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Anterior Cervical Discectomy
Anterior Cervical Discectomy with Fusion
Foraminotomy
Corpectomy
Laminoplasty
Recovery
Anterior Cervical Discectomy
What is it?
Pain in the neck and extremities, among other symptoms, may
occur when an intervertebral disc herniates – when the
annulus fibrosus (tough, outer ring) of the disc tears and
the nucleus pulposus (soft jelly-like center) squeezes out
and places pressure on neural structures, such as nerve roots
or the spinal cord. Bony outgrowths, called bone spurs or
osteophytes, which form when the joints of the spine calcify,
may also cause these symptoms.
Anterior cervical discectomy is an operation that involves
relieving the pressure placed on nerve roots and/or the spinal
cord by a herniated disc or bone spurs – a condition
referred to as neural compression.
Through a small incision made near the front of the neck
(i.e., the anterior cervical spine), the surgeon removes disc
material and/or a portion of the bone around the nerve roots
and/or spinal cord to relieve these compressed neural structures
and to give them additional space.
Discectomy involves removing all or part of an intervertebral
disc. The term discectomy is derived from the Latin words
discus (flat, circular object or plate) and -ectomy (removal).
Why is it done?
Pressure placed on neural structures, such as nerve roots
or the spinal cord, by a herniated disc or bone spur may irritate
these neural structures and cause: pain in the neck and/or
arms; and lack of coordination, numbness or weakness in the
arms, forearms or fingers. Pressure placed on the spinal cord
as it passes through the neck (cervical spine) can be serious
since most the nerves for rest of the body (e.g., arms, chest,
abdomen, legs) have to pass through the neck from the brain.
Patients who suffer from these symptoms are potential candidates
for this operation.
The Operation
An understanding of what an anterior cervical discectomy involves
will help you to approach your operation and recovery with
confidence.
Incision:
The operation is performed with you lying on your back. A
small incision is made to one side of the front of your neck.
Exposure:
After pulling aside the soft tissue – fat and muscle,
your surgeon exposes the source of the neural compression.
Removal:
Disc material – and, in some cases, a portion of the
bone – around the nerve roots and/or spinal cord is
then removed to relieve the compressed neural structures and
to give them additional space.
Closure:
The operation is completed when your surgeon closes and dresses
the incision.
Recovery:
Your surgeon will have a specific post-operative recovery/exercise
plan to help you return to normal life as soon as possible.
The amount of time that you have to stay in the hospital will
depend on this treatment plan. You will normally be up and
walking in the hospital by the end of the first day after
the surgery.
As you read this, please keep in mind that all treatment
and outcome results are specific to the individual patient.
Results may vary. Complications, such as infection, blood
loss, and bowel or bladder problems are some of the potential
adverse risks of spinal surgery. Please consult your physician
for a complete list of indications, warnings, precautions,
adverse events, clinical results, and other important medical
information.
_________
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Anterior Cervical Discectomy
with Fusion
What is it?
Pain in the neck and extremities, among other symptoms, may
occur when an intervertebral disc herniates - when the annulus
fibrosus (tough, outer ring) of the disc tears and the nucleus
pulposus (soft, jelly-like center) squeezes out and places
pressure on neural structures, such as nerve roots or the
spinal cord. Bony outgrowths, called bone spurs or osteophytes,
which form when the joints of the spine calcify, may also
cause these symptoms.
Anterior cervical discectomy with fusion is an operation
that involves relieving the pressure placed on nerve roots
and/or the spinal cord by a herniated disc or bone spurs -
a condition referred to as nerve root compression.
Through a small incision made near the front of the neck
(i.e., the anterior cervical spine), the surgeon:
- Removes the intervertebral disc to access the compressed
neural structures
- Relieves the pressure by removing the source of the compression
- Places a bone graft between the adjacent vertebrae, and
- In some cases, implants a small metal plate to stabilize
the spine while it heals.
Discectomy involves removing all or part of an intervertebral
disc. The term discectomy is derived from the Latin words
discus (flat, circular object or plate) and -ectomy (removal).
Spinal fusion involves placing bone graft between two or more
opposing vertebrae to promote bone growth between the vertebral
bodies.
Why is it done?
