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Disease Overview

The vertebrae of the backbone are cushioned by intervertebral discs that act as shock absorbers and allow frictionless movement of your back. It is made up of a soft gel-like center called the nucleus pulposus that is surrounded by a tough outer ring of annulus fibrosus. A herniated disc is a condition in which the nucleus pulposus bulges out through the damaged or broken annulus fibrosus. This puts pressure on the neural structures, such as nerve roots and/or the spinal cord. Besides, bony outgrowths, also known as bone spurs or bone osteophytes, are formed due to the accumulation of calcium in the spine joints. The pressure induced by a herniated disc or bone spur on nerve roots, ligaments or the spinal cord may cause pain in the neck and/or arms, numbness or weakness in the arms, forearms or fingers, and lack of coordination.
As most nerves to the body (e.g., arms, chest, abdomen, and legs) pass through the neck region from the brain, pressure on the spinal cord in the neck region (cervical spine) can be very problematic.

What is Anterior Cervical Discectomy and Fusion?

Anterior cervical discectomy with fusion is an operative procedure to relieve compression or pressure on nerve roots and/or the spinal cord due to a herniated disc or bone spur in the neck. The vertebra is approached from the from (anterior) of your neck.

Indications for Anterior Cervical Discectomy and Fusion

Anterior cervical discectomy with fusion is recommended only after non-surgical treatment approaches fail. Before recommending surgery, your surgeon considers several factors such as your health condition, age, lifestyle and anticipated level of activity following surgery.

Anterior Cervical Discectomy and Fusion Procedure

  • Your surgeon makes a small incision in the front side of the neck and locates the source of neural compression (pressure zone).
  • Then, the intervertebral disc that is compressing the nerve root will be removed partially or completely along with any bony material that is compressing or putting pressure on the nerves and producing pain.
  • Spinal fusion implies placing a bone graft between the two affected vertebral bodies to encourage bone growth between the vertebrae.
  • The bone graft acts as a medium for binding the two vertebral bones and grows as a single vertebra to stabilize the spine.
  • It also helps to maintain the normal disc height. In certain instances, metal plates or pins may be used for providing support and stability and enabling the fusion of the vertebrae.

Postoperative Instructions Anterior Cervical Discectomy and Fusion

A specific postoperative recovery/exercise plan will be offered by your physician to help you return to normal activity at the earliest possible. The duration of hospital stay depends on this treatment plan. You will be able to wake up and walk by the end of the first day after the surgery and resume your work within 3-6 weeks, depending on your body’s healing status and the type of work/activity that you plan to resume.

Risks or Complications of Anterior Cervical Discectomy and Fusion

In addition to the anesthetic complications, spinal surgery is associated with some potential risks such as infection, blood loss, blood clots, nerve damage, and bowel and bladder problems. Failure to fuse the vertebral bones with the bone graft (fusion failure) is an important complication of spinal fusion, which usually requires additional surgery.

What is Posterior Cervical Decompression?

Posterior cervical decompression is a surgical procedure performed through the back of the neck to relieve pressure over compressed nerves in the cervical spine region caused by inflamed spinal tissue or nerves, by removing portions of the cervical vertebrae. Injury or wear-and-tear can cause parts of the cervical vertebrae to compress the nerves of the spinal cord, leading to pain, numbness, or tingling in the part of the body that the nerve supplies.

Posterior cervical decompression can be performed through a minimal invasive approach. It does not require cutting and stripping of the muscles from the spine region, unlike the conventional open spine surgery, which requires spine muscles to be cut or stripped.

Cervical Spine Anatomy

The spine is made up of 33 small bones called vertebrae and is known as the spinal column or vertebral column. It can be divided into 5 parts: cervical, thoracic, lumbar, sacral, and coccyx region. The cervical spine is comprised of the first 7 vertebrae (C1-C7) and supports the neck and the head. The vertebrae are protected by spongy vertebral discs present between them and is supported by ligaments that hold them together and surround the underlying spinal cord.

Indications for Posterior Cervical Decompression

Posterior cervical decompression is usually indicated for herniated discs, spinal stenosis, bone spurs, bulging discs, spinal injury, spinal tumors and when conservative treatment options do not provide relief. 

Preparation for Posterior Cervical Decompression

You will have a preoperative assessment session before surgery. During your assessment, you must inform your doctor about any health conditions you may have, such as diabetes or bleeding disorders, and about any medications that you may be taking, such as blood thinners and over-the-counter medications. You may be asked to stop taking certain medicines for several days before the procedure.

