12 Walter Street, North Adelaide South Australia 5006
P: (08) 8239-1889
F: (08) 8239-2203
E: admin@orsoosti.com

For all appointments during working hours
please ring

(08) 8239 1889


Parking is available in Ward Street or Archer Street (North Adelaide Shopping Centre)


< Back to Procedure Information

Anterior Cervical Decompression and Stabilisation

INTRODUCTION

As in the lower back, the spinal joints of the cervical spine (the neck) are vulnerable to degeneration and this may involve both the disc and the facet joints.

The wear and tear process may lead to compression of the neural structures including the spinal cord and the individual nerve roots.

In the presence of compression of one or more nerve roots the patient may experience pain radiating to the shoulder, the arm and the hand.

The pain can be associated with numbness and weakness which, according to the level of compression, may affect one or more fingers and/or areas of the arm and the forearm.

The pain may be exacerbated by neck movement and/or stretching of the arm.

As for sciatica due to lumbar disc prolapse, most patients experiencing disabling arm pain from nerve compression in the cervical spine are likely to improve spontaneously within weeks without need for aggressive intervention.

In the presence of persisting disabling shoulder and arm pain proven by imaging to be linked to mechanical compression of the neural structures, surgery may become indicated.





SURGICAL TECHNIQUE

The surgery is generally carried out from the front of the neck to avoid possible trauma to the spinal cord.

The cervical discs and vertebrae are exposed using a transverse incision over the anterior aspect of the neck which generally heals quite well with no significant cosmetic disfigurement. (Fig1.)


The disc/s and/or bony spurs causing compression to the spinal cord and the nerves are removed by the Surgeon and following thorough decompression, the spine is stabilised using one disc implant (either metallic or made of carbon fibre composite) which replace the worn intervertebral disc with or without a thin metal plate linking the vertebrae together to avoid anterior displacement of the cage. (Fig 2.)



In the past, following removal of the disc, the Surgeon would have used bone, generally from the patient’s hip, to achieve solid union between the vertebrae and to avoid instability which may lead to increased neck pain.

By using disc implants with or without additional metal plates, it is possible currently to perform the operation without need for harvesting bone from the hip and/or other parts of the patient’s body.

This avoids a possible extra source of pain after the operation.
The purpose of the instrumentation, as in the lumbar area, is to re-establish the normal alignment of the spine and avoid narrowing of the space between the vertebrae which may affect the bony tunnels for the nerves.

The implants used during the surgery are left permanently and do not wear or lead to any changes in the state of the tissues surrounding them.

The patient’s own bone grows into the disc implant and the healing process is generally completed by six months.

POST-OPERATIVE COURSE

Following the surgery, the patient is allowed to mobilise the day after the operation using a soft collar.

Patients are encouraged to drink and eat, as tolerated, the morning after the operation.

Most patients may be able to be discharged from hospital within three days of the surgery as neck operations tend to be in general less painful than lower back surgery.

Patients should be able to be independent after a day or two, although may not be able to drive a car for approximately two weeks.

They should also avoid any overhead activities and/or prolonged forward bending for a period of approximately four weeks after the surgery.

It is appropriate for patients recovering from cervical spine surgery to avoid contact sport and/or activities associated with the risk of blows to the head and/or acceleration/deceleration injuries to the cervical spine for a period of at least six weeks.

COMPLICATIONS

Following the surgery, patients may experience swallowing and/or speaking difficulties linked to stretching of the oesophagus and/or trachea at the time of the surgery.

One of the possible complications of anterior cervical spine surgery is damage to the recurrent laryngeal nerve with subsequent development of a “husky voice”.

This is an uncommon complication although well described and more frequent in individuals with previous neck surgery.

Other possible complications may include bleeding, infection and nerve damage which in serious and rare cases, may lead to quadriplegia.

The overall results of neck surgery are, however, highly satisfactory for individuals with disabling neck and arm pain linked to proven compression of the neural structures.

The possibility of complications is low, although it increases in the presence of previous neck surgery, Diabetes, Rheumatoid Arthritis, Obesity and Cancer.

The risk of the operation should be justified by the severity of the patient’s symptoms prior to the operation and/or the possibility of spontaneous neurological deterioration.

 




< Back to Procedure Information