Pressure placed on neural structures, such as nerve roots
or the spinal cord, by a herniated disc or bone spur may irritate
these neural structures and cause: pain in the neck and/or
arms; and lack of coordination, numbness or weakness in the
arms, forearms or fingers. Pressure placed on the spinal cord
as it passes through the neck (cervical spine) can be serious
since most the nerves for rest of the body (e.g., arms, chest,
abdomen, legs) have to pass through the neck from the brain.
Patients who suffer from these symptoms are potential candidates
for this operation.
The Operation:
An understanding of what an anterior cervical discectomy with
fusion involves will help you to approach your operation and
recovery with confidence.
Incision:
The operation is performed with you lying on your back. A
small incision is made to one side of the front of your neck.
Exposure:
After pulling aside the soft tissue - fat and muscle, your
surgeon exposes the disc between the vertebrae.
Removal:
The intervertebral disc - and, in some cases, a portion of
the bone around the nerve roots and/or spinal cord - is then
removed to relieve the compressed neural structures and to
give them additional space.
Material Placement:
Through a separate incision, a small section of bone is obtained
from your iliac crest (i.e., your hip) for use as a bone graft.
The bone graft is placed in the disc space, where it helps
the adjacent vertebrae to fuse.
Stabilization:
A metal plate may be implanted on the front of the cervical
spine to increase the stability of the spine immediately after
the operation. Surgeons use these implants to decrease the
amount of time that you have to wear a cervical collar after
surgery and to increase your chances of developing a solid
fusion.
Closure:
The operation is completed when your surgeon closes and dresses
the incision.
Recovery:
Your surgeon will have a specific post-operative recovery/exercise
plan to help you return to normal life as soon as possible.
The amount of time that you have to stay in the hospital will
depend on this treatment plan. You will normally be up and
walking in the hospital by the end of the first day after
the surgery.
As you read this, please keep in mind that all treatment
and outcome results are specific to the individual patient.
Results may vary. Complications, such as infection, blood
loss, and bowel or bladder problems are some of the potential
adverse risks of spinal surgery. Please consult your physician
for a complete list of indications, warnings, precautions,
adverse events, clinical results, and other important medical
information.
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Foraminotomy
Cervical foraminotomy is an operation to enlarge the space
where a spinal nerve root exits the cervical spinal canal
to relieve the symptoms of a "pinched nerve."
Indications for Operation:
Compression of the cervical nerve roots can cause neck pain,
stiffness, and pain radiating into the shoulder, arm, and
hand, as well as numbness, tingling and/or weakness in the
arm and hand. Protruding or ruptured discs, bone spurs, and
thickened ligaments or joints can all cause narrowing of the
space where the nerve exits the spinal canal and cause the
above symptoms. Patients who do not improve with conservative
treatment may be candidates for the operation.
What happens afterward?
Some pain at the operative site is expected, but generally
resolves over time and can be controlled with oral pain medicines.
Some patients can be discharged the same day of surgery, but
most patients will require 24-48 hours in the hospital. Most
patients will notice immediate improvement in some or all
of their symptoms, however some symptoms may improve only
gradually. A positive attitude, reasonable expectations, and
compliance with the doctor's recommendations all contribute
to a satisfactory outcome. A cervical collar (brace) is rarely
necessary. Most patients can return to their regular activities
within several weeks.
The Operation
Incision:
A small incision is made in the middle of the neck after localizing
the area of interest with an x-ray.
Decompression:
The muscles on the side of the spine involved are dissected
and a retractor is placed. (Sometimes an endoscope and tubular
retractor or microscope are used). Bone from the posterior
arch of the spine and joint over the nerve are removed using
special cutting instruments and/or a drill. Thickened ligament,
bone spurs and/or bulging discs are removed to decompress
the exiting nerve, which is checked with a probe to insure
adequate space around the nerve root.
Closure:
The muscles and tissues are closed in layers with absorbable
sutures. The skin may be closed with absorbable sutures and
steri-strips, or surgical staples, which are removed when
the wound is well healed.
As you read this, please keep in mind that all treatment
and outcome results are specific to the individual patient.
Results may vary. Complications, such as infection, blood
loss, and bowel or bladder problems are some of the potential
adverse risks of spinal surgery. Please consult your physician
for a complete list of indications, warnings, precautions,
adverse events, clinical results, and other important medical
information.
