Anterior Cervical Disc Fusion
A cervical spine is made up of six intervertebral discs, which are situated between the adjacent vertebrae. These discs facilitate the cervical spine movement in various directions as it supports the head and the neck above. However, the cervical discs tend to deteriorate with time, becoming less flexible and flat. Such degenerative alterations can result in pain, like if the disc herniates, leaking inflammatory protein to the surrounding spinal nerve.
Most patients with cervical disc-associated pain (neck pain) do not usually require any surgical operation. However, if such non-surgical treatment options do not completely control the pain, the doctor can recommend anterior cervical disc fusion. This is a surgical technique that can help address the condition and ease neck pain.
What is Anterior Cervical Disc Fusion?
Anterior cervical disc fusion is a surgical procedure to remove degenerative or herniated disc from the neck. It aims to relieve nerve root and spinal cord pressure and minimize associated pain, tingling, weakness, and numbness.
There are two categories of anterior cervical disc fusion that surgeons often recommend to treat neck pain. They include;
- Anterior cervical discectomy
When performing this procedure, the surgeon addresses the condition through the front part (anterior) of the cervical spine or neck. The cervical disc will then be taken out from between both vertebral bones.
The surgeon normally performs fusion surgery simultaneously as the discectomy procedure to help stabilize the cervical section. The fusion procedure involves the placement of the bone grafts or implant where the disc was initially. This gives strength and stability to the area.
Why is Anterior Cervical Disc Fusion Performed?
Surgeons perform anterior cervical disc fusion due to various reasons, including;
- Removing a worn out, damaged, or injured disc in the spine
- Extracting some bone spurs from the vertebrae that are infringing or pinching on the nerves. The pinched nerves could cause numbness or weakness in the legs or arms. As a result, treating the cause of the compressed nerve within the spine through anterior cervical disc fusion is crucial. This is because it will ease or even eliminate such weakness and numbness.
- Treating a herniated disc, also known as a slipping disc. A herniated disc occurs if the soft substance in the middle of a disc is squeezed out via firm material on the disk's outer sides.
Ideal Candidates for Anterior Cervical Fusion Procedure
You might be a perfect candidate to undergo an anterior cervical fusion procedure if;
- You are experiencing significant weakness in the arm or hand
- The diagnostic tests, including CT scan, MRI, and myelogram, indicate signs of a degenerative or herniated disc
- You have severe arm pain that is worse than the neck pain
- The symptoms fail to improve following treatments such as medications and physical therapy
How Anterior Cervical Disc Fusion is performed?
The entire surgical procedure takes about one to three hours and involves several steps. They include the following;
- Patient preparation
Once in the operation room, the surgeon will ask you to lie on the operating table on your back. You will then receive general anesthesia to make you unconscious during the procedure and prevent pain or discomfort. As soon as you fall asleep, the surgeon will cleanse the neck region and prep it. If the operation plan involves the use of your bone, then the hip section will be prepped as well to acquire a bone graft. However, if a donor's bone is to be used, then the hip incision won’t be necessary.
- Creation of the incision
The surgeon will create an incision on the left or right side of the neck, 2-inch from the skin surface. A tunnel on the spine is then made by moving the neck muscles and pulling back the esophagus, trachea, and arteries. Lastly, the muscles providing support to the front region of the spine are raised and shifted aside. This enables the surgeon to view the discs and the bony vertebrae.
- Locating the damaged disc
The surgeon will use a fluoroscope (a specialized x-ray device) to insert a small needle or catheter into the disc. The fluoroscope will also guide him or her to find the impaired disc and vertebra. A special retractor is used to stretch apart the vertebrae bones both above and below the damaged disc after locating it.
- Removal of the disc
The disc's exterior wall will be cut. The surgeon uses small gripping instruments to extract approximately 2/3 of the disk. After that, he will look via a surgical microscope to take out the remaining disc. To access the spinal canal, the ligament running at the back of the vertebrae is extracted. Every disc material that is putting pressure on the spinal nerves is eliminated.
