This is the most common neck surgery done for neck and upper limb symptoms. This is done to relieve symptoms, mainly pain, caused by pressure on nerves that supply the shoulder and arms/forearms. The pressure on the nerves (pinched nerves) is caused either by disc prolapse/bulge or arthritis that causes narrowing of foramina (holes) through which nerves from the spinal cord originate and supply the limbs. This surgery is also done to relieve pressure on the spinal cord. The symptoms are usually pain in the neck and arms, weakness/paralysis, pins and needles, numbness and loss of dexterity.
Surgery
The operation is done from the front of the neck through a cut across the right side of the neck from the midline, measuring about 4 cms through which the spine is accessed between the trachea/esophagus and the carotid artery. After confirming the correct level of the disc that needs to be addressed, the disc is removed completely while looking under the microscope and the foramina are widened to relieve pressure on the nerves.
To keep the foramina patent, a cage (titanium or poly-ethylene ethyl ketone[PEEK]) is inserted in the empty space where the disc was. The cage is filled with artificial bone graft (calcium tri-phosphate or similar) to aid fusion between the vertebrae. To keep the cage in place, two or three screws measuring about 14-16mm are used to secure the cage to the vertebrae. The wound is then closed and a suction drain is placed that would be removed the next day.
Risks involved with this surgery
- Infection
- Bleeding
- Injury to the Oesophagus (food pipe) causing some swallowing difficulty that usually is temporary and lasts for 2-5 days
- Injury to the larynx/trachea (wind pipe) that causes hoarseness of voice, again temporary
- Injury to carotid artery causing a stroke – very rare
- Injury to the nerve root being addressed causing weakness/paralysis or numbness
- Injury to spinal cord resulting in quadriplegia/paraplegia – extremely rare
- Stretch pain/discomfort between shoulder blades – temporary
- Numbness around site of incision
- Non-resolution of symptoms, especially numbness that usually resolves last or doesn’t improve at all. Weakness improves with rehab generally.
- Non-union or non-fusion, usually known after 2 years
- Adjacent segment disease – that is accelerated disc problems at the level above the site of surgery due to more stress on that level – in about 10-20% of patients over several years
Post-Operative Period
The drain will be removed the next day and you will have an X-ray to confirm proper placement of cage and screws and as a baseline for future reference.
You will be given 3-4 waterproof dressings to be used while showering. There would be no stitches visible, and the original dressing can be removed any time after 7 days post-surgery.
After two to three nights, you will be discharged home and you are allowed to do most things at home gradually. You will be able to drive in about 2 weeks’ time and are allowed to lift weights as tolerated. Gym activities can be commenced after 6 weeks. Contact sport after 3 months.
You are allowed to go back to work after two weeks. Heavy physical work can start after 6 weeks in a graded manner.
Review will be between 4-8 weeks after surgery.