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Corpectomy
Cervical corpectomy is an operation to remove a portion of
the vertebra and adjacent intervertebral discs for decompression
of the cervical spinal cord and spinal nerves. A bone graft
with or without a metal plate and screws is used to reconstruct
the spine and provide stability.
Indication for operation
In some patients, the cervical spinal canal can be narrowed
by bone spurs arising from the back of the vertebral body
or the ligament behind the vertebral bodies. In this situation
it may be necessary to remove one or more vertebral body and
the discs above and below to adequately decompress the spinal
cord and/or nerve roots because the area of compression cannot
be addressed by an anterior cervical discectomy alone.
What happens afterward?
Most patients experience only mild discomfort at the operative
site, which is generally well controlled with oral pain medicines.
A mild sore throat is not uncommon and is usually short lived.
Most patients are discharged from the hospital in 24-48 hours.
Patients may notice immediate improvement in some or all of
their symptoms, however, some symptoms may improve only gradually.
A successful outcome will depend on your compliance with the
health care provider's recommendations, and a realistic expectation
for meeting the goals of surgery (which depend on one's condition
preoperatively).
Since cigarette smoking dramatically impairs bone healing,
smoking cessation will significantly improve the likelihood
for a successful fusion.
The Operation
Incision:
The patient is positioned on their back. If using the patient's
own bone, an incision is made over the hip to harvest bone
from the iliac crest. For the corpectomy, a small incision
is made on either side of the neck. (A longer "up and
down" incision may be required for multiple corpectomies).
Decompression:
The cervical spine is widely exposed by separating the spaces
between the normal tissues. The discs above and below the
vertebrae involved are removed. The middle portion of the
vertebrae is removed (some of which is saved for use in the
fusion) using special cutting instruments and drills to decompress
the underlying spinal cord and nerve roots.
Reconstruction:
A strut of bone is placed to span the bony defect and provide
support to the front of the spine. The bone is incorporated
(fused) into the remaining vertebrae over time. Bone from
the bone bank (allograft) may be substituted for the patient's
own bone. A metal plate and screws are often used to provide
extra support and facilitate the fusion process.
 ___________
Closure:
Absorbable sutures and sometimes skin staples are used to
close the incisions. A cervical collar may or may not be required
for use after surgery. The doctor will follow the fusion with
periodic x-ray exams after the operation.
As you read this, please keep in mind that all treatment
and outcome results are specific to the individual patient.
Results may vary. Complications, such as infection, blood
loss, and bowel or bladder problems are some of the potential
adverse risks of spinal surgery. Please consult your physician
for a complete list of indications, warnings, precautions,
adverse events, clinical results, and other important medical
information.
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Laminoplasty
What is it?
For patients with painfully restricted spinal canals in their
necks, this procedure immediately relieves pressure by creating
more space for the spinal cord and roots. The technique is
often referred to as an "open door laminoplasty,"
because the back of the vertebrae is made to swing open like
a door.
The Operation
Incision:
An incision is made on the back of the neck.
A groove is cut down one side of the cervical vertebrae creating
a hinge.
The other side of the vertebrae is cut all the way through.
The tips of the spinous processes are removed to create room
for the bones to pull open like a door.
The back of each vertebrae is bent open like a door on its
hinge, taking pressure off the spinal cord and nerve roots.
Small wedges made of bone are placed in the opened space
of the door.
End of Operation:
The door of the vertebrae swings shut, and the wedges stop
it from closing all the way. The spinal cord and the nerve
roots rest comfortably behind the door.
As you read this, please keep in mind that all treatment
and outcome results are specific to the individual patient.
Results may vary. Complications, such as infection, blood
loss, and bowel or bladder problems are some of the potential
adverse risks of spinal surgery. Please consult your physician
for a complete list of indications, warnings, precautions,
adverse events, clinical results, and other important medical
information.
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Recovery
As you prepare yourself mentally to undergo spinal surgery,
you also need to prepare yourself for the recovery period
that will follow your operation. While the surgery entails
work on the part of the surgeon, after that, the brunt of
the work is in your hands. To ensure a smooth and healthy
recovery, it is important that, as a patient, you closely
follow the set of instructions that your surgical team gives
you.
