Anterior Cervical Discectomy

WHAT YOU SHOULD KNOW:

• Anterior cervical discectomy (ACD) is surgery to remove one or more vertebral discs from your neck. A cervical disc is a sac filled with a gel-like material found between your vertebrae. Your vertebrae are the bones in your back that are linked together to form your spine. Your spine surrounds your spinal cord which contains your nerves. Your cervical discs and vertebrae are found in your neck. Your cervical vertebrae and discs help your spine support your head. Your discs allow your neck to make certain movements such as bending and turning. Your discs also help protect your spine from being damaged by movement.
  
  
• ACD is used to treat disc problems such as cervical disc herniation and spondylosis. Cervical disc herniation occurs when the gel-like material bulges out from between your vertebrae. The bulging disc may press on your nerves or spinal cord. Spondylosis occurs when your discs begin to degenerate (break down). The disc loses its height and may bulge into your spinal cord. Cervical disc problems may be very painful and decrease your neck and arm movement. You also may have numbness (loss of feeling) and tingling in your neck, arms, and legs.
  
  
• During ACD, your caregiver will remove one or more discs that are causing your symptoms. The discs may be replaced with a graft. The graft may be taken from your hip bone, or it may be a man-made graft. Bone pieces from a donor (another person) also may be used. Plates and screws may be used to keep your graft secure or to join your remaining vertebrae together. Having an ACD may decrease your symptoms such as pain and numbness. ACD also may prevent your nerves or spinal cord from being permanently damaged.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• During your surgery, you may bleed more then expected. Your nerves, spinal cord, blood vessels, or other tissues may be damaged during surgery. If the covering of you spinal cord is damaged, cerebrospinal fluid (CSF) may leak out. After surgery, you may have neck pain and swelling, bruising, and your wound may get infected. You may have a hoarse, rough voice and trouble swallowing. You may feel like you have something stuck in your throat and choke when trying to swallow. Your blood vessels may swell and you may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot may travel to your lungs or brain causing chest pain and trouble breathing, or a stroke. These problems can be life-threatening.
  
  
• If a bone graft was taken from your hip area, you may have hip pain. You also may have bruising and get an infection in your wound. The graft, plates, or screws used during your surgery may come loose. Your graft may collapse, break, or stick out into your spinal canal. The plates and screws also may become damaged and move into your spinal canal. You may need another surgery to fix these problems. Even with surgery, you may still have pressure on your nerves, and long-term neck problems.
  
  
• Without surgery, your neck and arm pain may worsen. Your arms and hands may always be numb. You also may have a constant burning or tingling in your arms and hands. Your discs may continue to break down and you may have trouble moving your neck and arms. You may begin to have trouble walking. You also may begin to leak urine or stool (bowel movements). Talk to your caregiver about any questions or concerns you have about your surgery, condition, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Antibiotics: Antibiotics may be given to help prevent an infection caused by germs called bacteria.
  
  
• Pre-op care: You will be taken to the room where your surgery will be done. Your caregiver may place supports under your neck and use special traction weights to gently stretch your neck.
  
  
• General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
  
  
• Nasogastric tube: A nasogastric (NG) tube may be put down your nose and into your stomach. An NG tube keeps air and fluid out of your stomach during surgery. The NG tube is usually taken out a short time after your surgery.

During your surgery:

• Fluoroscopy (special x-ray) may be used to find the right area on your neck for the incision (cut). A cut will then be made from the front of your neck to one side. Muscle and other tissues will be cut and secured out of the way to uncover your problem discs. A needle may then be inserted into your disc and an x-ray will be taken. The x-ray will show your caregiver if the needle is at the right disc level. Special pins are put into the discs above and below the one to be removed to open the disc space.
  
  
• Your disc will be removed along with any small bone pieces pushing on your nerves. Your graft will be put into the empty disc space, and the area may be filled in with bone chips. Screws and plates may be used to hold the disc securely in place and join your vertebrae together. Another x-ray may be done to show proper graft placement. The special pins will be removed, and your cuts will be closed with stitches. A bandage will be used to cover your wound (surgery site). The bandage will keep the area clean and dry and to help prevent infection.

After your surgery:

You will be taken to a room where you can rest until you are fully awake. Do not get out of bed until your caregiver says it is okay. A caregiver may remove your bandage soon after surgery to check your wound. When caregivers see that you are not having any problems, you may be taken back to your room.

• Cervical spine x-ray: A cervical spine x-ray may be done after your surgery to check your vertebrae. The x-ray is also done to check the placement of any grafts, plates, or screws used during surgery.
  
  
• Neck brace: You may need to wear a neck brace after your surgery. The brace will support your neck and hold it in the right position while you are healing.

Medicines:

You may be given the following medicines:

• Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait until the pain is very bad to ask for your pain medicine. The medicine may not work as well at controlling your pain if you wait too long to take it.
  
  
• Patient controlled analgesia: You may get pain medicine through an IV or an epidural line attached to a patient controlled analgesia (PCA) pump. Caregivers set the pump to let you give yourself small amounts of pain medicine when you push a button. Your pump may also give you a constant amount of medicine, in addition to the medicine that you give yourself. Let caregivers know if your pain is still bad even with the pain medicine.

Activity:

Caregivers may help you get out of bed to walk on the same day after your surgery, or the next day. Walking helps blood move through your body and may help prevent blood clots from forming. Call your caregiver before getting up for the first time. If you feel weak or dizzy while standing up, sit or lie down right away and call your caregiver.

Neurologic signs:

Neurologic signs are also called neuro signs, neuro checks, or neuro status. Caregivers check your eyes, your memory, and how easily you wake up. Your hand grasp and balance also may be tested. Neuro signs may help your caregiver check for any nerve or spinal cord damage after your surgery. You may need to have your neuro signs checked often. Your caregiver may even have to wake you up to check your neuro signs.

Physical therapy:

Your caregiver may have you start physical therapy before you leave the hospital. A physical therapist will help you with special exercises. These exercises help make your muscles stronger and may help decrease your pain.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.