Home › Patient Info › Operations procedures › Spinal fusion neck › Anterior Cervical Discectomy and Fusion with Cage and Plate
Anterior Cervical Discectomy and Fusion with Cage and Plate
Introduction
This is a guide to your upcoming operation. In it we explain what is likely to happen at each stage of the process. However your care will depend on your individual needs, so your progress may vary from this basic outline. Please become familiar with this guide and discuss any aspects you wish to with your surgeon or the nursing staff.
You will be admitted on the morning of surgery, unless this is impractical or you have some significant medical problems. You should expect to be in hospital for two days.
Before Surgery
You should stop taking anti-inflammatory drugs at least ten days prior to surgery as they can increase the risk of bleeding. These tablets include Voltaren, Nurofen, Brufen, Feldene, Naprosyn, Indocid, Celebrex and Mobic. If you are on low-dose aspirin, (eg. prescribed to prevent stroke or heart attack) you need to discuss this with your surgeon as you will likely need to cease this medication. If you are currently taking Warfarin (Coumadin or Marevan), Plavix or Iscover tablets, you should notify your surgeon as you will need to stop taking this medication under medical supervision. You should also stop taking any vitamin or mineral supplements ten days prior to your surgery.
You should keep the skin near the operation site clean. If you have a cut or pimple on the skin in the area, you should notify your surgeon prior to surgery.
Admission
You should not eat or drink 6 hours prior to surgery. This usually means from 2 am on the morning of your operation. (You may not be the first patient on the list, but the order may need to be changed unexpectedly)
You should bring with you:
- Personal effects (nightgown or pyjamas, slippers, dressing gown, toiletries)
- Any medication you are taking
- Medicare and private health fund membership cards
- Your medical consent and admission paperwork
Your x-rays and scans will be taken to the theatre on the morning of surgery by our staff.
Prior to going to theatre, you will:
- Have a shower with an antiseptic soap (Betadine)
- Be dressed in a theatre gown and disposable underwear
- Have special stockings fitted (to help prevent blood clots)
- Be asked to mark the painful arm (if applicable) with an indelible pen
If you wish, your surgeon will speak to a family member in person at the end of the day’s surgery list. Please notify the hospital nursing staff of the details.
The Procedure
You will be prepared for surgery by the nursing staff in hospital. You will be taken from the ward to the operating theatre on a trolley. The operation will take about one and a half hours, but you may spend up to three hours in the theatre complex, by the time you wait in the preoperative area, have the surgery and wake up in the recovery area.
The anaesthetic
The anaesthetist will give you a general anaesthetic. A small needle will be placed in the back of your hand or in your forearm. This will be connected to a drip. You will be asked to breathe on an oxygen mask and the drugs to make you fall asleep will be injected through the drip. You will be asleep and not be aware of anything further until the operation is completed. Antibiotics are given to you at this stage and a catheter may be inserted if required into your bladder.
The surgery
You will be placed on the operating table lying on your back. An x-ray will be taken with an image intensifier (fluoroscopy) to help identify the correct level at which to make the incision. Your neck will be prepped (cleaned with antiseptic solution) and draped (covered with sterile sheets).
An incision will then be made over the right / left side of your neck about 5cm long. The important structures in the neck are identified and moved aside. These include the trachea (windpipe), oesophagus (food pipe) and carotid artery (main artery to the brain). Once these are moved aside the spine is exposed. A needle is inserted into the disc and an x-ray is taken with the image intensifier again to make sure it is the correct one. The disc is then removed completely. If there are any bony spurs or disc fragments pushing backwards on the nerves or spinal cord these are carefully removed.
A cage is inserted between the vertebrae. A plate and screws are inserted into the vertebra above and below the graft. A drain is inserted into the neck to make sure any bleeding is drained away. The wound on the neck is closed with dissolving stitches under the skin.
The recovery
The anaesthetist will reverse the anaesthetic. You will wake up in the recovery room. The nurses there will check your observations and the movement in your hands and feet. Once you are sufficiently awake, you will be transferred back to the ward.
After Surgery
When you return to the ward, you will be resting in bed but will be free to move into a comfortable position. You will have a drip in your arm for fluids and for pain control, you will have a PCA. A PCA (patient-controlled analgesia) consists of another line into the drip in your arm and a pump that delivers a drug like Morphine, Pethidine or Fentanyl into the drip. You can control the amount of medication you receive by pressing a button. There is a safety lock-out mechanism built into the pump so that you cannot give yourself too much of the painkiller.
