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 Nothing by Mouth (NPO). Do not eat past midnight the night before your surgery. However you may drink small amount of water to take any medications up to two hours before admission.

It is not necessary to bring your medications with you, as these are supplied from the 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.

Please avoid smoking on the day of your surgery.

Please shower or bathe as normal in the morning, and remove any make up or nail polish.

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 recovery, where you will spend a short time recovering from the anesthetic and then you will be transferred back to the floor.

You will remain to be Nothing By Mouth (NPO) until you begin having bowel sounds again. The bowels maybe slow to begin working again, and it is important not to eat or drink too quickly post operatively to avoid sickness and further complications. You will have maintenance fluids intravenously to keep you hydrated.

On day 1 post operatively, you will be seen by the physical therapy team on the floor. 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 cervical collar to support your neck. You will have to wear this for at least 2 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.  You may experience some trouble swallowing and some swelling at the incision site but that will reduce as you heal.

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, while wearing the brace, but not too vigorously. Several short walks, rather than one long walk.

You will not be permitted to drive for 4-6 weeks.  However you may be a passenger during this time, as long as you take regular rest periods to adjust your position and wear your brace.

Flying is not a problem, but airports are. Avoid carrying luggage, especially off the carrousel. Try to avoid sitting for too long – get up and exercise when it is safe to do so. 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, until the fusion is solid, as demonstrated by the x-rays.

The nursing staff on the floor 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.  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.  You can take colace, senna and/or fiber to help with constipation.

Rehabilitation

From 2 weeks post op, assuming the x-ray appearances are satisfactory, you will start physical therapy. These exercises are very gentle initially and increase over 6 weeks, so that by 12 weeks post-op you will be in the gym, swimming or cycling regularly.

Patients are seen at 2 and 6 weeks post-operatively and then at 3, 6 and 12 months with x-rays taken at each visit to determine the stage of healing.

Brace for neck support

After your surgery you will need to wear a brace to support your muscles and cervical spine.  It should be worn when you are out of the house, walking, shopping, when you are sitting in the car, bus, or train.  You don’t need to wear it in bed or when you are sitting at home.

You may need to wear this for several weeks. You will be fitted with the appropriate size by the therapist on the floor or at your pre-op visit, and then be taught how to put it on correctly.

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.