Hospital Recovery
After the operation, you will be brought to the recovery room
or intensive care unit (ICU) for observation. When you wake
up from the anesthesia, you may be slightly disoriented, and
not know where you are. The nurses and doctors around you
will tell you where you are, and remind you that you have
undergone surgery. As the effects of the anesthesia wear off,
you will feel very tired, and, at this point, will be encouraged
to rest.
Members of your surgical team may ask you to respond to some
simple commands, such as "Wiggle your fingers and toes"
and "Take deep breaths." When you awaken, you will
be lying on your back, which may seem surprising, if you have
had surgery through an incision in the back; however, lying
on your back is not harmful to the surgical area.
Prior to the surgery, an intravenous (IV) tube will be inserted
into your arm to provide your body with fluids during your
hospital stay. The administration of these fluids will make
you feel swollen for the first few days after the operation.
When you awake from the anesthesia, you may feel the urge
to urinate. So, in addition to the IV, a catheter tube (also
commonly called a Foley Catheter) will be placed into your
bladder to drain urine from your system. The catheter serves
two purposes: (1) it permits the doctors and nurses to monitor
how much urine your body is producing, and (2) it eliminates
the need for you to get up and go to the bathroom. Once you
are able to get up and move around, the catheter will be removed,
and you can then use the bathroom normally.
During your hospital stay, you will get additional instructions
from your nurses and other members of your surgical teams
regarding your diet and activity.
Proper nutrition is an important factor in your recovery.
Your surgeon may restrict what you drink and eat, or place
you on a special diet, depending on the surgical approach
that was used during the operation. Calories and food intake
are an important part of recovery. Some patients find that
their physician orders are less restrictive than the diet
they follow at home. After the surgery, you will continue
to receive intravenous fluids until you are able to tolerate
regular liquids, which typically involves gradually transitioning
you from sips of clear fluids to full liquids (including JELL-O®
gelatin). From there, you will be given small amounts of solid
food until you are ready to return to a regular diet.
With respect to physical activity, in most cases, your surgeon
will want for you to get out of bed on the first or second
day after your surgery. Nurses and physical therapists will
assist you with this activity until you feel comfortable enough
to get up and move around on your own.
Home Recovery
Before you are discharged from the hospital, your doctor and
other members of the hospital staff will give you additional
self-care instructions for you to follow at home - a list
of "dos and don'ts," which you will be asked to
follow for the first 6 to 8 weeks of your home recovery. So,
if you are unsure of any of these instructions, ask for clarification.
Following these instructions is crucial to your recovery.
Nowadays, surgery involves one or more incisions depending
on the surgical approach used to perform the operation. Therefore,
when you are discharged home you may still have a surgical
dressing on your incision(s). Either a nurse will visit your
home to change the dressing or a caregiver, such as one of
your family members, will be taught to do it for you. It is
important that the dressing be changed daily and kept dry.
If any signs of infection are observed while changing the
dressing, call your doctor. These signs include:
- Fever - a body temperature greater than 101°F (38°C)
- Drainage from the incision(s)
- Opening of the incision(s), and
- Redness or warmth around the incision(s).
In addition, call your doctor if you experience chills, nausea/vomiting,
or suffer any type of trauma (e.g., a fall, automobile accident).
During this recovery period, you will also be instructed
to keep your incision(s) clean, making sure only to use soap
and water to cleanse the area. In general, you should not
shower until your doctor has permitted you to do so.
In addition to caring for your incision(s), you will also
be encouraged to:
- Drink plenty of fluids
- Maintain a healthy diet (high in protein)
- Walk or do deep-breathing exercises, and
- Gradually increase your physical activity.
Activities to avoid include any heavy lifting, climbing (including
stairs), bending, or twisting. You should also avoid the use
of skin lotion in the area of the incision(s); you need to
keep this area dry until it has had the opportunity to heal
well.
Follow up with your doctor on a regular basis during this
post-operative period, and make sure to call your doctor if
you have any concerns or questions.
As you read this, please keep in mind that all treatment
and outcome results are specific to the individual patient.
Results may vary. Complications, such as infection, blood
loss, and bowel or bladder problems are some of the potential
adverse risks of spinal surgery. Please consult your physician
for a complete list of indications, warnings, precautions,
adverse events, clinical results, and other important medical
information.
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