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Cervical Discectomy & Fusion

What is a Cervical Discectomy & Fusion?

A cervical discectomy and fusion is a surgical procedure performed on the cervical (neck) region of the spine to help relieve pressure on nerves, and perhaps even the spinal cord itself. Over time, wear and tear, arthritis or an injury can damage the structures of the cervical spine resulting in pressure and irritation to nerves and nerve roots. This pressure can cause severe pain, discomfort, and numbness not only to the neck, but down the arms as well. During the operation, a small incision is made, usually in the front of the neck, and the surgeon removes the bony material or disc that is causing the problem. In most cases, the surgeon then fuses or joins together the affected vertebrae using bone graft or bone graft and a metal plate.

cervical disectomy

Who is a Candidate?

Frequent pain and/or numbness in the neck or down the arms will usually result in a visit to the doctor. A diseased or damaged disc in the neck is a common cause of this pain or numbness, and can happen for a number of reasons. Over time, a disc can wear and “flatten,” resulting in the vertebrae above and below the flattened disc to slide back and forth, or even touch. This can pinch or irritate the nerves causing pain and numbness. Another cause may be a sudden injury, resulting in a bulging out or herniating disc, causing pressure on the nerves and nerve roots. Bony growths (spurs) can also form, and further narrow the pathways through which the nerves must travel.

What are the Alternatives?

Surgery is usually the last option considered. If your symptoms are mild, you may not require any treatment at all. Other conservative treatments such as physical therapy, medications, and steroid injections may relieve symptoms for a time; however they usually do not permanently change the underlying cause of the problem. In some cases, cervical discectomy and fusion may be the only solution to remove irritation and create more space for the nerves.

How are Back & Neck Problems Evaluated?

Your doctor will use a number of approaches to evaluate and diagnose neck problems such as a herniated disc. These include:

A Detailed History – Your role in providing a detailed history is very important. Your doctor will need to know where and when it hurts, if 
there was a recent injury or fall, and a description of the pain. Are there positions or activities that make it feel worse? What makes it feel better? All of these details can help your doctor pinpoint the problem.

A Physical Exam – Once your history is given, a thorough exam by a spine expert is another important step in getting a good diagnosis.

Diagnostic Imaging – Xrays can show the structure and alignment of the vertebrae, as well as the presence and size of bone spurs or other bony abnormalities.

CT or “computerized tomography” – This is a special kind of xray machine. Rather than a single xray, a CT scanner sends out a number of beams at different angles. These images are then read by a computer, producing detailed cross-sections or “slices” that can show the shape and size of the spinal canal and the surrounding structures.

MRI or “magnetic resonance imaging” – MRI is probably the most utilized study for disc evaluation. MRI uses a powerful magnet and radio waves. The images produced are very helpful in visualizing the soft tissues such as the spinal cord, as well as the discs and nerve roots.

Bone Scans – These are useful in revealing certain abnormalities such as infections, fractures, tumors and arthritis. Because bone scans are unable to differentiate between these problems, they are usually performed in conjunction with other diagnostic tests.

How Long is the Hospital Stay?

The time spent in the hospital after a cervical discectomy and fusion depends on several factors including your overall health and the extent of your particular surgery. Some people may be able to return home the same day while others may spend one to two days in the hospital.

How Long Will it Take to Recover?

Recovery time after cervical disectomy and fusion varies depending on your particular situation, the number of levels involved, as well as your general health. The key to a successful recovery is maintaining a positive attitude. You will be able to take short walks while in the hospital, and need to gradually increase the distance and frequency of your walks once at home. If a fusion has been performed, it can take up to three months for the vertebrae to completely join together. During this time, you may need to wear a brace to protect the operation area. Your doctor will give you specific instructions on activity levels, including when you can resume driving and return to work.

Frequently Asked Questions (FAQs)

Cervical Laminectomy / Posterior Fusion and Laminoplasty

What is wrong with my neck?

You have a “pinched nerve.” This can be produced by a ruptured disc or by bone spurs. Discs are rubbery shock absorbers between the vertebrae, and are close to the nerves which travel down to the arms. If the disc is damaged, part of it may bulge or even burst free into the spinal canal, putting pressure on the nerve and causing arm pain, numbness, or weakness. Bone spurs, usually the result of arthritis, can also put pressure on nerves. Occasionally, pressure from bone spurs or a ruptured disc may affect the spinal cord and cause other abnormalities in the arms, legs or lower parts of the body.

