Anterior Cervical Decompression and Fusion

Anterior Cervical Decompression and Fusion

An operation to relieve spinal nerve or spinal cord compression through the front of the neck is called an anterior cervical decompression. A fusion procedure can then be used to re-stabilise the spine. An anterior approach allows direct access to problems at the front of the spine using natural planes between neck structures for a minimally invasive, non-destructive operation.

Do you need an operation?

Nerve Compression (Radiculopathy)

Compression of a nerve in the spine interferes with its function and may cause any of the following:

- pain
- numbness
- weakness

Compression may be due to:

- disc protrusion (also described as a herniation, bulge)
- ligament bulging
- bony spurs (osteophytes)

Surgery aims to remove the pressure and tension on the nerve in order to relieve symptoms.

The decision to have surgery should depend on the severity of your symptoms and your ability to tolerate them. The impact of these symptoms should outweigh the potential impact and risks of surgery.

In most cases, surgery should not be performed until an appropriate amount of time (usually six weeks) has been allowed for spontaneous improvement. When symptoms are especially severe, earlier surgery may be performed. If there is progressive weakness, surgery should be performed emergently.

Spinal Cord Compression (Myelopathy)

Compression of the spinal cord interferes with its function and may cause any of the following:

- weakness, clumsiness or stiffness of the hands
- difficulty with fine movements - writing, buttons, feeding etc.
- unsteadiness or stiffness when walking
- numbness or altered sensation
- hyperactivity of the bladder

Compression may be due to :
- disc protrusion (also described as a herniation, bulge)
- ligament bulging or calcification/ossification
- bony spurs (osteophytes)
- mal-alignment of the spine (kyphosis, olisthesis)

Surgery aims to remove the pressure and tension on the spinal cord in order to prevent further damage. Improvement is often noted but not guaranteed.

The spinal cord is an extremely sensitive structure. Damage to the spinal cord is often irreversible. Surgery may not be able to reverse all symptoms. The primary aim of surgery is to prevent further damage. Surgery is therefore best performed when symptoms are mild, in order to prevent severe symptoms from permanent spinal cord damage.

The Operation

You will be given a general anaesthetic so that you are unconscious throughout the procedure. An incision is made on one side (right or left) of the front of the neck. The spine is approached between the breathing and swallowing structures on one side (pharynx/larynx/trachea/oesophagus) and the carotid artery/sternocleidomastoid muscle on the other.

Decompression: with the front of the spine exposed, the disc is removed. Any bony spurs or ligament causing compression is also removed. This is done under the operating microscope.

Fusion: a bone graft or an intervertebral cage is placed in the disc space. This will form the fusion between the bones. An anterior plate and screws may also be used to provide additional stability. If a bone graft is used there will be an incision over your hip (iliac crest).

Risks of Surgery

All surgery carries risks. Surgery is undertaken when the potential benefit to the patient outweighs the possible risks.

The risks associated with anterior cervical discectomy and fusion include :

- general risks: allergic reactions, heart and lung problems, clots in the legs or lungs
- bleeding problems: may require a blood transfusion
- wound problems: infection, scar formation or spinal fluid leakage
- voice or swallowing difficulties
- incomplete response to surgery: persistent symptoms
- nerve or spinal cord injury: weakness, sensory change, altered bowel, bladder and sexual function
- failure of instrumentation or fusion
- recurrence: further spine problems in the future

These may require prolonged hospitalisation, further surgery and delay recovery.

Smoking and Surgery

Smoking is associated with higher risks of anaesthetic and more complications from surgery. There is a lesser rate of surgical success in smokers. Fusion is more likely to fail in smokers because of bone graft 'rejection'. Quitting smoking is a difficult process, but there are important benefits to be gained by quitting before surgery.

After Surgery

Going Home

With the use of modern techniques, many patients are able to go home within 2-3 days of the surgery. Before discharge, you will need to be able to eat and drink satisfactorily, walk short distances, perform basic self-care and pass urine.

Early mobilisation and discharge is associated with quicker recovery and less complications.

Medications

Your pain should be controlled with oral medication alone. Constipation can be a side effect of some pain killers, so drink lots of water, eat a healthy. balanced diet and consider the use of stool softeners.

You should continue to take your normal medications as usual. Please discuss restarting 'blood-thinners' such as warfarin, clopidogrel (Plavix) or aspirin with Dr Ball.

Wound Care

Wounds are covered with a sterile dressing following the surgery. This can be removed 5 days after surgery. After this the wound can get wet in the shower.

Wounds are usually closed with dissolving stitches (sutures) under the skin. These wounds are reinforced with sticky (adhesive) strips on the skin. If they get wet, pat them dry with a towel and they will stay sticky. These can be removed after 5 - 7 days.

If staples or outside stitches are used, these can be removed 7 days following surgery by your local doctor.

Do not soak the wound (in a bath or pool) until you see Dr Ball after the surgery.

Please contact Dr Ball or your local doctor if the wound develops increasing redness or discharge, as this could suggest infection.

Activity Restrictions

A cervical collar (neck brace) may be prescribed after your surgery. Instructions will be given about how and when to wear it.

For the first few weeks after surgery, the following activities must be avoided

- sudden or excessive neck movements
- heavy lifting

Gentle walking is the best activity to maintain fitness and health following anterior spine surgery. Activity should be gradually increased to a daily 30-minute walk.

Physiotherapy should only be started 4 - 6 weeks after surgery.

Follow-up

Dr Ball will see you about 6 weeks after the surgery. Following this you will have appointments at 3 months and 6 months following the surgery.