Cervical Decompression & Fusion

Depending on the level involved you will have the disc removed from the front of the neck. At the back of the disc the spinal cord and the nerves will be freed surgically. Into this disc space we will then put a cage filled with bone graft that we will harvest from your iliac crest (the bone that forms part of your waistline). To make sure this bone graft stays in place and does not slip we may put a titanium plate in front of the 2 bones to lock the bone graft in. We do not always need to do this. The metalwork stays in place. The operation is performed through the front of your neck and you will usually have a transverse scar, this usually is in the crease of your neck. There are vital structures in the neck which need to be dissected to access the front part of your neck.

The bone graft will be harvested using a separate incision over your iliac crest.

If we are operating on only one level the operation usually takes about 1 hour. If we are operating on 2 levels the operation can take longer.

After you have been advised that surgery will be helpful for you, you will be invited to come to the spinal assessment clinic for an education session where the details of the operation and the post operative rehabilitation program will be discussed with you. Please bring a relative or friend along to this meeting so that they remember any points you may forget.

About 2 weeks prior to surgery you will be invited to come to the pre-assessment clinic, where the Nurse Practitioner will take all your blood samples and arrange a tracing of your heart (ECG) and also give you a basic medical check. If your symptoms change between the time you are listed for surgery and the operation itself please do let us know. If for example all your pain disappears then you may not need surgery.

Post surgical recovery

Following the operation you will be quite sleepy for the first few hours.

You will wake up with a drain in your neck, this will be removed the following day.

The next morning on the ward round we will get you to walk. This can be quite difficult because the bone graft site is painful and some patients often complain that the bone graft site is more painful than their neck.

Your walking will gradually improve and depending on how well you do, some people can go home after about 1-3 days following surgery.

After you will go home you will have regular wound checks to make sure you do not have a wound infection. If you do then you will need to call us straight away. This may be present as redness, heat and swelling.

Two weeks after surgery you will be seen in the out patient clinic by the surgeons and further follow-ups. Your follow-up period will be a total of about 2 years and you will be asked to fill in questionnaires on a regular basis so that we get a detailed idea of how you are getting on.

Risk of surgery

There are risks of surgery that you need to understand and accept before making your decision to proceed with surgery. Anterior cervical spine decompression and fusion is routinely done and most often quite a safe operation.

There is a small risk of developing a blood clot in the legs, this is called a thrombosis. You will wear special stocking on your legs to try and reduce this risk. We do not regularly use drugs for this, unless you have had blood clots before.

Rarely however there are catastrophic complications and these are always possible. It is similar to the risk of dying in a car crash every time one drives a car.

You could die from an anaesthetic or have a stroke during surgery. Because the spinal cord is so close to the operating site it could be damaged during surgery and you could be paralysed or have weakness from the neck downwards. These complications are rare.

One of the nerves that supply your vocal cords could be injured and you may have a hoarse voice after surgery, this usually recovers within about 3 months, and rarely never does. You will have some difficulty swallowing after surgery, but this should settle within a few days. The pain from the bone graft site usually settles in about 4-6 weeks, but in a minority of patients it persists and needs further treatment.

There are very important blood vessels in the neck and very rarely these could be damaged during surgery and cause significant problems. This is rare.

The risk of a wound infection is between 1% and may require further surgery to sort it out if it does happen. The other uncommon possibility is that your swallowing may be affected long term. In some cases this is because of the pressure of the plate, but in other instances the cause cannot be determined, but this usually settles on it own.

X-ray control is used throughout the procedure so if at all there is a chance or that you know that you are pregnant please let us know. This is very important.

Benefits of surgery

There is an 80% chance that surgery will help your arm symptoms and about a 70% chance that it will help your neck symptoms. This does however mean that there is a chance that your symptoms may continue as they are.

If you have a major complication you could be worse off than you are now. You need to understand and accept this before agreeing to proceed with surgery. A discussion should have taken place to put all the various risks in perspective and so you will have a clear understanding of the possible problems that lie ahead.

Recovery from surgery

Recovery from surgery can continue up to 12 months. This means that although you may experience a lot of the benefits of surgery straight away you will still continue to have some improvement in your symptoms up to 12 months later.

Post operative pain relief

Following surgery you will have a patients controlled analgesia system a PCA. In this you press a button and a machine automatically delivers painkillers into your blood stream. This means that you have control over the amount of painkillers you get and when you get it. It is computer controlled so you are unable to overdose.

Preparing for surgery

You must exercise regularly and keep fit and well prior to surgery. This reduces the rate of any complications. You have to stop taking any Aspirin and anti-inflammatory drugs, eg Brufen at 10 days prior to surgery because they can result in excessive bleeding during the operation.

If you are taking any drugs like Warfarin which can increase bleeding during surgery you need to let us know so we can make provision.

If you think you may be pregnant, it is very important to tell us, because we use x-rays during surgery.

If you are allergic to any drugs or dressings, it is important to tell us.

If you are on the oral contraceptive pill please talk to us because it does increase the risk of blood clot in the leg and we may advise you to stop taking it about 3-4 weeks prior to surgery.

You must stop smoking about 3 months before surgery and up to 6 months afterwards. Surgery is known to reduce the rate of bony fusion and also has a role to play in developing chronic neck pain.

Smoking also increases the risk of you getting a lung infection after surgery.

It is also important you be relaxed and have a positive attitude to recovery. The more motivated and strong willed you are the better and faster will be your recovery after surgery.

Rehabilitation

After neck surgery you should avoid driving the car for about 2 weeks. The surgery will result in only a slight restriction of neck movements if the fusion is restricted to one or two levels. In fact some people report an increase in their range of neck movements.

You should be able to return to work after about 4-6 weeks doing gentle activities and perform properly at about 3 months. After surgery you should try and reduce the amount of painkillers you use. It is quite common to have developed some form of addiction to taking the painkillers because you have been taking them for so long. This may be habitual or caused by the drugs themselves. It is important to recognise this and try and gradually reduce the amount of painkillers you require. You may experience some mood swings in the first few weeks following surgery and this is quite normal and only a temporary phenomenon.

You can speak to patients who have had this surgery done before- ask us to introduce you to patients from the support group.