Anterior cervical discectomy and arthroplasty
Anterior cervical discectomy and arthroplasty (PP code V2282)
Patients with a disc prolapse or degenerative ‘wear and tear’ changes in the neck will often have arm pain (brachalgia) due to nerve root compression. Depending on the appearance of the scans and the severity of the symptoms it may be necessary to consider anterior neck surgery to remove the ruptured disc and decompress the spinal cord or nerve roots. The results of surgery are generally good. For patients with brachalgia the arm pain will usually improve after surgery. Modern technology means that in certain circumstances joint replacement technology (arthroplasty) can now be considered. The National Institute for Clinical Excellence (NICE) publishes guidelines on when these operations can be considered.
The risks of surgery include:
- infection
- bleeding
- spinal fluid leak
- DVT/PE (clots in legs / lungs)
- scar tissue
- reoperation
- recurrent symptoms
- accelerated degeneration
- implant failure
- nerve root injury
- spinal cord injury
- pain, numbness
- weakness, paralysis
- incontinence, impotence
- hoarse voice
- soreness on swallowing
- airway obstruction
- general anaesthetic complications (heart attack, stroke)
The operation is carried out under a general anaesthetic and lasts approximately 45 minutes. It involves making a small incision on the right side of the neck (regardless of the side the patient has symptoms on). Once the discectomy has been completed and the spinal cord / nerve roots decompressed an artificial joint is placed under x-ray guidance.
The wound is closed usually using a cosmetically sensitive technique with dissolvable 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 before discharge). Most patients will go home the next day and will be recovering at home for approximately 4 weeks. Following surgery the patient may notice some neck pain and stiffness but this should settle with simple anti-inflammatory medication such as ibuprofen. Some patients will develop tingling in the arms after surgery due to swelling around the nerves at the site of the operation. This is temporary and will usually settle down after a few days.
Patients do not usually need to wear a neck collar or support. Specialist spinal physiotherapists will advice each patient on a postoperative exercise regime, to encourage neck movements. Further outpatient physiotherapy sessions will be offered, where indicated.
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