The cervical spine is present in the neck region and supports the weight of the head. Soft pads or intervertebral discs, present between the adjoining vertebrae, act as shock-absorbers and assist in movements of the head. Each disc is composed of a soft inner core called the nucleus pulposus and the fibrous outer band called the annulus fibrosus.
Anterior cervical discectomy (ACD) is a surgical procedure employed in the management of various disorders affecting the cervical spine which include disc herniation, disc degenerative disease and cervical radiculopathy. In ACD, the neurosurgeon approaches the affected disc from the front (anterior) of the neck.
The basic steps of anterior cervical discectomy include:
- The patient is taken to the operation room and administered general anesthesia.
- The patient is made to lie on the operation table, face up with the head bent slightly to the right.
- A small incision is made, usually above the left collar bone; avoiding injury to the nerves supplying the voice box.
- The muscles and the soft tissues are then retracted to approach the spine.
- X-ray imaging is employed to identify the affected intervertebral disc.
- The front portion of the disc is then removed with forceps while the back portion is removed with a small rotary cutting tool called a burr.
- A special microscope is employed for visualizing the disc and assists in accurate removal of the disc material and bone spur around the spinal cord.
- The adjoining surfaces of the vertebrae are prepared, which causes bleeding and aids in the healing process.
- The dimensions of the space between the vertebrae are measured and a suitable bone graft, taken from the pelvis, is fitted in to the disc space.
- Confirmatory X-ray may be taken to confirm the proper placement of the bone graft.
- Finally, a drainage tube is placed in the wound, the retraction over the muscles and soft tissues is removed, and the wound is sutured.
In case of spinal instability, after removal of the disc, the vertebrae adjacent to the disc are fixed with screws and a metallic plate and this is known as arthrodesis.
Patients may be discharged on the same day of the surgery or may be advised a couple of days of hospital stay. A neck brace is recommended, for a few months. Patients are initiated on a liquid diet which is gradually changed to normal food, depending on their recovery. Rest is advised as it helps in healing of the bone graft.
Risk and complications
Every major surgery is associated with complications. Some of the complications associated with anterior cervical discectomy include:
- Complications related to anesthesia
- Conditions such as thrombophlebitis
- Non-union or pseudarthrosis
- Damage to the spinal nerves
- Problem related to bone graft
- Persistent pain