Your doctor will explain the surgical procedure, its risks and benefits, and answer all your other surgery-related queries before the procedure. Blood tests, X-rays or other imaging tests may also be ordered to assess your medical condition. 

Procedure for Posterior Cervical Decompression

The procedure is performed in the back of the neck under anesthesia with you lying face down.  Your surgeon makes a small incision in the midline over your cervical spine region. The layers of neck muscles are separated using a retractor, and the affected nerve root is identified. The lamina (bony arch of your vertebra) may be removed (laminectomy) and the facet joints may be trimmed to reach the compressed nerve. Then, the bone or disc material and/or thickened ligaments are removed, relieving the pressure on spinal nerve structures, creating decompression. The neck muscles are brought back into their original position by removing the retractor. The incisions are closed with absorbable sutures and covered with a dressing.

Postoperative Care Instructions

You can expect your post surgery hospitalization to last up to 7 days. Full recovery from cervical decompression surgery can take an average of 5 weeks. You will be discharged with instructions that need to be diligently followed for a complete recovery, including:

  • You will be prescribed pain medications to keep you comfortable
  • You may be given a soft cervical collar to wear for comfort and pain relief for a couple of weeks
  • Incision site care instructions will be provided to keep the incision clean and dry
  • You may take a shower after 1 week if the incision is closed and well healed and not draining any fluid
  • You need to call your doctor if you notice any swelling, redness, drainage, or increased pain at the incision site
  • You will be instructed on sleeping posture, such as keeping the head of the bed elevated at 30 degrees with the use of pillows or by sleeping in a reclining chair
  • You will need to avoid driving for a couple of weeks due to lack of head movement
  • Walking activities are strongly encouraged to aid in recovery
  • No overhead activities or strenuous activities and no lifting more than 15 pounds to avoid strain on the healing vertebrae for the first 1 to 2 weeks
  • Follow-up appointments will be scheduled to monitor progress

Risks and Complications of Posterior Cervical Decompression

As with any surgical procedure, posterior cervical decompression involves potential risks and complications that may include:

  • Infection
  • Bleeding
  • Leakage of cerebrospinal fluid (CSF)
  • Spinal cord or nerve root injury
  • Blood clot in the lungs or legs
  • Spinal instability
  • Neck or arm pain
  • Further procedure

What is Posterior Cervical Fusion?

Posterior cervical fusion (PCF), a surgical procedure performed through the back of the neck, involves joining or fusing two or more damaged cervical vertebrae. The fusion of vertebrae is also known as arthrodesis. Sometimes, metallic plates may be used for fixing the vertebrae, this is also known as instrumentation.

Indications of Posterior Cervical Fusion

PCF may be employed for the management of cervical fractures, bone dislocations and deformities due to an abnormal curvature of the cervical vertebrae.

Posterior Cervical Fusion Procedure

The procedure is conducted in an operating room under general anesthesia. You will be made to lie face down on the operation table. A small incision is made over the center of the back of the neck. The muscles and the soft tissues are then retracted to approach the spine. X-ray imaging is employed to identify the affected intervertebral disc. The surfaces of the lamina of each vertebra to be fused are trimmed. This results in bleeding, which aids in rapid healing of the fused bones. In addition, small strips of bone graft taken from the pelvis are placed over the spinal column, which aids in the fusion of the bones.

Confirmatory X-rays may be taken to confirm the proper placement of the bone graft. Finally, the retracted muscles and soft tissues are placed in their normal positions and the wound is sutured.

Postoperative Care following Posterior Cervical Fusion

You may be discharged from the hospital within a week of the surgery. A neck brace is recommended for several months; however, this restriction may not be required if the vertebrae are fixed with a metal plate during the PCF surgery. You are initiated on a liquid diet, which is gradually changed to solid food depending on your recovery.

Physical therapy is recommended after 4-6 weeks of the surgery. Physical therapists help you perform routine activities without exerting any extra stress on the neck. Rest is advised as it helps in healing of the bone graft.

Risk and Complications of Posterior Cervical Fusion

Every major surgery is associated with potential complications. Some of the complications associated with posterior cervical fusion include:

  • Complications related to anesthesia
  • Thrombophlebitis (blood clot due to an inflammatory process)
  • Non-union or pseudarthrosis
  • Infection
  • Damage to the spinal nerves
  • Problem related to bone graft
  • Persistent pain