SPINAL SURGERY

in Hull and East Yorkshire

GEORGE SPINK FRCS (Neurosurg.) BSc Hons

 

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ANTERIOR CERVICAL DISCECTOMY

Patients with a disc prolapse or degenerative ‘wear and tear’ changes in the neck will usually have either arm pain (brachalgia) due to nerve root compression or worsening fine hand function (myelopathy) due spinal cord compression.

Depending on the appearance of the scans it may be necessary to consider anterior cervical surgery to remove the ruptured disc and decompress the spinal cord or nerve roots.

For patients with brachalgia the arm pain will usually improve after surgery. Patients with a myelopathy may see some improvement, but in many cases the aim of surgery is to prevent further deterioration and preserve the remaining function.


The risks of the operation include:

            Wound infection (2%)

            Spinal fluid leak (1%)

            Blood clot at operation site requiring re-operation (1%)

Nerve root injury resulting in worsening arm pain, numbness, weakness or paralysis (1%)

            Spinal cord injury resulting in arm / leg weakness or paralysis (1 in 2000)

Hoarse voice due to injury to the nerve to the voice box (temporary in 5%; permanent in 1%)

No improvement in symptoms (10% of patients with arm pain; variable in Myelopathic patients)

            Difficulty with swallowing (temporary in 5%, permanent in <1%)

            Risk of spinal instability requiring further surgery (1%)

            General anaesthetic risks, including a small risk to life


The operation is carried out under general anaesthetic and lasts approximately 45 minutes. It involves making a cut on the right side of the neck (regardless of the side the patient has symptoms on).  Once the discectomy has been completed most patients will have a fusion block or cervical cage placed. A few patients may benefit from a joint replacement or arthroplasty instead of a fusion. As a relatively new technique cervical arthroplasty (ACDA) has guidance on its use published by NICE (National Institute of Clinical Excellence), please click here for further details.

 CERVICAL CAGE (SOLIS)

 CERVICAL ARTHROPLASTY (DISCOCERV)

The wound is closed using a cosmetically sensitive technique with dissolving stitches so there are no clips to be removed. After the operation the patient will have a drain in the wound for 24 hours (this is removed on the ward), and will have a postoperative x-ray. Most patients will go home the next day and will be recovering at home for another 4-6 weeks. Following surgery the patient may notice some neck pain and stiffness but this should settle with simple anti-inflammatory medication, such as Neurofen. Some patients will develop tingling in the arm after surgery. This is due to swelling in the nerve following manipulation at surgery. It is temporary and will settle down after a few days.

Patients do not usually need to wear a neck collar or support. A specialist physiotherapist will advice each patient on a postoperative exercise regime, to encourage neck movements, rather than restrict them with a collar.