Anterior Cervical Disectomy

Anterior (anatomical term for front) Cervical (neck spine) Disectomy(removal of disc between the two vertebral bones) is a procedure that involves removing a damaged disc to relieve spinal cord or nerve root pressure to reduce pain, weakness, numbness, and tingling. After the surgeon removes the damaged disc, they may also fuse the bones together.

This surgery is indicated when there is severe pain and when any of the following conditions are met

• a herniated disc which presses on the nerve root next to it
• degenerative disc disease (spondylosis), causing small tears in the annulus and inflammation of the nerve root.
• when other non-surgical treatments have failed

Procedure

Pre-operative: It is important to inform the doctor if you are taking any blood thinning medications like aspirin and are allergic to any medications. Neurological examination includes documenting neurological status of bilateral upper extremitiesstrength, sensation, reflexes, and primary symptoms; and screening to identify any contraindications for surgery. Basic X-ray of cervical spine is taken.

This surgery is done through the anterior portion (front part) of the neck as it provides direct visualization of the cervical discs involved in causing the stenosis, spinal cord or nerve compression. Also, the patient tends to have less pain from this approach than from the posteriorportion (back part) operation.

This is usually an outpatient procedure. The surgery is performed utilizing general anesthesia. After a traverse skin incision is made in the front of the neck, one thin vestigial muscle is cut, and deep cervical fascia is divided. The deep structures are mobilizedand anatomic planes are followed right down to the spine. The limited amount of muscle division or dissection helps to limit postoperative pain following the spine surgery.The surgeon exposes the vertebra and a sharp incision is made to remove the annulus, herniated disc, and arthritic bone spurs or overgrowths. The intervertebral foramen, the bone channel through which the spinal nerve runs, is then enlarged with a drill giving the nerve more room to exit the spinal canal.

The open space is often filled with aautograft to ensure that the vertebrae does not collapse later and to increase stability to compression after the removal of skeletal traction. That can be a bone graft, taken from the pelvis or cadaveric bone; or an artificial implant. This process wherein the bone graft joins the vertebrae together is called "fusion". Sometimes a titanium plate is screwed on the vertebrae or screws are used between the vertebrae to increase stability during fusion, especially when there is more than one disc involved.

Complications

The complications that can happen due to this surgery are listed below:

• After the general anesthesia of surgery wears off, some patients experience nausea
• Nerve root damage
• Damage to the spinal cord
• Bleeding
• Infection
• Graft dislodgment
• Damage to the trachea/esophagus
• Continued pain
• Complete or partial quadriplegia.
• Postoperative hematoma
• Postoperative dysphagia
• Esophageal perforation
• Horners syndrome
• Symptomatic recurrent laryngeal nerve palsy

After the procedure

Patients may need to wear a padded, plastic neck brace to reduce the stress on the neck area and decrease pain.Approporiate wound care is mandatory to ensure fast healing. Patients should not take a bath until the wound healing is complete, usually around 2 weeks after surgery. Patients should not bend or twist the neck or perform heavy work or exercises including lifting after surgery. Patients can gradually begin to bend and twist their neck after 6-8 weeks post-surgery. Patient should start driving only 3-8 weeks after surgery. In addition, physical therapy and related healing modalities (e.g., massage, acupuncture) may be recommended in order to promote proper healing, as well as to strengthen the surrounding muscles. The total recovery period ranges from 6 to 8 weeks.