- Nerve decompression
The bone spurs pressing on the nerve root will be taken out. A drill is used to enlarge the foramen from which the spinal nerve goes out. This operation, known as a foraminotomy, allows the nerves to leave the spinal canal with ease by creating sufficient room.
- Preparation of the bone graft fusion
The ventilated disc area on both the top and bottom is prepped using a drill. The fusion procedure involves the removal of the bone outer cortical layer to disclose the inner blood-rich cancellous bone. The surgeon can use the bone graft obtained from;
The hip: This involves creating an incision on the skin and muscle around the hipbone crest. The hard outer layer (cortical bone) is then sliced through with a chisel to the inner layer or cancellous bone. This inner last comprises the bone growing proteins and cells. The bone graft will then be curved and inserted in between the vertebrae.
Fusion cage or bone bank: This involves filling the bioplastic cage or the damaged bone graft using leftover bone shreds that contain bone growing cells and proteins. After that, the graft will be inserted into space.
- Closure of the incision
Once the fusion procedure is complete, the surgeon removes the spreader retractors and suture together the skin and muscle incisions. They will then place biologic glue or steri-strips across the incision.
What to Expect After Anterior Cervical Disc Fusion Surgery?
After the procedure, you will be transferred into the postoperative recovery room before the anesthesia effect finally wears off. The health care team will monitor the blood pressure, respiration, and heart rate and address any pain you experience. You can raise the level of your activity level once you are awake, for instance, walking or sitting in a chair.
Most patients who undergo bone graft removal from the hip may experience more hip incision pain than in the neck. Usually, the patients who have a 1 or 2 stage anterior cervical disc fusion procedure are discharged the next day. But if you experience trouble breathing or have unstable blood pressure, you might be required to remain overnight.
Recovery and Results
Have a follow-up consultation with the doctor two weeks following surgery. In most cases, the recovery period takes four to six weeks. For a few weeks, x-rays can be taken to confirm if the fusion is taking place. Also, during your follow-up appointment, the doctor will determine when you can return to work.
Anterior cervical disc fusion surgery relieves arm pain in about 90 to 100 percent of patients. Arm fatigue and numbness, on the other hand, can last for several weeks or months. In 73 to 83 percent of patients with such cases, neck pain is alleviated. People suffering from arm pain benefit more from this procedure, unlike those suffering from neck pain. Maintain a good mood and thoroughly do the physical therapy workouts.
Risks of Anterior Cervical Disc Fusion
Every surgical procedure carries varying risks and complications. The general risks that are likely to occur include infections, bleeding, adverse reaction to anesthesia, and blood clots formation.
On the other hand, if the cervical disc fusion is performed alongside discectomy, there are higher risks of complications. They can include;
- Failure of the vertebrae to fuse: At times, the vertebral bone may fail to connect due to various reasons, including smoking, obesity, osteoporosis, or malnutrition.
- Swallowing difficulties and hoarseness: Temporary hoarseness can sometimes occur after surgery. This happens if the frequent laryngeal nerve controlling the vocal cords gets damaged during the procedure. This might take a few months to recover.
- Migration of the bone graft: Although rare, the bone graft sometimes shifts from the standard position in the vertebrae. Hence, another surgery might be necessary.
- Nerve damage and constant pain: Damage of the nerves can result in numbness and sometimes paralysis
- Adjacent segment disorder: Spine segment fusion transfers too much pressure into the bones and disc below and above the fusion. Eventually, this disintegrates the adjoining level, causing pain.
Doctors often recommend anterior cervical disc fusion surgery to minimize and eliminate severe pain within the back and neck. Such pain is normally caused by varying underlying issues with the cervical discs. The procedure is suitable for patients with chronic pain and arm weakness. It’s also the best option if other alternatives, including medications and physiotherapy, are less effective.
CloudHospital is determined to addressing neck pain caused by cervical disc disorders through anterior cervical discectomy fusion. It consists of various surgeons, orthopedists, and other medical providers who are highly trained and experienced. Besides, they work together to ensure that every patient receives comprehensive care and treatment.