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.

Getting Ready

Before your surgery:

• Ask a family member or friend to drive you home when you are ready to leave the hospital. Do not drive yourself home.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• Ask your caregiver if you need to stop using aspirin, prescribed, or other over-the-counter medicine before your surgery.
  
  
• You may need to have blood tests before your surgery. A cervical spine x-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI) tests may be done. These imaging tests may be needed to look at your neck, vertebrae, and discs before your surgery. You also may need an electromyography test of your arms to check the function of your nerves. Ask your caregiver for more information about these and other tests you may need. Write down the date, time, and location of each test.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.

Treatment

What will happen:

• You will be taken to the room where your surgery will be done. You will be given general anesthesia medicine to help you fall, and stay asleep. Your caregiver may use traction weights and place supports under your neck to gently stretch your neck for surgery. Your caregiver may give you antibiotic medicine to prevent an infection by germs called bacteria. Fluoroscopy (special x-ray) may be used to find the right area on your neck for the incision (cut). A cut will be made on one side of your neck from the front to the 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. 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. When caregivers see that you are not having any problems, you may be taken back to your hospital room.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your surgery.
  
  
• Your voice becomes hoarse.
  
  
• You have new or worsening numbness or tingling in your arms or legs.

Seek Care Immediately if

• You begin leaking urine or stool, and it is not normal for you.
  
  
• You suddenly have trouble breathing.
  
  
• You are unable to move your neck.
  
  
• You are unable to move one or both of your arms.
  
  
• You are unable to move one or both of your legs.

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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.