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(This is the section that explains the detail of the operation or procedure above and should be read in conjunction with the section Your Neck Operation).
A cervical disc arthroplasty is performed for a cervical slipped disc. The reason why your specialist performs this procedure is because there is pressure on a nerve root that needs to be relieved. The aim of the operation is to remove the whole of the disc from the front of the neck. The secondary aim is to preserve spinal movement on that specific level by replacing the disc with an artificial disc prosthesis.
This operation is performed to prevent the abnormal movement at the adjacent disc segments that often occurs after an anterior cervical discectomy with fusion. A fusion is the traditional way of treating a slipped disc, but there is a definite movement away from this approach towards the use of a mobile prosthesis, such as an artificial disc. With a cervical disc replacement, less biomechanical stress is placed on the rest of the neck, because there is no fusion and therefore mobility is maintained.
When undergoing this operation you will be lying on your back and the specialist will be operating from the front. Your skin will be sterilised over the front of your neck with a combination of iodine and an alcohol solution and then the area will be covered with sterile drapes. A small incision will be made in the front of your neck and the tissue will be carefully separated up to the spine.
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The top drawing demonstrates the position that the patient is placed in before the operation. Please see the section Anterior Cervical Discectomy for a picture description of how the disc is removed. The drawing below demonstrates the placement of the artificial disc, also called a disc prosthesis, between the vertebrae in the space that was created by removing the disc.
With the use of a microscope, the damaged disc will be removed. Thereafter, an artificial disc prosthesis will be carefully placed in the middle of the space that was created by removing the disc. The position will be confirmed by an X-ray in theatre. There are many disc prosthesis and companies are developing new products all the time.
A drainage pipe will be placed in the wound and connected to a reservoir and the wound will be closed. This will allow all excess blood to drain away and not cause a blood clot next to the breathing tube, which can be quite dangerous.
Following the operation, you will be taken to the recovery room to recover from your anaesthetic. Afterwards you will be monitored for several more hours to ensure that no blood clots form under the skin in the area of your neck. You may mobilise after the operation and the hospital staff will administer prescribed analgesics for post-operative pain.
The drawing above demonstrates a disc prosthesis in place as seen from the front. The prosthetic disc moves like a normal disc and preserves the movement across the section of the spine that is being operated on, unlike a fusion, where the two vertebrae grow together (fuse).
Ward care
In the ward you may walk around freely. Some specialists request that their patients wear neck collars. This is often because of the specialist’s preference or because of certain technical factors. Other specialists will allow you to mobilise without a collar and wear it only at certain times whereas other specialists use collars only infrequently.
You will most probably be seen by the physiotherapist who will demonstrate the appropriate neck exercises. The drainage pipe in your neck will normally be removed on the day after the operation or rarely the next day.
Discharge
You will normally be discharged two or three days after surgery with analgesics to take home. A painful throat and even some hoarseness can be quite common and can last for as long as a few months, but usually lasts only for a few days. Discomfort between the shoulder blades is a frequent occurrence, because the operation restores the height of the disc space and this causes temporary discomfort that will usually pass after a few weeks at most. Wound care will be discussed with you by the hospital staff or your specialist.
Rehabilitation
It is incredibly important to get a lot of rest and exercise following your surgery. Do not try to rush back to work. It is important to walk for exercise and also exercise in conjunction with the guidelines from your physiotherapist. You may perform normal activities and should only wear a neck brace if your specialist prescribed it. You should refrain from exercises that involve impact, for three months. This would include jogging, mountain biking and equestrian pursuits.
Follow-up
Routinely you will receive a date for your follow-up appointment with your specialist. This may vary from anything between two and six weeks, but you will be seen earlier if there are any complications. You would usually undergo an X-ray of your neck a few months after the operation to evaluate the position of the prosthesis.
It is important to realise that you will have to protect your neck for the rest of your life and apply good neck habits.
Dr Liebenberg consults from selected clinics, when he is in South Africa. Please inquire if you would like to see him specifically.
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