Surgery to the front of the neck
From BCSS
Contents |
Information leaflet for patients
An operation of the type described in this leaflet is a standard procedure carried out by orthopaedic surgeons and neurosurgeons in many centres. However, it is important that you understand the risks and benefits of such surgery. This leaflet is only intended to provide you with general information about this type of surgery. Your surgeon will discuss with you the particulars of your individual case.
Reasons for surgery to the front of the neck
There are many different reasons for carrying out an operation to the front of the neck but this leaflet only deals with those conditions that result from “wear and tear” of the bones, discs and joints in the neck, and the effects that those conditions can have on the spinal cord and the individual nerves. Wear and tear or degenerative change in the neck is called a number of things by different people, one common term being “spondylosis”
The operation may be carried out to relieve pain coming from the neck into the arm from a localised problem in the neck, or to relieve pressure on the spinal cord or nerves, or a combination of the two.
The Operation
The operation is carried out through a small cut at the front of the neck. The subsequent scar is usually almost invisible after several months. A large part of the relevant disc or discs are removed and if the nerve or nerves to the arm need to be freed, this is carried out at the same time. Sometimes, only the disc is removed (discectomy), but it is often thought necessary to fuse or lock the bones together (discectomy and fusion). This might involve removing a piece of bone from your hip, although there are many techniques nowadays that may avoid the need for this. Metallic internal fixation is often carried out to supplement this “fusion” procedure and this may involve the use of a small “cage” and/or metal plate inserted between the vertebrae.
Benefits of Surgery
Where there is pressure on a nerve with severe symptoms in the arm, the majority of patients will have dramatic relief, particularly of their arm pain. However, sometimes the pressure on the nerve has resulted in some permanent damage, in which case the relief of symptoms and return of function may be incomplete and disappointing. This is especially so in the case of weakness and numbness.
If there is pressure on the spinal cord giving rise to problems in the arms and legs, then the main reason for carrying out the surgery is to prevent matters getting worse. Improvement is unpredictable and recovery is often incomplete. It is a bonus if there is significant improvement in the function of the spinal cord.
As far as pain in the neck is concerned, the surgery may well lead to significant improvement in the pain, but as is often the case with wear and tear degenerative problems, it is likely that you will still have some neck pain and stiffness. The main point of the surgery is to relieve pressure on the spinal cord or nerves, and not to treat neck pain.
Risks of Surgery
The scar on the front of your neck, or any scar related to removal of bone from your hip, is not normally a problem. However, some patients have pain at the site where bone graft has been taken.
Any surgical wound can become infected but the risk of infection in wounds for this type of surgery is very low indeed. When infection occurs, this is not usually a serious matter and the risk of long-term problems from this is very low. If metal has been attached to the spine at surgery, infection can sometimes result in serious complications.
The oesophagus (gullet) and larynx (voice box) have to be moved to one side to perform the surgery and this can result in bruising which can lead to temporary hoarseness of the voice and/or discomfort on swallowing, which usually settles in a few days. Occasionally, some problems with swallowing can persist, and rarely there may be permanent hoarseness and weakness of the voice as a result of the surgery.
The spinal cord and nerve roots are bathed in a fluid (cerebrospinal fluid) and the surgery can result in some leak of this fluid. Of itself, this is not a serious matter and the risk of long-term problems is very low.
What understandably worries patients most about an operation on their neck is the risk of permanent paralysis. Surgery of this sort involves working close to both individual nerves and the spinal cord and the risk of paralysis can never completely be ruled out. In relation to individual nerves, particularly if the nerve is badly trapped before an operation, the nerve can suffer harm which can result in permanent increased pain or numbness or weakness in the arm. As far as the spinal cord is concerned, complications could result in permanent paralysis from the chest down and being in a wheel chair or even very occasionally in permanent paralysis of both arms and legs and serious interference with breathing or even death. Fortunately the risk of catastrophic complications such as this is extremely low in this type of surgery. Your surgeon will warn you if the risk in your case is increased for any reason.
If you have any doubts or questions on reading this leaflet, you should discuss them with your surgeon.
Disclaimer: This information has been provided by the British Cervical Spine Society for the information of patients. The Society accepts no responsibility for the effects of any surgery that may be decided on by an individual surgeon and his patient.
BCSS August 2006
