Anterior cervical spine surgery is a procedure done on the neck to release pressure from the nerve roots and spinal discs. You may consider this surgery when you feel pressure on your nerves in the cervical region (neck). Because it is an ‘anterior’ surgery, the spine is operated on from the front side of the neck.
Causes of nerve root and spinal cord compression
- Disc prolapse – Disc prolapses are also known as slipped disc or disc herniation. Disc prolapses happen when the soft disc centers (nucleus pulposus) are torn and displaced into the spinal canal. This squeezes the nerves extending from the spinal cord, causing immense pain.
- Bony Outgrowths – Bony outgrowths or osteophytes can also compress the spinal cord and nerve root. These outgrowths are usually formed because of spinal arthritis.
- Thickening of the ligaments supporting the spinal column
- Fractures and tumors can also cause compression in rare cases.
Symptoms of nerve root and spinal cord compression
The compression and subsequent inflammation of the affected nerve root by a prolapsed disc causes pain in the arms and neck. This pain is evident when coughing and sneezing. Other symptoms include numbness, weakness in the arms and hands, as well as a feeling of ‘pins and needles.’ Prolapsed discs may also cause difficulty in walking, clumsiness, and issues with urinating. Remember, the intensity and presence of these symptoms may vary from person to person.
Indications for surgery
For a majority of people, these symptoms will fade without requiring any surgery. Surgery may be necessary when:
- Symptoms do not decrease following a reasonable period of non-operative treatment
- Significant or increasing muscular weakness due to the nerve compression
- Spinal cord compression or Myelopathy, which demonstrates the need for early surgery
About the surgery
Anesthesia: The surgery is done under general anaesthesia. Patients will be lying on their backs.
The procedure: The surgeon makes a 2.5 to 5 cm cut on the skin in the front of the neck. By gently pushing the muscles and blood vessels to one side, the spine is exposed. The surgeon will then remove the prolapsed disc and/or osteophyte with special instruments. This will also relieve the pressure on the spine and nerve roots. The surgeon may insert a bone graft (from the pelvic bone) or spacer (cage) to fill in the space of the prolapsed disc. To further support the spine, a titanium plate may also be used. A drain tube prevents blood clots. Dissolvable sutures (stitches) are used to close the skin.
After the surgery
In the recovery room: After the surgery, you may feel some pain on the operated area when you wake up. Pain medications, antibiotics, and IV fluids will help you stay hydrated and stable. You may also receive a temporary urinary catheter to use the bathroom. Additionally, a neck collar will help keep you comfortable and secure.
In the ward: After your surgery, you’ll be on a liquid diet before slowly going back to a full, regular diet. The drain tube and catheter will be removed. You’ll be able to walk around. Typically, you’ll stay in the hospital for 1-3 days, depending on your surgeon’s suggestions.
At home: Remember to stay active to speed up your recovery! Take short walks every day and slowly increase the distance. Please avoid heavy lifting, strenuous activity, and excessive movement of your neck. If you can, try to have someone to help you with your chores and errands for the first few weeks. The last thing you want to do is over-exert yourself!
Risks and potential complications
Keep in mind all surgical procedures come with a risk of complications. You should thoroughly talk about these risks with your surgeon before the procedure. Remember to list out any allergic reactions to anesthesia or other medicines. Other chronic illnesses related to your heart or lungs – such as hypertension, diabetes and asthma – should also be disclosed. Provide a list of all your current and past medications. Remember, unexpected complications such as stroke, heart attack, and pneumonia are not caused by surgical treatment and are generally rare. However, these rare complications may have serious consequences.
Surgical complications may consist of infection, bleeding, spinal fluid leak, injury to the veins and arteries near the spine or injury to the spine’s nerve tissue or its surrounding protective layer. Injury to the spinal cord or the nerves may occur during surgery and can result in complete paralysis of all four limbs or paralysis of certain muscles in the arms or legs, with loss of normal sensation. Loss of bowel and bladder control can also occur in consequence of injury to the nerves. An injury to the covering layers of the nerves (dura) can result in a leak of spinal fluid and this may occasionally require a surgery again.
Injury or trauma to the trachea (windpipe), esophagus (food pipe) or the vocal cord nerve may happen during surgery. Damage to the vocal cord nerves may result in a harsh or weak voice. The bone graft may not heal and fuse the spine (non-union) and rarely the bone graft may become dislodged, requiring further surgery.
Although antibiotics are given before and after surgery, there is a 1-5% chance of wound infection. Superficial mild infections can be treated with antibiotics, while deep infections may require a wound wash-out under anaesthesia. If you have had an infection in any other area (urinary bladder, chest and skin) immediately before surgery, you may be at a higher risk of post-operative infection in the spine, so make sure to let your surgeon know.
Deep vein thrombosis (DVT – clotting of blood in your calf muscles) and pulmonary embolism (clot migrating to your lungs) are not common after an elective spine surgery, especially when you are out of bed and walking within 24 hours after surgery. We do not routinely use medications to prevent DVT; however, if you have had an episode of DVT in the past, let your surgeon know.
In rare cases, solid fusion may not occur. When this happens, further surgery to re-fuse the spine may be necessary. Non-fusion (non-union) rates are higher for patients who have had spinal surgery in the past, as well as smokers, patients who undergo multiple level fusion surgery, and patients who have undergone radiation for cancer. Not all patients who have a non–union will need to have another fusion procedure. As long as the joint is stable, and the symptoms are better, further surgery is not necessary. Conversely, there is a risk of having a successful fusion but without relieving the nerve pain.
Notify your surgeon immediately if you notice the following after surgery:
- Excessive bleeding
- Redness or discharge from the wound
- Weakness or numbness in the arms and legs
- Persistent headache
- Difficulty in passing urine
Talk to your surgeon
This is a concise overview and does not include all the known facts about your condition and the surgery. If you have any questions, make sure to seek any clarifications from your surgeon and his team. It is important for you to attain a clear understanding of your condition and the risks, benefits, and limitations of the surgical procedure before taking action.