Anterior Cervical Discectomy and Cost in India

Anterior Cervical Discectomy is a surgical procedure to relieve spinal pressure or nerve root pressure on the neck by removing all or part of the damaged intervertebral discs and replacing with a bone graft and/or implant.

This is performed from the anterior or, the front part of the neck. Cervical refers to the part of the spine in the neck.

There are two steps to operating Anterior cervical discectomy:

• Anterior cervical discectomy: It is approached from the front side of the neck. A disc of the vertebrae is removed.
• Fusion: To stabilize and strengthen the neck region, a fusion is done by means of a bone graft and/or implants to the replace the removed disc. It is operated at the same time a discectomy is done.

The surgery is also commonly referred to as ACDF – Anterior Cervical Discectomy and Fusion. It usually is recommended for younger patients from 20-45 years of age. 

Diagnosis for Cervical disease

Anterior Cervical Discectomy is performed due to:

• Cervical herniated disc: This is the leaking out of the disc from the inner core of the disc due to neck injury or trauma. Symptoms are spontaneous, the patient feeling numbness and tingling sensation in the arm and down to the fingertips. There may also be an arm pain and weakness of the muscle. 
• Bone spurs (Osteophytes): An outgrown from the bone caused by arthritis. This indicates a degeneration of spine due to time. Bone spurs may indirectly trigger other spinal disorders like osteoarthritis and spinal stenosis.
• Cervical degenerative disc disease: This occurs when one or more of the cushioning discs starts to wear off in time. The reason may be genetic as some people are prone to rapid wear and tear. Injury, obesity, and smoking could also be reasons that accelerate and cause degeneration of the discs. A person may experience a neck pain which radiates into the arm.

Diagnostic tests

• MRI
• CT Scan
• Myelogram (using X-Rays to examine the spine by injecting a special dye)

Procedure

Before Procedure

• Physical examination of the affected area 
• Diagnostic tests
• Provide all your medical history to your doctor
• You will be informed of your condition, what measures need to be taken and why
• Nonoperative measures like physical therapy or pain medications may be recommended 
• Avoid smoking
• Sleep well and eat a healthy balanced diet
• Fasting is done 8 – 12 hours before surgery
• Remove all nail/acrylic polish, jewelry, contact lenses, dentures, and make-up

During Procedure

With general anesthesia and the patient lying on the back with face upward the surgery has a few steps:

• Anterior surgical approach: A 1-2-inch incision is made on the neck skin horizontally. Sometimes, for a multilevel case, a vertical incision is made. The soft tissues are moved to expose the anterior spine.
• Disc removal: During the surgery, an X-Ray image of the spine is taken to identify the correct disc level. Once the damaged disc is identified, it is then removed. 
• Decompression: Dissection of the ligament is carried out to observe any disc material which might have contributed to spinal stenosis. Along with this, any bone spurs present are removed to relieve pressure from the spinal cord or nerve roots. This is done with an operating microscope with microsurgical neurological techniques. 
• Cervical Fusion: After discectomy is done, a bone graft (from the patient’s own or bone bank) and possibly a titanium implant or cage is inserted in the disc space. This prevents the disc space from collapsing and promoting the fusion of two vertebrae into one unit.  It also helps in decompression as it allows adequate room for the spinal cord and nerve roots. At the front of the spine, a small plate is often attached with screws into the vertebral bones to reinforce stability across the disc space and help with the fusion process. With fusion, bone is formed in the disc space uniting the vertebral bones above and below into one bone. The incision is closed with sutures and may be dressed with a small gauze bandage. 

After Procedure

• A hospital stay could be at least a night depending on the patient, it could take around 4 – 6 days as well.
• After being discharged, you will be asked to do a follow-up 4 – 6 weeks after surgery, including an X-Ray to inspect and monitor the healing process.
• You will feel soreness, swelling, and pain, but oral pain medication will be given to you.
• Physical therapy will be recommended once the healing has taken place. This could be 6 – 8 weeks after surgery.
• Patients are advised against taking anti-inflammatory agents for 3 months and refrain from elective medical procedures like dental work for at least 3 months. 

Advantages of an ACDF procedure

• Anterior approach helps indirect access to the spine. It provides visualization and direct access to the cervical spine.
• There is a lesser postoperative pain. Anterior approach makes it uncomplicated to perform the procedure and gives lesser incision pain.

Risks and complications of ACDF

The risks and complication arising from this procedure is variable and depends on many factors like:

• Result of the surgeon’s ACDF surgery
• Patient’s health and lifestyle conditions like a condition of the disc, bone strength, smoker or non-smoker and other factors.
• Inadequate relief after surgery
• Trouble swallowing (dysphagia) that could last from a temporary few days to persistent months
• Failure of bone graft to heal thereby creating a non-union or pseudarthrosis
• Damage to the nerve root, spinal cord, or vocal cord 
• Infection
• Spinal fluid leakage
• Excessive bleeding