What is an anterior cervical discectomy and fusion?
Anterior cervical discectomy and fusion (ACDF) is a surgery to remove a herniated or degenerative disc in the neck in order to decompress the nerve root/s that are causing neck and arm pain. An incision is made in the throat area to reach the front of the spine. The disc is removed and a graft is inserted to fuse together the bones above and below the disc. This procedure does not limit your neck movements.
What is a posterior cervical foraminotomy?
Posterior cervical foraminotomy is an alternative surgical procedure to relieve symptoms of a pinched spinal nerve. This procedure is performed through the back of the neck and it creates more space for the spinal nerve to pass through. In properly selected patients, posterior cervical foraminotomy is as effective as ACDF surgery without requiring a fusion procedure.
Preparing for surgery
- Understand exactly what surgery is planned, along with the risks, benefits, and other options.
- Tell your doctors ALL the medicines and natural health products you take. Some of these can increase the risk of bleeding or interact with anaesthesia.
- If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin/dispirin/grandpa be sure to talk to your doctor. We will tell you if you should stop taking these medicines before your surgery. Make sure that you understand exactly what your doctor wants you to do.
- Your doctor will tell you which medicines to take or stop before your surgery. You may need to stop taking certain medicines a week or more before surgery. So talk to your doctor as soon as you can.
- Inform your doctor/anaesthetist regarding if you are willing to receive blood transfusions if required.
- Important to make your anaesthetist aware of any allergies/ previous anaesthesia reactions as well as habits such as smoking and alcohol intake.
- Regarding any major surgery, you will be admitted the day prior to surgery for a full work up that includes routine bloods, ordering blood for the procedure, starting pre-operative steroids and meeting the team including physiotherapists/occupational therapists and nursing staff.
- A steri-scrub will be provided for you to wash on the day of surgery.
- Please do not shave your hair as I usually attempt hair-sparing techniques if possible
- I often have a neuropsychologist examine you prior to surgery for a baseline report.
- If you have an advance care plan, let your doctor know. Bring a copy to the hospital. If you don't have one, you may want to prepare one. It lets your doctor and loved ones know your health care wishes. Doctors advise that everyone prepare these papers before any type of surgery or procedure.
What happens after surgery?
- All patients will be admitted to ICU following surgery for observations
- You may be able to mobilise in bed and sit upright to eat.
- Following surgery you may feel some discomfort during swallowing and I encourage to first attempt fluids then solid food.
- The next day you will be helped by the physiotherapist to mobilise out of bed. Routine xrays will be taken and if no complications present, you will be transferred to the ward.
- It is not necessary to wear a collar unless instructed by the Doctor. I encourage a neck brace to be used during the first few weeks whilst in a car or heavy movements at home.
- Discharge occurs usually day 2-4 post surgery. We will provide you with dressings that can be used daily at home. You may shower with the dressing as they are waterproof. A wound will review your wound in 10 days post-surgery. Subcutaneous stitches are routinely used and these are absorbable. (No Stitches to be removed)
- Patients are encouraged to follow up with the physiotherapist two weeks post-surgery for neck strengthening and massage and it is common to still have neck pain/stiffness post-surgery as trigger point areas require intensive physiotherapy.
- Patients are booked off from work usually 3-4 weeks with a follow up visit.
- Please avoid any heavy exertion during the first few weeks and neck straining activities. A good pillow for sleeping and neck support is useful during this period.
- I encourage to cut down on smoking/drinking alcohol as this retards healing, risks failed fusion and may lead to scarring around the nerve root which will cause pain.