Explanation of Cervical Spine Surgery
You are scheduled for surgery on your cervical spine. This may or may not include a fusion of the cervical spine. Dr. Taylor has determined the type of procedure that is necessary after reviewing your symptoms, which included a physical assessment of your symptoms, your x-rays, and other studies that you have had completed.
The Cervical Spine
Your cervical spine is composed of 7 bones known as vertebrae. The vertebrae in the cervical spine are cushioned by an elastic type shock absorber known as the disc. The first two cervical vertebrae do not have discs between them. Each disc has a soft center, known as the nucleus, which is surrounded by a tough outer ring, known as the annulus. The discs allow motion between the vertebrae. The discs, bony structures, ligaments and strong muscles all work together to stabilize the spine. The spinal cord connects the brain to the rest of the body. The spinal cord and nerves travel from the cervical spine through to the sacrum.
The Problem Concerning Your Cervical Spine
Compression or squeezing on the nerves in the spinal cord or nerve roots may be causing many of the different types of symptoms that you may be experiencing. These symptoms may include headaches in the back of the head, pain in the neck, shoulder, upper back, arm, and/or fingers. Numbness, tingling and weakness are other symptoms that you may experience occasionally or regularly. Other more serious symptoms include loss of balance and problems with coordination and dexterity.
The compression of the nerves are caused by some of the following conditions:
- Herniated disc: Disc are made up of a large portion of water. The hard outer ring of the disc, known as the annulus, may develop a tear, which allows the soft material inside the disc to bulge through the tear. The bulging portion of the disc can press on the nerve root or the spinal cord. There are many reasons that may cause the annulus to tear which include a trauma of some sort to the spine and degenerative disc disease.
- Degenerative Disc Disease: Degenerative Disc Disease is a breakdown of the disc. This may cause the disc to crack, flatten, or turn to bone. As the bone flattens, the vertebrae rub together and may cause bone spurs. The bone spurs irritate the nerves.
- Spinal Stenosis: Spinal Stenosis is a narrowing of the spinal canal. Bone spurs narrow the space through which the nerve roots exists in the spinal canal.
The cervical surgery that you have been scheduled for is to correct the problems that you have having with your cervical spine. There are several types of surgeries that Dr. Taylor can perform to help correct the problems you are having.
The surgeries include:
- Anterior Cervical Discectomy and Fusion – This involves removing the disc and replacing the disc with bone to allow the vertebrae to fuse together as one.
- Anterior Cervical Corpectomy and Fusion – This involves removing the disc and a portion of the vertebrae to allow the bones to fuse as one.
- Posterior Cervical Fusion – This involves the fusing of the cervical spine from the back of your neck. Please address any questions to Dr. Taylor or Lori, Dr. Taylor’s nurse.
The incision will be made according to the approach Dr. Taylor has decided to take to correct your cervical spine. The length of the incision depends on how many levels of the cervical spine need to be corrected. Anterior incisions usually will gradually fade over the next year. Posterior incisions do not heal as well and often leave a noticeable scar.
A neck brace will be worn after surgery. The type of brace depends on the type of surgery you will have and the number of levels that will be addressed surgically. The brace should be worn as directed by Dr. Taylor. Usually if a fusion is involved, the brace is used for six weeks after surgery. The brace is made to limit the motion of your neck, to support and to protect the spine while the bones are healing. Your neck immobilization is necessary to prevent injury to the bone graft or instrumentation.
It is an unusual occurrence for you to need blood during any of the procedures that have been discussed. Dr. Taylor will address with you if you will need to donate blood for your surgery. There is a consent that you will need to sign that allows you to receive blood in a life threatening emergency. Otherwise, blood loss is usually about 1 cup during these types of surgical procedures.
Risk and Complications
Dr. Taylor has discussed the possible risks and complications of the surgery with you.
- Side effects from anesthesia
- Damage to nearby structures
- Spinal cord or nerve damage
- Bleeding or possible need for transfusion
- Persistent hoarseness and/or swallowing problems. This is possible if you would have the surgery to the front of your neck, an anterior approach.
- Bone graft shifting or displacement. This is possible with a fusion of the bone.
- Failure of the metal plates and screws.
- The bone graft not healing properly, necessitating another operation.
There are a few things that need to be done before your surgery.
- Before your surgery you may have blood work, which can include a hepatitis test and a HIV test, a chest x-ray and an EKG. This will be scheduled for you and will be done during pre-testing when you meet with the anesthesia staff. If it has been some time since you have seen your primary physician, it would be best that you see your medical doctor before your pre-test date.
- To prepare your home for your recovery after surgery, please put necessary items within reach so that you may avoid a lot of movement of your neck. During the six weeks of your recovery you will not be able to lift more than 15 pounds. Please make arrangements before surgery to have any heavy items purchased before surgery such as dog food, etc.
- If you are having a posterior procedure (surgery on the back of your neck), we will need to shave your hair on the back of your head to the tip of the ear across to the other tip of your ear.
After surgery you will go to the orthopedic floor, unless you request a private room. You may need to be hospitalized for 1-3 nights.
The evening after surgery:
- Activity: If you are strong enough you will be able to get out of bed with the assistance of the hospital staff.
- Diet: You will start on either a clear liquid or regular diet, whichever you feel you can tolerate. Your windpipe, which is known as the trachea and the esophagus, which is the tube that connects the mouth to the stomach, lie in front of the cervical spine. During the surgery, the trachea and esophagus are gently held out to one side so that the vertebrae can be seen. This may be necessary for hours, which may cause a great deal of swelling after surgery. After surgery some people complain of throat tenderness and pain, a choking type of sensation, and/or a feeling of fullness in the neck. These symptoms may gradually decrease over the next few weeks or months. The difficulty swallowing may persist after your surgery. Use caution when eating dry foods or large portions of meat. Remember to chew carefully and to take small bites of food.
- Pain Control: When you are discharged from the Recovery Room and transferred to your hospital room you will have an I.V. (intravenous fluids) running into a catheter in your arm. You may have a button to push that is connected to a machine that gives you the pain medicine when you feel that you need it. You may be switched to pain pills in the evening of surgery or the next morning depending on how your pain is controlled.
- You will have a drain coming from the incision in your neck. The drain removes the extra fluid from under your skin. This helps to reduce the swelling in your neck and it helps Dr. Taylor and the nurses to monitor the amount of blood loss.
The Morning After Your Surgery
- Activity: You may be up as you desire and tolerate.
- Diet: You may slowly resume back to a regular diet.
- Pain: You will be switched to pain pills. Dr. Taylor and the other doctors assisting him will write for your pain medications before you go home. Please let them know of any drug allergies.
NOTE: Your drain will be removed before you are allowed to go home.
Please feel free to call the office with any questions or concerns. Please review the discharge instructions packet before your surgery.