Print out instructions for spine surgery below.

ANTERIOR CERVICAL DISCECTOMY AND FUSION

Most likely, the pain, numbness, or weakness in your neck, arms, hands or legs, has ultimately led you to seek help. You have been diagnosed as having a cervical herniated disk and require an Anterior Cervical Discectomy. Disks are the shock-absorbing cushions between the vertebrae of your spinal column. These disks can herniate for a variety of reasons, including age, stress, strain and sudden impact.

Herniation of the disk results in the soft inner contents of the disk pushing through the fibrous outer wall and pressing against the nerves that run parallel to the spinal column. These nerves affect the arms and hands.  If the herniation is more central, the spinal cord can be compressed and cause symptoms down the entire length of the spine which may include difficulty walking or impairment of bladder or bowel function.
Even slight movement can cause the nerve or spine to be irritated and thus cause pain, numbness and weakness in the arms, hands or legs. The Anterior Cervical Discectomy procedure is designed to remove this herniated material from the nerves and relieve your symptoms.

This procedure is done through a small incision in the front of the neck. There is minimal trauma to the neck tissues and the intervertebral disk and/or bone spurs are removed anterior to the spinal cord. This approach allows for minimal spinal nerve or cord traction and thus a quicker recovery period. A small piece of bone graft is placed in between the verbebral bodies to occupy the disk space.  Then, a small plate is placed on the anterior aspect of the cervical vertebrae in order to provide stability.   The plate can be seen on the x-ray below. 

Testing before your Surgery

· On the day of your office visit, you will receive a prescription for pre-surgical testing to detect any abnormalities. These tests can be done up to one month prior to your surgery date. The results must be reviewed by the neurosurgeon's office no later than three working days before your surgery date. The prescription allows Passavant Hospital or any certified laboratory approved by your insurance company, to do the tests and forward the results to the neurosurgeon's office for review.

· You will also receive a medical clearance form to be completed by your primary care physician.  This form should be completed no more than thirty (30) days prior to your surgery and faxed to our office at 412-630-7644.

· If you see any medical specialists, such as a cardiologist or endocrinologist, please notify our office.  Sometimes it is necessary for these physicians to provide clearance prior to your operation.

∙ If you need pain medications or have any questions before your surgery, please contact our office at 1-877-635-5234.

The Procedure and its Benefits

Anterior Cervical Discectomy Fusion takes about one to two hours to perform. Your incision will be about 1 to 2 inches long on the anterior side of your neck.  You may be required to wear a cervical collar after your surgery.  Some patients need a soft collar and others require a more rigid collar.  Your surgeon will order a specific collar for you depending on your type of surgery.

The risks involved with this type of surgery are: Infection, excess bleeding, damage to dural nerve root, bladder and bowel dysfunction, cerebrospinal fluid leak, no relief of symptoms, excess scarring, increased neurological dysfunction, anesthetic complications, complications related to hospital stay and/or positioning, damage to adjacent structures like esophagus, trachea, carotids and nerves, hardware failure, screw fracture, difficulty swalowing and/or death.

Generally, you will be walking the day of surgery and can be discharged one to two days after your operation. If you have any further questions regarding these risks, please contact our office.

After surgery, minor discomfort from your incision is common but temporary. This can be relieved with mild pain medication. Following the procedure, you may experience persistent numbness, weakness and pain along the path of the nerve that was decompressed, but these symptoms are generally temporary and gradually go away.

Members of the health-care team

You will meet a number of health professionals during this time. Their goal is to help you recover and return you to your prior activities. A brief description of each of these professionals follows:

Neurosurgeon. You have already met this person, who will perform the surgery and direct your care afterward. Please feel comfortable asking questions of your surgeon - communication is an essential key toward recovery.

Nurse. A nurse will obtain information and assess your condition both in the surgeon's office and in the hospital. The office nurse will evaluate you before you see the surgeon and again with the surgeon at the time of your visit. The office nurse will help explain the procedure, answer questions and arrange your surgery. The hospital nurse will assess you in the hospital, and help you before, during and after your surgery. The nurse also will answer questions from you and your family.

Physician assistant. The physician assistant (PA) has been trained to perform many tasks done by a physician. The PA will perform your history and physical examination and review the surgical procedure. The PA can answer questions and will follow you in the hospital after surgery, along with your physician. The PA will review your discharge instructions on the day after your procedure and facilitate your discharge planning.

The day of surgery

One to two days prior to surgery you will be contacted by a nurse in the surgical department at Passavant hospital, who will review your health and medication history. If you have not received a call by 3:00 pm, the day before your surgery, please call 412-367-6567. Please be prepared and have a list of questions and your medications by the phone.  This nurse will tell you what time you need to arrive at the hospital for your operation.

