Cervical Discectomy
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Key Takeaways
- A cervical discectomy is a surgical procedure to treat a damaged intervertebral disc in the cervical spine, located in the neck.
- A cervical discectomy is typically recommended only when nonsurgical treatment cannot relieve symptoms, such as severe neck pain.
- Anterior cervical discectomy and fusion (ACDF) is the most common cervical discectomy procedure, where surgery is performed from the front of the neck.
- You will need to limit neck movements after surgery to minimise the risk of developing chronic neck pain. Physiotherapy and medication may help with your recovery phase.
What is a Cervical Discectomy?
A cervical discectomy is a surgical procedure that involves treating damage to the intervertebral discs in your cervical spine, located in your neck. It may involve the complete removal of a herniated disc or bone spurs that are putting pressure on your spinal nerves. This is then followed by replacing the removed portion with a bone graft or an implant cage. It is typically performed to help relieve pain, discomfort, stiffness, and other complications affecting the neck and arms.
The cervical spine consists of the first seven vertebrae in your spinal column. These vertebrae are important for supporting your head and allowing it to make side-to-side, rotatory and forward flexion and extension movements. They also protect the spinal cord and arteries that supply blood to the brain. There are also structures such as muscles and ligaments attached to the cervical spine to support the movements of your head, neck, shoulders, and arms.
Why is a Cervical Discectomy Performed?
Gradual degeneration, injury, or disease affecting the intervertebral discs can potentially cause issues in your cervical spine. One concerning condition is when the disc’s soft inner part, the nucleus, leaks out and presses onto a nearby spinal nerve. This can cause significant pain and discomfort that may radiate to other areas, such as your arms or shoulders. In some cases, the disc may need to be removed entirely to treat your symptoms. Symptoms may include severe neck pain, reduced range of motion, and persistent stiffness.
The cervical discectomy involves surgically removing the affected disc. Once it is removed, a spinal fusion is performed, where bone grafts are taken from your body (autograft) or a donor (allograft) to stabilise the spine. Over time, the vertebrae will heal together and form a single, solid bone. Bone spurs and other fragments may also be removed during the treatment process, if necessary.
Conservative (nonsurgical) treatment is typically recommended as the first approach for treating your condition. If nonsurgical methods are unable to provide significant symptom relief, then your doctor will discuss cervical discectomy as an option.
Essential Considerations for Cervical Discectomy
Before undergoing a cervical discectomy, your doctor will explain what to expect before, during, and after the procedure.
Recovery Outcomes for Cervical Discectomy
The most common surgical method of cervical discectomy is called anterior cervical discectomy and fusion (ACDF). The procedure involves performing the surgery on the front of the neck, which is known as an anterior approach. If a structural issue in the neck could interfere with surgery, then a posterior approach — from the back of the neck — may be performed instead. The procedure is considered minimally invasive, as only a small incision is needed to access the damaged intervertebral disc.
After the surgery, you may be monitored for some time to ensure the surgery went smoothly. Additional physical examinations may be conducted to assess your neck’s mobility and flexibility post-surgery. Your doctor will then schedule follow-up appointments to monitor your progress, which may include a review of your recovery plan. It typically takes several months to make a full recovery, depending on factors such as your general health, age, and more.
Risk Factors for Cervical Discectomy
Cervical discectomy does carry potential risks, and your doctor will share this information to help you make an informed decision about the surgery. Take the time to understand these risks and ask questions to clarify any concerns or doubts you may have. Some potential risk factors include:
- Blood clots, such as deep vein thrombosis
- Bleeding
- Infection
- Mild or persistent weakness in your arms or legs
- Difficulty speaking or swallowing
- Recurring symptoms affecting the cervical spine
- Additional symptoms that may require additional treatment
Preparing for Cervical Discectomy
During the initial consultation, your doctor will thoroughly review your medical history and ask questions to better understand your condition and diagnose your symptoms. Diagnostic tests may be carried out to confirm the diagnosis, determine your cervical spine’s condition, and ensure you are a suitable candidate for cervical discectomy. Your doctor will explain the surgical procedure and guide you through the surgery. You are encouraged to ask them questions to help you understand the procedure and manage your expectations.
Before Cervical Discectomy
Your doctor will explain what you can expect from the cervical discectomy. Here are several key points to consider before your surgery.
- Current health: Certain medical conditions may increase the risk of complications after surgery. A comprehensive health screening helps your doctor plan your surgery. If you are currently on any medications, especially blood thinners, you may need to switch to other alternatives or stop taking them temporarily.
- Illness: Notify your doctor if you are feeling unwell on the day of your surgery, and they may postpone your surgery to minimise the risk of harmful side effects.
- Fasting: You may be required to avoid food and drink for 6 hours before surgery. However, you should continue to stay hydrated with small sips of water during that time.
- Health evaluations: If you have any upcoming dental or urinary procedures, rescheduling them may help reduce the risk of infection.
