Helpful Links:
General information: Patients with a cervical disc prolapse or degenerative ‘wear and tear’ changes in the neck will often have either arm pain (brachalgia) due to nerve root compression or worsening fine hand function (myelopathy) due to spinal cord compression. Depending on the appearance of the scans and the severity of the symptoms it may be necessary to consider anterior neck surgery to remove the ruptured disc and decompress the spinal cord and nerve roots.
Target and results: The results of surgery are generally good. For patients with brachalgia the arm pain will usually improve after surgery. Patients with a myelopathy may see some improvement, but in many cases the aim of surgery is to prevent further deterioration and preserve the remaining function.
Risk of complications:
- Infection is less than 2 percent. It may affect the superficial tissues or may affect deep spinal structures that may need revision surgeries.
- Hoarse voice, the risk is 4-8percent, may be temporary. It results from injury to the recurrent laryngeal nerve which supplies the vocal cord.
- Bleeding from the major vessels of the neck. It is a rare but serious complication.
- Cerebrospinal fluid (CSF) leak, inadvertent breach of the thecal sac may lead to leaking of the fluid surrounding the brain and the spinal cord. Instant repairs is possible, however, it may need an extended admission in the hospital or further procedures. There is also very small risk of meningitis.
- Soreness on swallowing (dysphagia) which is about 10%, most of the patient will improve after 24-48hours after the surgery.
- Adjacent level accelerated degeneration, some evidence suggested adjacent level degeneration of about 15% in 5 years time.
- Worsening of the neck pain which may affect up to 20% of the patients, most of the times is temporary.
- Implant failure, failure bony fusion may lead to pseudoarthrosis, revision surgery may need fusion from the front and back.
- Neural tissue injury: the most serious complication may cause life changing consequences in form of weakness or paralysis of arms, legs, sphincters, sensory or sexual changes. The risk is very small, <1%.
- Failure to improve symptoms.
- General anesthetic complications (heart attack, stroke)
- Deep venous thrombosis/pulmonary embolism (clots in legs / lungs).
Procedure
ACDF is a standard procedure that is carried out on routine base. The procedure is usually carried out under general l anesthesia and lasts approximately 60-90 minutes. The patient is positioned on his back, head slightly extended. Sometimes we may use head pins (Myefield clamp) to keep the head still. It involves making a small transverse incision on the anterior of the neck, followed by dissection through the neck structures to expose the spinal column from the front. X-rays guided checking the affected disc space is usually carried out. Discectomy under microscope followed by insertion of the intervertebral cage which replaces the disc space and enhance the spinal fusion process. Sometimes we add plate and screw fixation for further stabilization of the spine, especially in traumatic disc herniation Final check of the cage position under x-ray guidance before closure of the wound.
The wound is closed in layers with dissolvable stitches so there are no clips to be removed. After the operation the patient will have a drain in the wound for 24 hours (this is removed on the ward before discharge). Most patients will go home the next day and will be recovering at home for approximately 4 weeks. Following surgery the patient may notice some neck pain and stiffness but this should settle with simple pain killers. Specialist spinal physiotherapists will advice each patient on a postoperative exercise regime, to encourage neck movements. Further outpatient physiotherapy sessions will be offered, where indicated. Patient is usually followed up in the clinic in 8-12 weeks after surgery. If any complication happens, the patient will stay until everything get sorted. Usually the patient can go home after 24-48h. All regular medication will continue except the blood thinning medication like Warfarin, Apixoban, Aspirin, cloidogrel etc, needs advised individually. Most of the cases can started after 48h from the surgery.