You will have a dressing on your neck wound and a drain from the wound. You may have a soft collar. You may have a catheter in your bladder so that you will not need to worry about getting up to pass urine. You will have sequential compression devices on your legs, which gently squeeze your calves to decrease the chance of clots in the legs.
You may feel nauseous and have a sore throat but you will be allowed fluids to drink.
Later in the day, your physiotherapist will visit, take you for a walk with the aid of a rollator (walking frame with wheels) and give you instructions about your activities during the recovery period, including an exercise programme.
The Day After
You will have a shower with the help of the nursing staff.
Your throat will be sore but you will be allowed a normal diet when you feel you can swallow comfortably. Your drip and PCA will be removed from your arm when your fluid intake is adequate. You will be given tablets for pain relief. The drain will be removed from your neck.
The sequential compression devices will be removed from your legs. The physiotherapist will visit and make sure you are walking well and can cope with stairs.
Once you are able to stand and walk comfortably, the catheter (if you have one) in your bladder will be removed. The nursing staff will observe that you are able to pass your urine normally afterwards. You need to tell them if you have not passed urine within six hours after the catheter is removed.
You will usually be well enough to go home on this day.
The Day Of Discharge
Once you are walking safely and are able to look after yourself, and only need tablets for pain, you will be able to go home. You may travel home in a car, but you should stop for a break if the trip is longer than half an hour or so. If you live more than one hour (100 km) from Brisbane, it may be better that you stay in Brisbane for a few days after your discharge from hospital. At that time, you will also be able to travel by plane if necessary.
Your wound will be reviewed and the dressing will be changed prior to your hospital discharge. If you have wound clips, you will need to make an appointment with your GP 3 days post-operatively for the removal of these wound clips.
When You Get Home
You can expect some pain in the neck and down the arm. The arm pain may come and go over the next few weeks but is usually not as severe as the pain was before surgery. This is normal and you should not be concerned. You may take the tablets given to you as needed for pain. If you become constipated, you may need to increase your fluid or fresh fruit intake or obtain appropriate medication from the chemist.
You may experience some pain across the back of the neck and between the shoulders for the first few weeks. This is normal and is related to your positioning during theatre and stretching of the facet joints with this type of surgery.
You may also have a sore throat and difficulty swallowing for some weeks. This is not uncommon and settles with time, usually by the seven-week mark.
You should take your dressing off about 8 days after surgery. If it falls off before this and the wound is clean, you should not worry. As the body dissolves the internal stitches, there is sometimes a mild reaction around the wound, seen as some redness and inflammation.
You should wear your stockings for one week, or until you resume normal activities. You should wear your collar if one has been issued for up to six weeks if required (only when mobile).
You should follow the guidelines given to you by your physiotherapist with regard to physical activity and exercise. You should increase your activity level slowly with an aim to be back to most activities at six weeks. You should endeavour to complete your exercise programme twice a day and to take progressively longer walks building up to 30 minute sessions twice daily. Once your wound has healed you may do pool work as advised by your physiotherapist.
You should avoid sudden twisting and bending movements of your neck and spine and should not stretch past the point of pain. Reach for objects on the floor by bending your knees. Minimise work done with arms over your head. You should not lift, pull or push anything heavy (i.e. nothing over 5 kg) until after your post-operative visit with your surgeon.
You may sleep on your back or on your side with a single pillow. You do not need to wear your collar in bed. If a fairly passive role is taken, you may resume sexual activity three to four weeks after your operation.
You should be safe to drive at four weeks. You may return to work at four weeks if you have a sedentary job such as administrative or clerical, or seven weeks if your job is more physical.
We will contact you in the following week after you get home to check how you are and remind you of your post-op appointment with Dr Licina. This appointment will be seven to eight weeks after surgery and you will need to have an x-ray on this day. The cost of the post-op visit (not the x-ray) is included in the surgical fee. Any subsequent visits pertaining to this surgery will be charged at the rebate rate.
You should see your local doctor or contact your surgeon if:
- You develop severe and constant neck or arm pain or severe difficulty in swallowing
- You have bleeding or discharge from your wound
- You are unwell and have a fever