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Anterior Cervical Discectomy

For some people with chronic neck pain or other disorders that affect the cervical spine, an anterior cervical discectomy may be needed. The following information discusses this common surgical procedure.

The Cervical Spine
The human spine is divided into three sections:

1) the cervical spine or neck (which is made up of 7 vertebrae)

2) the thoracic spine (which is made up of 12 vertebrae)

3) the lumbar spine or low back (which consists of 5 vertebrae)

spine

The cervical spine begins at the base of the skull and supports the weight of the head. The spinal cord runs from the brain down through the cervical spine, controlling the function of the body's organs and limbs. In between each of the 7 vertebrae of the cervical spine are soft pads or discs which act as shock-absorbers and allow for bending and movement of the head. Each disc is made up of two parts, a soft center called the nucleus and a tough outer band called the annulus.

Cervical Pain
Millions of people suffer from pain in their necks or arms. A common cause of cervical pain is a rupture or herniation of one or more of the cervical discs. This happens when the annulus of the disc tears and the soft nucleus squeezes out. As a result, pressure is placed on the nerve root or the spinal cord and causes pain in the neck, shoulders, arms and sometimes the hands. Cervical disc herniations can occur as a result of aging, wear and tear, or sudden stress like from an accident.

vertebral segment

Most cases of cervical pain do not require surgery and are treated using non-surgical methods such as medications, physical therapy and/or bracing. However, if patients experience significant pain and weakness that does not improve, surgery may be necessary.

Surgical Technique
An anterior cervical discectomy is the most common surgical procedure to treat damaged cervical discs. Its goal is to relieve pressure on the nerve roots or on the spinal cord by removing the ruptured disc. It is called anterior because the cervical spine is reached through a small incision in the front of the neck (anterior means front). During the surgery, the soft tissues of the neck are separated and the disc is removed. Sometimes the space between the vertebrae are left open. However, in order to maintain the normal height of the disc space, the surgeon may choose to fill the space with a bone graft.

A bone graft is a small piece of bone, either taken from the patient's body (usually from the pelvic area) or from a bone bank. This piece of bone fills the disc space and ideally will join or fuse the vertebrae together. This is called fusion. It usually takes a few months for the vertebrae to completely fuse. In some cases, some instrumentation (such as plates or screws) may also be used to add stability to the spine.

After Surgery
Patients will feel some pain after surgery, especially at the incision site. Pain medications are usually given to help control the pain. Upon a physician's direction, moist heat and frequent repositioning can also provide some relief. While tingling sensations or numbness is common, and should lessen over time, they should be reported to the doctor. Most patients are up and moving around within a few hours after surgery. In fact, this is encouraged in order to keep circulation normal and avoid blood clots.

However, most patients need to remain in the hospital, gradually increasing the amount of time they are up and walking, before they are discharged. Prior to discharge the doctor will provide the patient with careful directions about activities that can be pursued and activities to be avoided. Often patients are encouraged to maintain a daily low-impact exercise program. Walking, and slowly increasing the distance each day, is the best exercise after this type of surgery. Some discomfort is normal, but pain is a signal to slow down and rest.

Signs of infection like swelling, redness or draining at the incision site, and fever should be checked out by the surgeon immediately. Keep in mind, the amount of time it takes to return to normal activities is different for every patient. Discomfort should decrease a little each day. Increases in energy and activity are signs that recovery is going well. Maintaining a healthy attitude, a well-balanced diet, and getting plenty of rest are also great ways to speed up recovery.

Updated on: 05/03/12
Dr. Haid describes the anterior cervical discectomy with possible fusion and instrumentation concisely and in understandable language. It is true that the majority of cases of cervical neck pain and arm pain resolve with non-surgical management. When choosing operative candidates, it should be stressed that neck pain alone with no signs or symptoms of nerve or spinal cord compression may not improve with this surgery, even if a herniated cervical disc is present. This surgery works best to alleviate symptoms from spinal cord or nerve compression and is less valuable for treating neck pain alone.

Scott P. Sanderson, M.D.

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