complete fusion takes place in three to six months.
Bone spurs are removed to relieve compression on the spinal cord. The incision is closed and small bandages are applied to the neck and hip.
According to the Mayfield Clinic, arm pain is relieved in 92 to 100 percent of patients. Neck pain is relieved in 73 to 83 percent of patients.
Recovery Time
Most patients are discharged the same day. Some discomfort may be noted at both incision sites. Hoarseness and sore throat can occur. A cervical collar should be worn up to 4 weeks. Limited activity for the first 2 weeks should include lifting no more than 5 pounds, bending the head front or back, vacuuming or gardening, driving and sexual activity. See the doctor after 2 weeks for further instructions.
Risks
Do not take any non-steroidal pain medication such as Motrin, aspirin, ibuprofen, or Advil. Anti-inflammatory drugs can cause bleeding and reduce bone healing. Check with your doctor on what drugs to avoid.
Surgical risks that can occur with most surgeries are reaction to anesthesia, bleeding, infection, and blood clots. With spinal and fusion surgery additional risks can develop such as difficulty swallowing, the bone graft can shift, the hardware used in the fusion can break, the vertebrae above and below the fusion can succumb to stress over time, and nerve damage can result from surgery.
Know Your Surgeon
Check the credentials of the surgeons in your area before choosing the one for your surgery. The state medical board maintains a list of physicians that gives information pertaining to their education, experience, awards, disciplines and malpractice suits.
Decide who will perform your surgery with confidence. Once you have selected a surgeon you can review the surgical process, recovery time, risks and expected results with him. Now that you have educated yourself concerning this type of surgery, you will know the right questions to ask.
References
American Association of Neurological of Surgeons: Cervical Spine
https://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Cervical%20Spine.aspx
Mayfield: Anterior Cervical Discectomy and Fusion
https://www.mayfieldclinic.com/PE-ACDF.htm
North American Spine Society, Know Your Back: Herniated Cervical Disk
