Anterior Cervical Discectomy
What is it?
Anterior cervical discectomy is an operation performed on the upper spine to relieve pressure on one or more nerve roots, or on the spinal cord. The procedure is explained by the words anterior (front), cervical (neck), and discectomy (cutting out the disc).
Why is it done?
Neck and arm pain, among other symptoms, may occur when an intervertebral disc herniates. This happens, either suddenly with injury or slowly over time, when some of the disc’s jelly-like center (the nucleus pulposus) bulges or ruptures through its tough, fibrous outer ring (the annulus fibrosus) and presses on a nerve.
When a disc ruptures in the cervical spine, it puts pressure on one or more nerve roots (often called nerve root compression) or on the spinal cord, as seen in (Figure 2). This pressure causes symptoms in the neck, arms, and even legs. Further pressure may be caused by rough edges of bone, called bone spurs, that naturally build up around some herniated discs.
In this operation, the cervical spine is reached through a small incision in the front of your neck. After the soft tissues of the neck are separated, the intervertebral disc and bone spurs are removed. The space left between the vertebrae may be left open or filled with a small piece of bone. In time the vertebrae may fuse, or join together.
If used, the pre-formed bone graft may be obtained from a bone bank. It will not be rejected by your body, because it is avascular (contains no blood cells). In some circumstances, or if your surgeon prefers, the bone graft might instead be removed from your own hip through a second incision.
What happens afterwards?
Successful recovery from anterior cervical discectomy requires that you approach the operation and recovery with confidence based on a thorough understanding of each process. Your surgeon has the training and expertise to correct physical defects by performing the operation; he and the rest of the health care team will support your body’s efforts to heal its damaged tissues. Full recovery will also depend on you having a strong, positive attitude, setting small, realistic goals for improvement, and working steadily to accomplish each goal.
Anterior Cervical Discectomy: The Operation
Surgery for anterior cervical discectomy is performed with the patient lying on his or her back. A small incision is made in the front of the neck, to one side (Fig. 3).
Exposure and removal of the herniated disc
After fat and muscle are pulled aside with a retractor, the disc is exposed between the vertebrae. An operating microscope may be used as part of the disc is removed with a forcep (Fig. 4).
Specialized instruments or a surgical drill may be used to enlarge the disc space (Fig. 5). This will help the surgeon to empty the disc space fully and relieve any pressure on the nerve or spinal cord from bone spurs or the ruptured disc.
Placement of the bone graft
If your surgeon has chosen to use a bone graft, it will be placed in the disc space to help fuse the vertebrae it lies between (Fig. 6). Any of several graft shapes may be used.
The operation is completed when the neck incision is closed in several layers (Fig. 7). Unless dissolving suture material is used, the skin sutures (stitches) or staples will have to be removed after the incision has healed.
Certain risks must be considered with any surgery. Although every precaution will be taken to avoid complications, among the most common risks possible with surgery are: infection, excessive bleeding (hemorrhage), and an adverse reaction to anesthesia.
Other risks possible with anterior cervical discectomy include: stroke; injury to the recurrent laryngeal nerve, which causes hoarseness and may or may not be permanent; and injury to the involved nerve root(s) or the spinal cord, both of which can cause varying types and degrees of paralysis.
Clinical experience and scientific calculation indicate that, in general, surgical risks are limited; however, surgery remains a human effort. Unforeseen circumstances can complicate any surgical procedure and lead to serious or even life-threatening situations. Although such complications are infrequent, you and your family should feel free to discuss the question of risk with your physician.