Cervical Disc Replacement
This decade has seen the development and increasing popularity of cervical disc arthroplasty, in order to overcome some of the shortcomings of fusions. Devices have evolved from rudimentary ball and socket articulations to its current refined iteration. Current devices have metal alloy bases with a polymer (plastic) articulation sandwiched in between them. Large clinical studies have demonstrated the safety and efficacy of cervical disc replacement and a trend to improved results in terms of return to work and lower rates of re-operations.
This operation is most commonly performed to relieve compression of the spinal cord as well as the nerves of the cervical spine (myeloradiculopathy) . The compression is typically caused by a herniated cervical disc.
This involves a small incision, typically one and a half inches, in the front of the neck. There is a dissection between muscle and tissue planes to approach the cervical spine. The diseased disc segment is excised under microscopic guidance and replaced with an artificial disc to relieve compression of nerves and restore motion of the spine.
link to risks in anterior cervical surgery
After surgery patients may experience pain in the region of the incision. Some neck and arm pain as well as tingling or numbness may also be present. Initially it may be of greater intensity than pre-operatively, but will subside over time as the healing process occurs. This discomfort is caused from surgical retraction of tissue as well as inflammation and swelling of the previously compressed nerves.
Some patients experience a sore throat and swallowing difficulty after general anesthesia and surgery. This is from manipulation of tissue and the presence of the breathing tube for anesthesia. The sore throat usually will subside within a week. The swallowing difficulty may take longer. Using throat lozenges or lemon drops, sipping cool liquids, or sucking ice chips may soothe this pain.
USE OF PAIN MEDICATION
Narcotic pain medication will be available for pain relief after surgery. Narcotics are very effective for pain relief but may cause other side effects. The possible effects vary among patients and may include: sleepiness, nausea, constipation, flushing, sweating, and occasionally euphoria or confused feelings. If these occur notify your nurse. For your protection, you will receive narcotic medication only when you request it and if deemed medically appropriate by your physician.
Patients are encouraged to mobilise with the assistance of a nurse or physical therapist as early as 4 hours after surgery. Early activity after surgery is extremely important to help prevent the complications of prolonged bed rest such as pneumonia and blood clots. It also promotes recovery, relieves muscle stiffness, allows for development of a well-organized scar, and improves your outlook.
Elastic stockings (TED hose) were given to you immediately after surgery to prevent phlebitis (inflammation in your veins) in your legs. You may remove them after being discharged from the hospital. Do not start any programs of exercise or physical therapy unless discussed with your physician or Dr Nair.
Your diet will begin with clear liquids, and be advanced to your normal daily diet as soon as your condition permits. Your IV will be removed as soon as we are reasonably certain it will no longer be required for medications and hydration.
BOWEL AND BLADDER FUNCTION
During surgery patients you will have a catheter (tube) in the bladder to monitor your urine output. Upon its removal you may feel a stinging sensation for 2 to 3 days, which is normal. Some patients may have difficulty urinating after surgery. If this occurs, notify your nurse who may assist you in voiding techniques. This may require placing a catheter in your bladder. After surgery, constipation frequently occurs from inactivity and the side effects of pain medication. Stool softeners and laxatives will be available.
Deep breathing is very important after surgery to maintain lung expansion and reduce the risk of pneumonia. Patients will be provided with an incentive spirometer and instructed about its use. This device should be used every 15 to 30 minutes during your wakeful hours initially, then every 1 to 2 hours as your activity returns to normal. This device is yours to take home. Continue to use it at home for at least 1 week after your discharge.
Smoking is strongly discouraged. There is clear evidence that smoking dramatically increases your risk of post-operative complications. There is also evidence that smoking adversely effects bone healing and nerve recovery. Second hand smoke also applies, so family members and friends should avoid smoking while around you.
Most patient’s are typically discharged on the third to fourth post operative day, however if you have underlying medical conditions or your social situation demands it, you may benefit from a period of rehabilitation.
link general cervical post op instructions.