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Cervical Disc Replacement - Atlanta Spine Clinic

Locations

Decatur - Get directions

Conyers - Get directions

Surgery Center - Get directions

Make an Appointment

Or call: 678-369-6934

Send us an email

Cervical Disc Replacement

Who needs it?

If one or two discs in the neck are badly damaged and causing either neck pain or pain into an arm (due to the disc bulging and compressing the nerve behind it) or if the spinal cord itself is being compressed by the disc, then the patient may be a candidate for disc replacement surgery. This surgery is typically reserved for those cases where “conservative” treatments such as physical therapy and injections have failed to control the symptoms.

Pre operative advice

48 hours before surgery, take some gentle laxatives (colace, senna) to ensure you have your bowels opened on the day of surgery.

On the day of your surgery it is important to remain Nil By Mouth (NPO). Do not eat past midnight the night before your operation. However you may continue to drink water up to two hours before admission, where you will be advised further.

It is not necessary to bring your medications with you, as these are supplied from Pharmacy at The Hospital (you can use your medications when you return home). However, if you take a number of medications, please bring a list of names and doses so they can be appropriately supplied by the pharmacy department.

Please bring your scans with you to The Hospital.

How is it done?

The surgery is done through the front of the neck, just as the traditional discectomy and fusion operation. However, once the disc has been removed, instruments are brought into the operative field to very precisely prepare the ends of the bones above and below the discectomy, to allow accurate seating of the disc prosthesis. To allow this a slightly larger incision may need to be used. Several types of prosthetic disc are now in routine use in the US

Post operative care

You will wake up in the post anesthesia care unit (PACU), where you will spend a short time recovering from the anesthetic. You will then be transferred back to the ward.

You may be given a Patient Controlled Analgesia pump (PCA). You will be given a button to press for a dose of pain relief from the pump, and there is a lockout period so it is not possible to have too much. This is an effective way of controlling your pain, especially while you can’t eat and drink.

Post operatively, you will be seen by the physical therapy team on the ward. They will start teaching you how to safely get out of bed, and will help you to start walking again. You may feel lightheaded or dizzy the first few times you get up — this is normal, and will wear off. The therapist may also fit you with a collar to support your neck. You will have to wear this for several weeks.

Your wounds will be managed by the nursing staff; they will be dressed as needed. They will also provide you with the appropriate information for discharge.

When you go home

For the first 6-8 weeks, it is important that you take things easy. Do not start lifting or exercising during this period. You may walk about as pain allows, whilst wearing the collar, but not too vigorously. Several short walks, rather than one long walk, will be beneficial.

You will not be permitted to drive for 6 weeks, until you feel fit to perform the emergency stop. However you may be a passenger during this time, as long as you take regular rest periods to adjust your position.

Flying is not a problem, but airports are. Avoid standing for long periods or carrying luggage, especially off the carrousel. Try to avoid sitting for too long — get up and exercise when it is safe to do safe. Please also check with your airline before flying.

With regards to working, please discuss this with your surgeon, as this varies depending on the work you do. Patients may return to work in a sedentary occupation when they feel comfortable. Those in manual jobs may need to be off work for longer.

The Nursing staff on the ward will have given you some information on wound care prior to discharge. If you have any concerns regarding you wound, please do not hesitate to contact us. The stitches are dissolvable and will not need removing. In general, all dressings can be changed after 72 hours, with a new dressing applied every day thereafter if the incision is draining. However, if no drainage is present, the dressing may be discontinued. Moreover, you may shower and wet the incision after 72 hours, but bathing or soaking the incision is not recommended for 2 weeks.

Pain killers can be constipating so we encourage you to eat food that will help to keep your bowels working well. Drink plenty of water.

What are the risks?

There are short term risks, arising at the time of surgery and long term risks occurring thereafter. Short term risks include damage to the spinal cord behind the damaged disc. This is said to be around a 1% risk per disc operated upon. The nerve roots behind the disc may potentially be damaged by the surgery or bleeding causing a build up of pressure. The structures in the neck including the trachea, esophagus and blood vessels are at risk. There is a small nerve, the recurrent laryngeal nerve, which runs in the groove between the trachea and esophagus, which if damaged, may lead to vocal cord paralysis on the affected side. This may require treatment from a throat specialist or may resolve spontaneously.

Putting all these risks together, including the general risk of anaesthesia and infection, the total is around 1 — 2%.

The late risks include the possibility that the disc will not heal, leading to a return of the pain the patient previously suffered.

Will the disc replacement wear out?

This is unlikely, but as the device is relatively new, we cannot be absolutely sure. The biomechanical tests which have been performed on these discs have been thorough and do not show evidence of breakdown after the equivalent of many years of “normal” and “exacerbated” use.


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