Anterior Cervical Discectomy: 6 Things You Need to Know about the Surgical Procedure
Almost 100 million Americans suffer from back and neck pain every year, but not all pain is equal. Some people are able to heal via a combination of treatment options, including medication, stretching, and laser treatments, while others require surgical intervention. Neck pain can be especially debilitating as it can limit your productivity at work, negatively impact your ability to participate in athletic activities, and decrease your overall wellbeing. More than 25 million Americans missed work due to neck pain in 2012.
Many different biological and psychological factors contribute to neck pain prevalence and intensity. These include autoimmune diseases and neuromusculoskeletal disorders, long-term stress, depression, and a lack of social support. In many cases, laser therapy, yoga, massage, and aquatic therapy can help alleviate neck pain, although surgery may be required when damaged spinal discs exacerbate symptoms for an extended period of time.
Anterior cervical discectomy (ACD) is one of the many treatment options for neck pain. Here's a look at common conditions that may make ACD necessary, how the procedure works, and the recovery timeline.
Common Causes
Spinal discs wear down over time, shrinking and dehydrating as we age. This process, known as cervical spondylosis, can contribute to bone spurs and other signs of osteoarthritis, often requiring ACD for treatment. The most common reason for an ACD, however, is cervical disk herniation. In this case, neck pain is brought about by a weakened or torn outer ring of a spinal disk. This causes the inner part of the disk to bulge and put pressure on the spinal cord or nearby nerve roots.
Cervical stenosis and cervical degenerative disk disease (CDDD) are two other common conditions that might ultimately require ACD. Commonly caused by arthritis or aging, cervical stenosis happens when a narrowing spinal canal constricts the spinal cord. CDDD, meanwhile, occurs when the spinal cord or nearby nerves are compressed due to gradual degradation, reducing the space between disks and potentially causing instability.
Determining if ACD Is Needed
Neck pain varies from person to person—and what one person may consider debilitating, another can tolerate. Some people may experience relief within days or weeks just by using medications and completing physical therapy, whereas others have chronic neck pain that these treatment options cannot solve. Candidates for ACD typically experience weakness in the arms, numbness, and difficulty with coordination in conjunction with prolonged neck pain.
A specialist, usually a board-certified spine surgeon, can assess your degree of neck pain and determine if there is evidence of nerve root or spinal cord compression, a leading indicator for ACD candidacy.
Diagnostics
A combination of physical exams, X-rays, and MRI/CT scans can be used to assess a person's need for an ACD. Dr. Gbolahan Okubadejo, one of the premier spine surgeons in New York, first performs a physical exam to assess patient reflexes, muscle strength, and the severity of their spinal condition. X-rays offer clear images of the spine, allowing surgeons to accurately target areas of concern. MRI/CT scans, meanwhile, provide more detailed images, offering greater accuracy in diagnosing disk degeneration and spinal stenosis.
Surgery Prep
Your healthcare provider will provide you with specific instructions for preparing for your ACD surgery, but in general, there are a few things to consider before the procedure. Patients must disclose all of the medications and natural health products they take to their surgeon to avoid risk of complications. Some may even have to bathe or shower with a special soap that contains chlorhexidine multiple times before surgery. Chlorhexidine reduces bacteria on the skin, mitigating risk of infection after surgery.
Patients must also not be wearing any cosmetic accessories, including makeup, jewelry, and nail polish, when they arrive at the medical facility for surgery. They also need to take out contact lenses and dentures, if applicable.
How ACD Works
ACD surgery is performed under general anesthesia and involves a slight incision in the anterior (front) of the neck, allowing the surgeon access to the cervical spine to remove the damaged disk and bone spurs that might be exacerbating neck pain. The surgeon performs this part of the procedure with an operating microscope and microsurgical neurosurgical techniques.
Once the disk is removed, the surgeon stabilizes the spine via either a spinal fusion and fixation or arthroplasty. For a spinal fusion, the surgeon replaces the disk with a bone graft and uses a titanium plate and screws to hold the bones in place and promote spinal stability as the graft fuses with adjoining bones. An arthroplasty, meanwhile, involves the implantation of an artificial disk into the same space from which the damaged disk was removed.
About 80% of patients report substantial pain relief following an ACD procedure, while 90% of patients return to work within three to six weeks.
The Recovery
Patients are usually able to leave the hospital the day after surgery, but have to come back for a follow-up visit with the surgeon, usually within six weeks. The surgeon takes X-rays at this follow-up to see how the bones are healing.
Patients can take oral pain medication, such as aspirin, to limit post-surgical pain and prevent the growth of calcium surrounding the artificial disk (arthroplasty). They should wait to receive clearance from the surgeon to perform rigorous exercise and may need to wait up to four months post-op to do physical therapy.