This rather common procedure is performed by most surgeons trained specifically in the field of spine surgery.  It is usually offered to the patient who is suffering from a herniated disc or narrowing of the tunnel that the nerves pass through.  The section regarding Cervical (neck) radiculopathy reviews this subject and should be examined by the reader.   The decision to undergo this procedure should be carefully discussed with your spine surgeon.  Furthermore, the ultimate responsibility for making the final decision of undergoing this surgery lays upon the patient. 

First, the procedure will be discussed followed by some issues special for this procedure.  Patient is prepared by the staff prior to the procedure, seen by the anesthesiologist and is brought into the operating room.  In most cases medications will be provided to relax the patient since this time is usually anxiety provoking.  Patients are then anesthetized and respiratory support is provided.  No memory to these events will be present after recovery from the procedure.  The area of the skin is prepared to remove any bacteria, reducing risk of an infection.  An incision is placed over the skin in front of the neck and the first muscle layer (Platysma) is cut and retracted.  The blood vessels and the other muscles groups are pushed aside and an interval is developed between these outer structures and the trachea (windpipe).  Deeper dissection leads us directly on the spine.  The offending level is identified by X-ray and the disc is removed from the specific intervertebral space.  Some surgeons choose to use an operating microscope (as seen on the left) yet other may choose special magnifying glasses.  After removal of the disc, the space must be filled with bone to facilitate fusion and prevent later deformity.  Refer to the section below for a discussion regarding bone grafting and their sources.  The exact measurement for the space is taken and appropriate sized bone graft is placed.  When appropriate, we choose to supplement the bone graft with a plate and screws.  This provides added support to the construct and maintain the alignment of the bone graft.  Some studies show faster and higher rate of fusion using a metallic plate.  We utilize Titanium plates since it does not interfere with MRI scans should it be needed at a later time.  A drain is placed in the wound to drain any blood that accumulates in the wound and the skin is carefully closed.  We utilize a special technique of skin closure to achieve a more cosmetically pleasing scar.  All of our sutures are buried under the skin surface and this avoids the suture tracks seen with other techniques.  A more cosmetically enhanced scar is important to most of our patient since it is located in front of the neck.  Sterile dressing is applied to the wound and the patient is awakened from the anesthetics.  A neck brace is then applied and the patient is taken to the recovery room.  After a short stay in the recovery room, patients are taken to their room and usually discharged the following day.  Post operative pain is usually minimal.  Most patients will complain of sore throat which resolves within a few days.

Few Basic concepts regarding this procedure are noteworthy.  Some surgeons choose to perform this operation in a surgical center on an outpatient basis while others may choose to admit the patient for one to two days in the hospital.  This decision should be made prior to the date of the procedure and make appropriate arrangements.  Second important factor is bone grafting.  After removal of the offending disc, an empty space remains in that area that is replaced by bone.  This bone can be harvested from the patients hip area (Pelvis) or can be provided by donated bone from cadaveric specimens.  The disadvantage of Autologus (patients own bone) is the moderate to sever post operative pain and the possibility of infection in the donated area.  Of note is the fact that autologus bone has a slightly higher rate of fusion and better results.  The advantage of cadaveric bone is that it avoids the pain that is associated with harvesting from patients own pelvis.  Slightly lower fusion rates have been reported with cadaveric bone but when this bone is supported by screws and plates implanted in the area, the fusion rates and success of surgery are comparable.  Currently the use of cadaveric bone vs. bone from the patient depends on patient and surgeon preferences.  Even though it is still possible to transmit disease using cadaveric bone, its chances are comparable to being struck by lightening.  Cadaveric bones are obtained from bone banks and undergo rigorous testing procedure before being provided for operative procedures. These issues are usually discussed prior to the procedure between the patient and surgeon.  

Patients may have a concern regarding the adjacent levels which are healthy and their risk for deterioration after this operation.  Indeed, there is elevated stress on the neighboring spinal segments with any fusion procedure.  However, most patient will undergo a recovery period and will not be bothered by adjacent level disc disease.  The surgeon must decide which level or levels to fuse and diagnose the level causing the pain and dysfunction.  This could be a very difficult task and could be confusing.  Your surgeon will base his decision based on his judgment and experience to arrive at a logical and reasonable surgical tactic.   The ultimate goal of the surgery is to relieve the pressure over the nerves, remove the offending disc, and achieve fusion between the two spinal segments to avoid deformity and instability of the neck.  

After the operation the patient will periodically follow in the office to monitor for progress and healing.  The incision is carefully examined to make sure its healing progress and detect any early stage infection.  X-rays are taken periodically to follow the fusion process which may take 3-6 months until completion.  We will carefully look at X-rays to see the alignment of any metallic implants placed.  Once fusion takes place, the metallic plates and screws have no function but they remain in place since their removal requires another surgery.  Usually patients are un-aware of their existence and have no complaints regarding these implants.  

Complications are infrequently seen but are discussed with patients prior to the procedure.  Included here are only the most common ones and as we continue to improve medical technology and science we discover new complications as well.  Fortunately, these complications are usually manageable.  The most common complaint patients have is sore throat.  This usually resolves on its own but can be helped with an anesthetic solution which is used to numb the throat.  Other complications include but not limited to infection, bleeding, damage to nerves and vessels, injury to the tube carrying food to our stomach (Esophagus), injury to the wind pipe (trachea), nerve injury, spinal cord injury and others.  However these are rare events and each one deserves a whole section of information.  

In summary, the patient should have an understanding of the procedure in advance.  You should trust your surgeon to do the best he can and lead you to a productive, pain free, and functional life to enjoy.  Still much more information is available regarding your disease and proposed surgical procedures.  Other alternative procedures are available and include procedures that approach the neck from the back.  For a summary alternative procedures refer to Cervical Foraminotomy, Cervical Micro-Endoscopic Foraminotomy, and Cervical Laminectomy.