- Post-surgery support: After your discharge, you should have a family member or close friend around to help with daily activities or accompany you when going out.
- Lifestyle changes: Avoiding smoking, reducing alcohol intake, staying active, and attending follow-up appointments are essential to ensuring your recovery goes well.
On the day of surgery, a final medical check and an anaesthesia review will be conducted. You will then change into a surgical gown and wait for the procedure to begin.
During Cervical Discectomy
You will be placed under general anaesthesia before surgery begins. Once you are anaesthetised, your surgeon will carefully make an incision at the front of the neck, typically in a location where the scar is not easily noticeable. If your doctor recommends a posterior cervical discectomy instead, the incision will be made along the back of your neck. The surgeon will then carefully move nearby blood vessels, the oesophagus, and the windpipe (trachea) aside to access the cervical spine and prevent unwanted complications due to accidental damage to these structures during surgery.
To reach the damaged or herniated disc, the surgeon may need to partially cut several ligaments that are in the way. With a clear view of the disc, the surgeon will carefully remove it and any bone fragments, scar tissue, or debris that could impinge on the nerves or cause other complications. A spacer will be inserted to replace the disc, and the space between the vertebrae will be filled with bone grafts.
The surgeon may use plates, screws, or rods to hold the vertebrae together and allow the bone to fuse, stabilising the cervical spine. They will then examine your cervical spine again to ensure the surgery proceeded smoothly. Once the blood vessels, oesophagus, and trachea are moved back into position, the incisions will be closed with stitches. You will then be transferred to the recovery room for observation before returning to the ward.
After Cervical Discectomy
Depending on your recovery post-surgery, you may need to be monitored for a few days to ensure there are no signs of complications. If your doctor believes your recovery is going well, you may be allowed an early discharge. They will also share helpful tips to support your recovery at home, including how to care for your cervical spine.
Caring for your surgical wound, keeping it clean, and being careful as you move around will also support your recovery. Pain medications may be prescribed if you experience any discomfort after surgery. You will also be taught how to use a soft cervical collar or a neck brace to support your neck and head while you recover. Furthermore, you may have to be careful with how you move your head and neck to minimise complications.
The bone graft placed in your cervical spine may take several months to grow and stabilise the spine. Your recovery phase could take anywhere from several weeks to months and will depend on various factors, including your age, general health, and other factors.
It is important that you follow your doctor’s postoperative care instructions to facilitate a smooth recovery with minimal complications.
- Start with light activity as recommended by your doctor. As you slowly regain your strength, you can slowly increase your activity level.
- Avoid strenuous physical activities, including lifting heavy objects, that could put pressure on your neck, shoulders, and arms.
- Try to minimise head and neck movements to prevent straining your cervical spine. Avoid overexerting yourself to reduce the risk of injury to the fused bone.
- Avoid sitting down in a hunched position for too long, as it may strain your cervical spine.
- Attend physical therapy sessions to support your recovery. Your physiotherapist will help you with an exercise regimen featuring targeted exercises to strengthen your cervical spine and gradually improve your neck’s range of motion and flexibility.
- Take your prescribed medications at the specified times and recommended dosage. If you experience any sudden side effects, stop taking the medications and notify your doctor immediately.
- When wearing a neck brace, ensure that you wear it as instructed by your doctor. In most cases, you will need to wear it for several weeks after the surgery.
- Have someone who can help support you with your recovery, especially when moving around or performing your daily activities.
- Practice healthy lifestyle habits to reduce the pressure or strain on your cervical spine. This may include managing your weight, eating well-balanced diets, and avoiding smoking or alcohol consumption.
Frequently Asked Questions
You should speak to your doctor about whether you can resume driving. Ideally, you should avoid driving for a few weeks to reduce the risk of excessive strain on your cervical spine, which could cause unwanted complications.
Physical therapy typically starts between six weeks to three months after surgery, depending on the overall recovery of your cervical spine.
During the first few weeks after surgery, you may need to rest and recuperate at home. Some short walks with a family member or friend can be beneficial for your recovery. Once it is safe to resume light activities, your physiotherapist will guide you through your exercise regimen. Be careful not to overexert your neck during activities to minimise the risk of complications.
Related Treatments
Anterior Cervical Diskectomy and Fusion (ACDF) is a spine surgery that removes a damaged or herniated cervical disc to relieve nerve compression, then inserts a bone graft to fuse the affected vertebrae and stabilise the neck.
Cervical spine fusion is a surgical procedure to treat conditions affecting the vertebrae in your cervical spine. The procedure involves fusing two vertebrae to form a single, solid bone, thereby treating damage to the vertebrae and supporting the stability and flexibility of the cervical spine. Cervical spine fusion can be performed using several approaches, informed by the nature of the injury or degeneration. Recovery typically takes between six months and a year for the fused bone to solidify. Proper care is necessary to facilitate recovery and minimise the risk of complications.