You will be thinking of many things on the day of your surgery, and it is only natural to be overwhelmed and possibly confused about what to do. This information and other information provided can help you become familiar with the process involved with your hospitalization and surgery. We hope that these help to answer your questions and reassure you about your procedure.

Arrival at Passavant Hospital

Plan to arrive at Passavant Hospital on the first floor and take the main elevators to the second floor.

· Eating or drinking after midnight the night before surgery is NOT permitted unless otherwise instructed.

· You will be visited by a nurse and/or PA, who will perform a preoperative assessment.

· Results from your laboratory work will be reviewed again.

· If you have a family doctor clearance letter, it will be collected.

· You will meet with the anesthesiologist who will review the risks of general anesthesia and answer your questions about the anesthetic.

· Your neck will be scrubbed by the nurse in preparation for surgery.

· An intravenous (IV) line will be inserted, and you will be given antibiotics and fluids.

Operating Room

Located on the Second floor

· You will meet with a nurse and nurse anesthetist who will take you back to the operating room. 

· You will be asked to review your name, date of birth and procedure outside of the operating room and again when you enter the operating room.

· After surgery, you will be taken to the Recovery Room.

Recovery Room

Outside Operating Room

· Your vital signs will be checked frequently, the surgical dressing will be checked and your symptoms will be assessed.

· You may receive pain medication.

· Your IV fluids will continue.

· You will not be allowed to eat or drink.

· An anesthesiologist will discharge you from the Recovery Room after you are completely awake, which usually takes one to two hours.

· You then will be taken to the Patient Unit located in Passavant Hospital

Your family will be informed as to which Unit you will go to.

Patient Unit

Passavant Hospital

· The nursing staff will assess you on arrival to the floor and monitor your progress.

· Your IV line will be removed after you drink fluids.

· You will be asked to take deep breaths to prevent pneumonia and do ankle and calf exercises to prevent blood clot complications. Pain medications are available; you should ask for this if you need it.

· You will be assisted out of bed the first time you get up. Then, you are encouraged to walk on your own in your room and the halls.

· The PA will remove the operative dressing the morning after surgery.  You may have a drain that will also be removed.

· Generally you will be allowed to remove your cervical collar for showering, but you must hold your head and neck in a neutral position. Please discuss this procedure with your nurse.

· You will be encouraged to ask the staff any questions.

Discharge

· Most patients will need to wear a cervical collar for several weeks. Instructions as to the care and application of the collar will be provided. Generally you are discharged one to two days after surgery. Your nurse and PA will discuss your discharge instructions. Please prepare questions to ask at this time.

· You will be given a discharge instruction sheet that will include restrictions, activities, physical therapy, medications and care of the incision.

· Remember to arrange your transportation home prior to this day. You will not be allowed to drive yourself home. If you anticipate a problem with your transportation, please notify the staff prior to your surgical date. The discharge time is before 11 am.

Discharge Instructions

· A follow-up appointment will be given to you on your day of discharge.  If the time or location is not convenient, please call 1-877-635-5234 to reschedule.

· Until you are seen in follow-up, you should limit your activities.  You may walk as much as you would like.  However, you should avoid lifting more than five pounds or bending. 

· You may not drive until you are seen in follow-up.

· Your cervical collar should be worn at all times unless otherwise directed at discharge.

· The dressing should be changed daily with dry gauze and tape.  You will be given supplies when you are discharged. 

· You will be given prescriptions for a pain medication, muscle relaxant and antibiotic.  Take these medications as instructed.  Make sure to ask questions at your discharge time.

· You should call our office immediately if you experience any of the following:  fevers, chills, night sweats, swelling at the incision, redness or drainage from the incision, shortness of breath, sudden difficulty swallowing or hoarseness, new weakness or pain in your arms or legs.

∙ After your operation, if you have any questions regarding your incision or symptoms that you may be experiencing, please contact our office at 1-877-635-5234.

Most of the information you will need about your stay is in a brochure you will receive or the UPMC Information Handout, included in your admission packet. Pertinent telephone numbers, directions, maps, lodging and parking information are highlighted in the handbooks. Your discharge instructions will help you become familiar with any limitations you will have after surgery.

Call, toll-free, at 1-877-635-5234 to learn more.

DISCLAIMER: Every effort has been made by the author(s) to provide accurate, up-to-date information. However, the medical knowledge base is dynamic and errors can occur. By using the information contained herein, the viewer willingly assumes all risks in connection with such use. Neither the author nor UPMC shall be held responsible for errors, omissions in information herein nor liable for any special, consequential, or exemplary damages resulting, in whole or in part, from any viewer(s)' use of or reliance upon, this material.

 CLINICAL DISCLAIMER:Clinical information is provided for educational purposes and not as a medical or professional service. Person(s) who are not medical professionals should have clinical information reviewed and interpreted or applied only by the appropriate health professional(s).

© 2008 Tri-State Neurosurgical Associates - UPMC