What is an Anterior Cervical Discectomy?
A discectomy is a procedure that removes a damaged, arthritic, or herniated intervertebral disc (the “cushion” between adjacent bones of the spine). An anterior surgical approach means an approach from the front of the body, and the cervical spine is the spine in the neck. So an anterior cervical discectomy is a procedure that removes a damaged intervertebral disc from the spine in the neck, using a surgical approach from the front of the neck.
An anterior cervical discectomy is often performed along with procedures called fusion and fixation to ensure spinal stability. A fusion is the implantation of a bone graft that will fuse (grow together) with vertebrae (bones of the spine) in the area. A fixation is the implantation of screws, rods or plates. A fixation is a common way to hold the bones in place while they fuse. An Anterior Cervical Discectomy and Fusion is often abbreviated ACDF.
An anterior cervical discectomy is similar to a related procedure called an anterior cervical corpectomy, and the two surgeries may be used to treat similar conditions. The difference is that a corpectomy is a more extensive procedure, typically used when the disease extends beyond the areas than can be dealt with through a discectomy. In a discectomy, only the damaged portion of a disc and bone spurs are removed, whereas in a corpectomy, the vertebrae (bone of the spine) are also removed.
When is this procedure performed?
Anterior cervical discectomy is performed for patients who have experienced changes such as degeneration and bone spurs (growth of bony projections) in the discs of the cervical spine, and for those with herniated discs.These conditions can affect the amount of space available for the spinal cord and nerves. As a result, the spinal cord and nerves can become compressed (pinched), and even injured.
Surgery is typically the recommended treatment when the spinal cord is at risk of damage. Surgery may also be warranted for those patients who do not find relief with nonoperative treatment.
How is this procedure performed?
This procedure is performed under general anesthesia.
The surgeon first makes an incision on the front of the neck, then moves aside soft tissues to expose the anterior spine. The surgeon removes the damaged disc(s) and any bone spurs to remove the pressure from the spinal cord or nerve roots. This part of the procedure is often performed with an operating microscope, using microsurgical neurosurgical techniques.
Next, the surgeon may perform either a spinal fusion and fixation to ensure the spinal column is well-aligned and stable, or an arthroplasty in which the disc is replaced by an artificial cervical disc. To perform a spinal fusion, the surgeon replaces the disc with a bone graft taken from the patient’s own body or from a bone bank. The surgeon then implants a titanium plate and screws to fix the bones (hold them in place). The implantation of titanium hardware (the fixation) provides spinal stability as the bone graft fuses (grows together) with the adjacent bones. Once the bones have fused, the spine is stable. If an arthroplasty is performed, the surgeon will select the appropriate size artificial disc and implant it into the disc space. Both fusion and arthroplasty are performed under direct vision of the surgeon and verified with intraoperative X-rays to ensure precise placement.
The incision is closed with sutures underneath the skin and dressed with a small gauze bandage.
What happens after surgery?
You will awaken in the postoperative recovery area, called the PACU.
Blood pressure, heart rate, and respiration will be monitored. Any pain will be addressed and monitored.
Once awake, you will be moved to a regular room where you’ll increase your activity level (sitting in a chair, walking).
Patients who have had bone graft taken from their hip may feel more discomfort in their hip than neck incision.
Most patients having a 1 or 2 level ACDF are sent home the same day. However, if you have difficulty breathing or unstable blood pressure, you may need to stay overnight.
Discharge instructions
Discomfort : After surgery, pain is managed with narcotic medication. Because narcotic pain pills are addictive, they are used for a limited period (2 to 4 weeks). As their regular use can cause constipation, drink lots of water and eat high fiber foods. Laxatives (e.g., Dulcolax, Senokot, Milk of Magnesia) can be bought without a prescription. Thereafter, pain is managed with acetaminophen (e.g., Tylenol).
Hoarseness, sore throat, or difficulty swallowing may occur in some patients and should not be cause for alarm. These symptoms usually resolve in 1 to 4 weeks.
Restrictions:
- If you had a fusion, do not use non-steroidal anti-inflammatory drugs (NSAIDs) (e.g., aspirin; ibuprofen, Advil, Motrin, Nuprin; naproxen sodium, Aleve) for 6 months after surgery. NSAIDs may cause bleeding and interfere with bone healing.
- Do not smoke. Smoking delays healing by increasing the risk of complications (e.g., infection) and inhibits the bones’ ability to fuse.
- Do not drive for 2 to 4 weeks after surgery or until discussed with your surgeon.
- Avoid sitting for long periods of time.
- Avoid bending your head forward or backward.
- Do not lift anything heavier than 5 pounds (e.g., gallon of milk).
- Housework and yard-work are not permitted until the first follow-up office visit. This includes gardening, mowing, vacuuming, ironing, and loading/unloading the dishwasher, washer, or dryer.
- Postpone sexual activity until your follow-up appointment unless your surgeon specifies otherwise.
Activity:
- You may need help with daily activities (e.g., dressing, bathing), but most patients are able to care for themselves right away.
- Gradually return to your normal activities. Walking is encouraged; start with a short distance and gradually increase to 1 to 2 miles daily.
- A physical therapy program may be recommended.
- If applicable, know how to wear a cervical collar before leaving the hospital. Wear it when walking or riding in a car.
- Bathing/Incision Care
- You may shower 1 to 4 days after surgery.
- No tub baths, hot tubs, or swimming pools until your health care provider says it’s safe to do so.
- If you have staples or stitches when you go home, they will need to be removed.
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