Frequently asked questions about cervical spine surgery

There are several causes of neck pain. The most common cause is strain on the muscles and ligaments that support the neck due to overuse, poor posture or minor injuries. Anti-inflammatory medications, heat and a short period of rest are often helpful in reducing the pain, which often stops within a few days.

Arthritis is another cause of cervical pain. As we age, the joints in our neck may develop arthritis that is like the degeneration that develops in other major joints, such as the hips and knees. In a similar manner, the discs – which function as the neck’s shock absorbers – may degenerate. As this process advances, the discs become dehydrated and cause pain. Fractures, tumors or infections of the cervical spine can also cause pain.

These terms are often used to describe the same problem. A bulging disc refers to a disc that protrudes slightly back against the nerve elements but does not appear to be completely ruptured. A disc herniation is a more serious problem where the disc is either fully ruptured or so extended it causes compression on the nerves.

Surgery is necessary in only a small number of patients with spinal problems. Factors that may lead to the need for surgery include:

• Response to prior treatment.
• Level of pain and loss of function.
• Degree of nerve damage or threat of future nerve damage.
• Spinal damage.
• Long-term outcome without surgery.

The patient and his or her doctor need to make a careful and thoughtful decision to proceed with surgery.

Because minimally invasive spine surgery, or MISS, does not involve a long incision, it avoids significant damage to the muscles surrounding the spine. Typically, this results in less pain and a faster recovery after surgery.

The indications for minimally invasive spine surgery are the same as those for traditional open surgery. Spine surgery is usually recommended only when a period of nonsurgical treatment – such as medications and physical therapy – has not relieved the painful symptoms caused by your back problem. In addition, surgery is only considered if your doctor can pinpoint the exact source of your pain, such as a herniated disk or spinal stenosis.

There are numerous minimally invasive techniques. The common thread between all of them is that they use smaller incisions and cause less muscle damage. Minimally invasive techniques can be used for common procedures like lumbar decompression and spinal fusion.

Source: American Academy of Orthopaedic Surgeons

The approach that your surgeon chooses depends on the type of problem you have. Approaching your neck through the front is done most of the time and has the advantage of less muscle injury and tends to be less painful. Going through the back of the neck is necessary at times, but is more painful because there is more muscle involved. Your surgeon will know which approach is best for you.

When a disc is removed from the front of the neck, a fusion is done to restore the height and normal alignment of the spine and to aid in faster healing time. Fusions are also done for deformed and arthritic necks and for instability. Sometimes a patient may be a candidate for a total disc replacement, or TDR. Your surgeon will discuss this option with you.

The risks of anterior cervical discectomy and fusion are low. Risks include, but are not limited to, infection; bleeding; cerebral spinal fluid leak; failure of fusion; nerve injury; spinal cord injury; trouble swallowing; hoarseness of voice; and the risks of the general anesthetic. The risks for posterior surgery are similar.

Some patients will be able to go home the same day of surgery. Most people are in the hospital one night and go home the next day, although some patients may stay two days.

Blood transfusions are very rare after this surgery.

Your heart will be monitored during surgery. If it is necessary, your heart will be monitored after surgery during your hospital stay.

Many surgeons advise their patients to stop smoking before surgery and to think about quitting for good. Tobacco products have an adverse effect on blood vessels, which can affect the body’s way of healing wounds and bones. The risk of infection and lung problems after surgery is also greater for patients who use tobacco. There are many sources of information offered to help people quit smoking.

This depends on the patient, the condition that was treated and the surgical technique chosen. Certain patients may be able to drive and return to work within a few days. More active pursuits and recreation may be postponed for weeks or a few months. Heavy labor or strenuous activities may have to be avoided for an even longer period of time. Talk to your surgeon before starting physical work or recreational activity.

Limit lifting to less than 10 pounds. Avoid excessive twisting and high impact activities. Always clear strenuous activities with the surgeon prior to doing them.

Pain medication is often needed after surgery. The strength of these medications and the length of time they are used depend on the nature of the surgery itself. Sometimes a patient needs to take narcotic pain medication for four to six weeks after spinal surgery and maybe even longer. All medications may have side effects which should be discussed at length with your surgeon prior to their use. Keep in mind you should not drive while taking pain medication.

Fusing the spine causes increased workloads on the adjacent segments of the spine. This can lead to increased wear and tear and early degeneration, which may or may not cause symptoms in the future. Observing proper body mechanics while being active helps to preserve the adjacent areas for a longer period of time.

Some patients do require a brace after surgery. The decision to wear a brace and how long it should be worn needs to be made between the patient and the surgeon.