Patient Information
Anterior Cervical Discectomy: Restoring Spine Health
What is an Anterior Cervical Discectomy?
Purpose of the Procedure
The primary goal of an anterior cervical discectomy is to alleviate the symptoms caused by pressure on the spinal cord or nerve roots. Specifically this will alleviate pain radiating down your arm. By decompressing the spinal cord, the expectation is to preserve the current neurological function of the arms and legs. Some patients experience improvement in weakness over the next few weeks and months, but this is difficult to quantify.
The Procedure
An anterior cervical discectomy is a surgical procedure designed to alleviate pressure on the spinal cord and nerve roots in the cervical spine, which is the neck region of the spine. The approach involves making a small incision in the front of the neck, a technique known as an anterior approach. This approach offers a direct path to the affected area without disturbing the muscles and structures in the back of the spine.
Step by Step
1. Anaesthesia: The procedure is performed under general anaesthesia, ensuring that you are comfortably asleep and pain-free throughout the surgery.
2. Incision: A small incision is made in the skin at the front of your neck. This incision is carefully placed within a natural skin crease to minimize scarring and access the cervical spine.
3. Retracting Tissues: Muscles and other tissues are gently moved aside to access the spine. Special retractors are used to keep these structures safely out of the way.
4. Disc Removal: The damaged disc or bone spurs responsible for causing pressure on the spinal cord or nerve roots are meticulously removed. Removing these structures relieves the pressure and helps preserve normal spinal function.
5. Spinal Fusion (if required): Depending on your specific condition, a special breeze block called a cage is placed in the disc space. This cage encourages the growth of new bone, eventually fusing the adjacent vertebrae together. This fusion adds stability to the spine and prevents movement at the surgical site.
6. Closure: After the necessary adjustments have been made, the incision is closed with sutures. I usually use absorbable sutures, eliminating the need for suture removal later.
Potential Risks
As with any surgical procedure, there are potential risks associated with an anterior cervical discectomy. These following risks are taken from information from the British Assiciation of Spine Surgeons:
Damage to a nerve root. This only occurs in less than 1 out of 100 cases. This can leave you with numbness and weakness of your arm or hand.
Tearing of the outer lining or covering which surrounds the nerve roots (dura). This is reported in fewer than 1 out of 100 cases. This can usually be repaired in the same sitting but rarely a persistent leak of spinal fluid may occur post operatively and further surgery to repair this may be necessary.
Recurrent arm pain / symptoms.
Bleeding in the wound, which could result in difficulty breathing or swallowing. This is rare but if it occurs, it may be necessary to take you back to theatre to try to stop the bleeding.
Infection. Whilst we normally give a dose of antibiotics at the start of the operation, superficial wound infections may occur in up to 4 out of 100 cases. Deep wound infections may occur in fewer than 1 out of 100 cases. Most of the time this can be treated with a course of antibiotics, but sometimes with the rare deeper infections, further surgery to wash out the wound may be required.
Blood clots (thromboses) in the deep veins of the legs (DVT) or lungs (PE). We can help prevent this by wearing TED stockings and special pumps around the calves. We also give a blood thinning injection (Clexane) the next day. The most effective way is to get moving as soon as possible after your operation. Walk regularly as soon as you are able to, both in hospital and when you return home and keep well hydrated by drinking plenty of water. Women are also advised to stop taking any medication which contains the hormone oestrogen (like the combined contraceptive or HRT) four weeks before surgery, as taking this during spinal surgery can increase the chances of developing a blood clot.
Non-union or lack of solid fusion (pseudoarthrosis). This can occur in up to 5 out of 100 cases.
In the long term, or in years to come, pain can develop from problems at other levels in the neck (adjacent level segment disease). We can help prevent this with specific exercises you will be given.
Swallowing and speech disfunction is another rare complication. This usually resolves, but in very rare circumstances this can be permanent.
Damage to the spinal cord and paralysis (the loss of use of the arms and legs, loss of sensation and loss of control of the bladder and bowel). This is extremely rare but can occur through bleeding into the spinal canal after surgery (a haematoma). If an event of this nature were to occur, every effort would be made to reverse the situation by returning to theatre to wash out the haematoma. Sometimes, however, paralysis can occur as a result of damage or reduction of the blood supply to the nerves or spinal cord and this is unfortunately not reversible.
Stroke, heart attack or other medical or anaesthetic problems – extremely rare and reported as happening in 1 out of 10,000 cases.
General anaesthetic fatal complications which have been reported in 1 out of 250,000 cases.
Recovery
Recovery following an anterior cervical discectomy varies from patient to patient, but most individuals only need to stay in the hospital for one night and are discharged following a thorough physiotherapy review. Neck stiffness in the first 6 weeks is common, but with the neck exercises advised, this improves. I normally advise taking 6 weeks off work for the best results, but this can also vary between patients. During this period patients are expected to be able to be mobile and go for walks outdoors.
Disc Replacement (Arthroplasty) and Our Approach
In recent years, disc replacement (arthroplasty) has emerged as an alternative to fusion surgery. However, evidence suggests that while disc replacement may not offer superior results to fusion (no difference inadjacent level disease), it carries a higher risk of complications. At The Spine MDT, we prioritise your safety and long-term well-being. Our approach is rooted in evidence-based practices, and we carefully weigh the benefits and risks of each procedure before recommending a course of action. Our primary goal is to find the least invasive treatment that offers the longest-lasting result for your individual needs.
In Conclusion, an anterior cervical discectomy is a procedure aimed at relieving pressure on the spinal cord and nerve roots in the neck. It can significantly improve your quality of life by reducing pain and restoring spinal function. If you are considering this procedure or exploring treatment options for your cervical spine condition, our team of experts is here to guide you. Contact The Spine MDT to schedule a consultation and take the first step toward regaining your spinal health and overall well-being.
Medical illustrations are taken from The British Association of Spine Surgeons
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