Anterior Cervical Discectomy
Over time, the discs in the spine may degenerate or become weak. This can lead to a herniated, torn, or hardened disc that causes quite a bit of pain. Discs can also be damaged through injury. Sometimes, other treatments just can’t help and the patient considers surgery to remove the damaged disc. This does have some risks, but it can also give a patient many years of relief from pain and improved mobility.
When does a person consider a discectomy?
Fortunately, there are many different forms of treatment for back and neck pain caused by degenerating discs. Sometimes, the pain may be coming from inflamed muscles that are being pulled out of place by disc herniation or hardening. This can sometimes be improved by strengthening those muscles through physical therapy. There are also options for medications that can help with the pain and inflammation. If all other routes of treatment have not been working, or if the patient’s condition worsens very quickly, a doctor may suggest surgery. A discectomy and fusion of a person’s spine is actually a relatively common surgery. However, surgery is not a catch-all solution for the pain. It may not work or it might cause other issues as well.
Discectomy and Fusion risks and benefits
As with any surgery, an anterior cervical discectomy and fusion has its risks and benefits. It is important to be informed about these before going into the procedure. A cervical discectomy refers to specifically a disc removal in the neck, not in the back. This is an important distinction to make.
Anytime the spine is being operated on, there is a risk of nerve damage. There are so many nerves connected to the spinal cord, and at the level of the neck there are many other organs and things that could be affected. There are also general complications that come with surgery and anesthesia that are rare, but can be severe. Some of the more common side effects that can occur with this specific surgery are problems swallowing, damage to the trachea or esophagus, or mild nerve issues. Very few people experience any spinal cord damage or problems. There are also a few cases where patients have not gained much pain relief or there are issues with the hardware that was placed during the surgery.
Despite the risks, there are many great benefits to an anterior cervical discectomy. Many patients experience relief from pain, more mobility, and usually a relatively fast recovery. In addition, after surgery most doctors recommend a physical therapy regimen that will help the surgery to be successful. If this is followed carefully, patients see more growth and healing. 92-100% of patients received relief from arm pain, and up to 83% of patients gained total relief from neck pain. Those are great odds!
What happens in a discectomy and fusion?
Before surgery, make sure to follow the instructions the doctor gives you about eating and drinking or other preparations. The procedure for an anterior cervical discectomy and fusion (or ACDF surgery) begins with the patient being placed under a local anesthetic. An incision about two inches long is made in the side of the neck, either on the right or left side.
The surgeon pushes the organs, tissues, and muscles away from the spine, creating a tunnel to the disc. The doctor will then use a fluoroscope, which creates a real-time x-ray so that he can see into the neck and spine. They then use a special retractor to separate the bones and discs. The damaged disc is located, and the doctor will cut away about two-thirds of the disc. This will be the exposed portion. The docto then uses a surgical instrument to see the rest of the disc and remove that as well from behind the spinal cord. Any bone spurs that have developed are cut away.
A replacement bone graft will be inserted into the area where the disc once was. This will be either from your own bones or from another person. This will keep the vertebrae from grinding together, but it will not be the same as having a disc there. Then, the doctor will screw in a metal plate that will hold the bone graft into place and keep the surrounding vertebrae in alignment. The retractor will be removed, the muscles and surrounding organs or tissues will be put back into place, and the incision will be closed up using stitches or surgical glue. This may turn into a scar, depending on the location and the wound care after surgery.
Alternative: Disc Replacement
An alternative and newer surgery that has been developed is known as cervical disc replacement surgery. This is where instead of inserting a bone graft, the doctor will put in a replacement disc. These discs are made of high-grade materials that mimic the elasticity and natural movement of the real ones. This can be a great alternative. They have been shown to be effective and seem to have great long-term effects as well. Discuss with your doctor the option of disc replacement and see if your insurance will cover it.
After the surgery, you must have a follow up appointment and x-ray approximately 2 weeks after to make sure that it was successful. Recovery will generally take about 4-6 weeks. This can be shortened through wound care and wearing a cervical collar or brace. After the neck has healed, many doctors will begin physical therapy that will help the spine and muscles to recover and adjust as well, which can increase pain relief and range of motion.
ACDF surgery and you
Always consult with your doctor before deciding if surgery is for you. If you are experiencing chronic neck pain with no relief, ask your doctor if a discectomy could be an option for you. It may help you to live pain-free. Just be sure to weigh the risks before making your decision. Hopefully with your doctor’s help, you can find the best solution for you!
Only a doctor can tell you if you have this ailment. This is for informational purposes and should not be used in lieu of a doctor’s opinion.