What is required to fix the problem?

An incision is made in the posterior part of the neck. Muscles supporting the spine are pushed aside temporarily, and bone is removed/moved to open the spinal canal. The nervous structures are protected, while the nerve/spinal cord are freed of pressure from the discs and/or bone spur. If bone spurs and arthritis are the cause of your problem, you may require a bigger incision and more bone may have to be removed. In the case of laminectomy most of the time a fusion must also be performed.

What is spinal fusion? When is this operation necessary?

A fusion is the formation of a bony bridge between at least two bones, in this case two vertebrae in your spine. The vertebrae are the blocks of bone which make up the spinal column, much like building blocks stacked on top of each other to make a tower. Normally each vertebrae moves within certain limits in relationship to its neighbors. In spinal disease, this movement may become abnormal and/or painful, or the vertebrae may become unstable and misaligned, putting pressure on the spinal nerves and/or spinal cord. In cases like this, surgeons try to stabilize the vertebrae using pieces of bone, which we call bone graft. The bone graft may be obtained either from the patient himself, usually from the pelvis, or from a bone bank. There are advantages and disadvantages to either source. The bone graft is laid between the vertebrae. The bone graft has to heal and unite to the adjacent bones before the fusion becomes solid. Spine surgeons often use rods to protect the bone graft and immobilize this area during the healing period, attaching them to the spine using screws.

In most cases, the major indication for spine surgery is pain. Weakness, numbness, clumsiness, and gait instability may also be an indication for surgery. Often nonsurgical measures can control the pain satisfactorily. If the pain persists and interferes with daily activities or if other neurological problems develop, then surgery may be necessary to relieve the problem. In most cases, the patient makes the final decision about surgery because of pain. If neurological damage is occurring, your doctors may strongly recommend that you proceed with the operation.

Who performs this surgery? When is this operation necessary?

Both orthopedic surgeons and neurosurgeons are trained in spinal surgery and both specialists may perform this surgery. It is important that your surgeon specialize in this type of procedure. In most cases, the major indication for spine surgery is pain. Weakness, numbness, clumsiness, and gait instability may also be an indication for surgery. Often nonsurgical measures can control the pain satisfactorily. If the pain persists and interferes with daily activities or if other neurological problems develop, then surgery may be necessary to relieve the problem. In most cases, the patient makes the final decision about surgery because of pain. If neurological damage is occurring, your doctors may strongly recommend that you proceed with the operation.

How long will I be in the hospital? When can I go back to work?

Most patients stay 2-3 days. Complications may require longer stays.

Going back to work depends on the type of work you do. If a brace is required, you will not be able to drive until you no longer need the brace. For sedentary jobs, work may resume when you feel comfortable and can get to work. For jobs which require more strenuous physical exertion, a longer healing time may be required. Your surgeon will discuss this with you individually.

Will I need a blood transfusion? Will I need to wear a neck brace?

Some blood loss is expected with this operation, but the need for transfusions is rare.

Most patients will wear some type of neck brace after this surgery. The type of brace and length of time you need to wear the brace will be determined by your surgeon.

What can I do after surgery? What shouldn't I do after surgery?

Please refer to the Cervical Fusion Discharge Instructions for details. You should try to walk and take care of yourself as much as you are able to. You should try to exercise each day. You may perform other low-impact activities not requiring lifting or neck movement as allowed by your brace. If a brace is not required, you may drive when allowed by your surgeon.

You should avoid lifting heavy objects, avoid all overhead lifting. Avoid twisting, repetitive bending and tilting your head back to look overhead are also stressful to the neck. If you are a smoker, you definitely should not smoke until your fusion is completely solid. Smoking interferes with bone healing and fusion.

Will my neck be normal after surgery? What are my chances of being relieved of my pain?

Even if you have excellent relief of pain, your neck will not be completely normal. However, most people can resume almost all of their normal activities after disc surgery. People who do heavy work generally take longer to recover and may not be able to do everything they could do before their injury.

Most patients get relief from their nerve symptoms or arm pain. Neck and shoulder pain are less predictably relieved by surgery. Up to 15 percent of patients may have some neck and shoulder aching after surgery; this percentage may be higher in patients who have a substantial amount of neck and shoulder pain before surgery. Other conditions such as fibromyalgia may also produce continued pain even after successful surgery.

Could I be paralyzed? What other risks are there?

The chances of neurological injury are very low, and the possibility of catastrophic injury such as paralysis, is highly unlikely, though not impossible. Injury to a nerve root with isolated numbness and/or weakness in the arm is possible.

There are general risks with any type of surgery. These include, but are not limited to, the possibility of wound infection, uncontrollable bleeding, collection of blood clots in the wound or in the veins of the leg, dural tear, pulmonary embolism (movement of a blood clot to the lung), heart attack, stroke, death, recurrent/persistent symptoms and failure of fusion. The chances of any of these events happening, particularly to a generally healthy patient, are low.

Could this ever happen to me again? Should I avoid vigorous physical activity?

Unfortunately, yes. The underlying problem that led to surgery cannot be cured. (arthritis, bone spur formation, disc degeneration). These processes may continue leading to possible recurrence in the future. Adjacent discs may be or may become abnormal too, and could cause symptoms in the future.

Exercise is good for you. You should get some sort of low-impact aerobic exercise at least 3 times a week. Walking either outside or on a treadmill and using an exercise bike are all examples of the type of exercise which is appropriate for spine patients.

Anterior Cervical Fusion

What is wrong with my neck?

You have one or more damaged discs in your neck. Discs are rubbery shock absorbers between the vertebrae, and are close to the nerves which travel out to the arms. If the disc is damaged, part of it may bulge or even burst free into the spinal canal, putting pressure on the nerves and causing arm pain, numbness, weakness and/or pain in the neck or shoulder area. Occasionally, this pressure may affect the spinal cord and cause other abnormalities in the arms, legs or lower parts of the body. Bone spurs, usually the result of arthritis, can also put pressure on nerves or the spinal cord. Loss of the normal “shock absorber” function, or arthritis around the damaged disc, can also produce mechanical pain around the neck or shoulders with neck movement or awkward positions.

What is required to fix the problem?<

Sometimes the best approach to your problem is to remove the damaged disc and bone spurs from the front, or anterior part, of the neck and to perform a fusion between the adjacent vertebral bodies. Certain conditions, however, require the surgeon to perform the fusion using a posterior approach instead.

What is spinal fusion?

A fusion is the formation of a bony bridge between at least two bones, in this case two vertebrae in your spine. The vertebrae are the blocks of bone which make up the spinal column, much like building blocks stacked on top of each other to make a tower. Normally each vertebrae moves within certain limits in relationship to its neighbors. In spinal disease, the movement may become abnormal and/or painful, or the vertebrae may become unstable and misaligned, putting pressure on the spinal nerves and/or spinal cord. In cases like this, surgeons try to stabilize the vertebrae using pieces of bone, which we call bone graft. The bone graft may be obtained either from the patient himself, usually from the pelvis, or from a bone bank. There are advantages and disadvantages to either source. The bone graft is laid between the vertebrae. The bone graft has to heal and unite to the adjacent bones before the fusion becomes solid. Spine surgeons often use rods to protect the bone graft and immobilize this area during the healing period, attaching them to the spine using screws.

Who performs this surgery? How is the operation performed?

Both orthopedic surgeons and neurosurgeons are trained to do spinal surgery. It is important that your surgeon specialize in this type of procedure. An incision, usually about two to three inches in length, is made across the front of the neck. The windpipe, esophagus (food pipe) and other tissues are temporarily pushed aside and the abnormal disc or discs are removed completely. If your own bone is to be used for the fusion, another small incision is made over the front of the pelvis and one or more small bone grafts are removed to replace the disc or discs. In most cases this bone will heal or “fuse” to the vertebrae above and below it within six to nine months, creating a solid bony bridge between the two vertebrae and eliminating movement between them. Internal plates and screws are often used to improve stability and conditions for bone healing.

When is the operation necessary?

In most cases, the major indication for spine surgery is pain. Weakness, numbness, clumsiness, and gait instability may also be an indication for surgery. Often nonsurgical measures can control the pain satisfactorily. If the pain persists and interferes with daily activities or if other neurological problems develop, then surgery may be necessary to relieve the problem. In most cases, the patient makes the final decision about surgery because of pain. If neurological damage is occurring, your doctors may strongly recommend that you proceed with the operation.

How long will I be in the hospital? Will I need a blood transfusion?

Most patients leave in 24 hours; however, anterior/posterior cervical fusion patients may be in the hospital for 2-3 days.

Rarely do we need to give a transfusion. Only in rare tumor or unusual reconstruction cases will a transfusion be needed.

What can I do after surgery? What shouldn't I do after surgery?

Please refer to the Cervical Fusion Discharge Instructions for details. You should try to walk and take care of yourself as much as you are able to. You should try to exercise each day. You may perform other low-impact activities not requiring lifting or neck movement as allowed by your brace. If a brace is not required, you may drive when allowed by your surgeon.

You should avoid lifting heavy objects, and avoid all overhead lifting. Avoid twisting, repetitive bending and tilting your head back to look overhead as these are also stressful to the neck. If you are a smoker, you definitely should not smoke until your fusion is completely solid. Smoking interferes with bone healing.

When can I go back to work? Will I need to wear a neck brace?

That depends on the type of work you do. If a brace is required, you will not be able to drive until you no longer need the brace. For sedentary jobs, work may resume when you feel comfortable and can get to work. For jobs which require more strenuous physical exertion, a longer healing time may be required. Your surgeon will discuss this with you individually.

Most patients will wear some type of neck brace after this surgery. The type of brace and length of time you need to wear the brace will be determined by your surgeon.

Will my neck be normal after surgery? What are the chances of being relieved of the pain?

No. While most patients have excellent relief of arm pain after surgery, your neck will not be completely normal. While most patients with a one or two-level surgeries will not notice significant loss of motion, the stiffened segment of your spine does put additional stresses on adjacent discs, which may already be abnormal to some extent. These other discs may cause symptoms. Although most patients can resume most of their normal activities after healing, you should take care of your neck. Your surgeon can discuss this with you in detail.

80-95 percent of the patients obtain relief from their arm pain. Relief of neck pain is less predictable, usually in the range of 65-75 percent.

Could I be paralyzed? What other risks are there?

The chance of neurological injury with spinal surgery is low, but not impossible. Injury to a nerve root with isolated numbness and/or weakness in the arm is possible. Less than one in 1,000 cases may result in paralysis, either complete or partial.

The risks of this operation include, but are not limited to, anesthesia, wound infection, uncontrollable bleeding, collection of blood clots in the wound or in the veins of the leg, dural tear, pulmonary embolism (movement of a blood clot to the lungs), failure of fusion, persistent/recurrent symptoms, injury to nearby structures like the esophagus, arteries and veins, and heart attack. The chances of these complications occurring are 2-3 percent of the cases. Death may rarely occur during or after any surgical procedure.

Could I have difficulty swallowing? Will my voice be affected?

Most patients report mild discomfort with swallowing for a few days after surgery. Occasionally, swallowing difficulties may be more significant and last for longer periods of time. Rarely, it may be necessary to place a feeding tube while swallowing returns to normal. If swallowing difficulty persists longer, notify your physician.

Some patients may be hoarse after anterior cervical spine surgery. Usually this goes away within a few days or weeks. Rarely, the hoarseness may be persistent for a longer period of time or even be permanent.

Is the entire disk removed? Could this happen to me again?

Yes. And unfortunately, yes. Similar conditions which led to the disc damage being treated now may have already started in one or more of the other discs, in your neck. A small percentage of fusions do not heal normally, which may require additional surgery. The chance of this happening increases if fusion is attempted at more than one level, which is why spine plates are sometimes used for multi-level fusions. Over 90 percent of patients do well. Less than 10 percent have some recurring problems.

Should I avoid physical activity?

No. Exercise is good for you. You should get some sort of vigorous, low-impact aerobic exercise at least three times a week. Walking either outside or on a treadmill, using an exercise bike, and swimming are all examples of the type of exercise which is appropriate for spine patients.

Contact Us

Make an appointment with our Spine Care Coordinator to learn more about our patient-centered process for back surgery or to schedule a tour.

Dave Smith, Spine Care Coordinator
815.748.2968

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