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Anterior Cervical Disc Replacement

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About The ProcedureAnterior Cervical Disc Replacement

An artificial cervical disc seeks to replace the movement and cushioning function of damaged cervical disc.

Anterior cervical disc replacements are done through an incision on the front of the neck. The incision length can be as short as an inch and a half but varies based on how many levels are being operated on and the size of your neck.

After making the incision Dr. Paul gently retracts the esophagus, trachea and blood vessels to gain access to the front of your spine.  He then removes the disc and removes the disc, or bone.  This is done in a manner to relieve pressure on the spinal cord and nerves.

Additional bone and ligament may be released to restore normal height and alignment to the disc space. This is done to improve the long term health of your spine and avoid future surgeries. The disc replacement is then inserted. A plastic surgery closure is used for the skin.

Your disc replacement is MRI compatible, but can create some artifacts on future cervical spine images. It is not known to set off metal detectors.

How long does it take Dr. Paul to perform the Cervical Disc Replacement?

Surgery times vary extensively but we can provide some guidelines. Surgery typically requires 45 minutes to one hour and fifteen minutes.

Additional time can be required in cases of prior surgery. Remember, there is substantially more time involved in putting you to sleep, prepping, and draping prior to surgery and then the additional time required to wake you up. As a result, many hours are required.

Dr. Paul usually calls the waiting room to update a family member or friend about you. Kevin or Adam will also typically check on you in the recovery room and speak to the nurse and Dr. Paul about your recovery. Nursing will let your family know when they can see you. The wake-up and recovery time varies quite a bit but is often more than two hours.

Anterior Cervical Disc Replacement Patient Animation Video
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Preparing for Surgery

Making arrangements before surgery helps ensure all necessary steps are taken and allows you to focus on recovery.

Day of Surgery

Information to help you arrive on time for your procedure and to better help you understand the process on procedure day.

After Surgery

After surgery, you can expect to have some pain. Your surgeon and the staff will use every reasonable measure possible to help.

Recovering at Home

Exercise is extremely important; activity stimulates circulation and deep breathing which speeds recovery.

Preparing for Surgery

Making arrangements before surgery helps ensure all necessary steps are taken and allows you to focus on recovery.

Day of Surgery

Information to help you arrive on time for your procedure and to better help you understand the process on procedure day.

After Surgery

After surgery, you can expect to have some pain. Your surgeon and the staff will use every reasonable measure possible to help.

Recovering at Home

Exercise is extremely important; activity stimulates circulation and deep breathing which speeds recovery.

Common Surgical Risks

We have attempted to define the more common risks of surgery under each of the procedures outlined. It is impossible to outline all potential poor outcomes, but we have attempted to do so in good faith. It has not been formed as legal protection for us – only to better inform you. Please read them thoroughly.

Infections are a known complication of lumbar surgery. Infection rates are more associated with smoking, poorly controlled diabetes, obesity as well as other health factors. Less invasive and shorter procedures also have lower complication rates. Infections requiring additional surgery are extremely rare in Dr. Paul’s practice.

Bleeding can be a serious complication since blood accumulation can compress the spinal cord or nerve roots. For that reason we require discontinuing blood thinners, some anti-inflammatories and all herbal medications.

Spinal Leaks are a known complication in spine surgery but typically can be managed. They occur approximately 3 to 5% of the time They can be the result of adherent bone, disc, ligament or scar tissue to the dura and the membrane surrounding your nerves or spinal cord. They are far more associated with revision surgery, severe nerve compression and advanced age. If this occurs, we typically repair the leak during your operation. You may be required to lay flat for a short period of time afterwards. Late presenting or persisting spinal leaks can require additional surgery. Spinal leaks typically do not affect long term outcomes.

Neuropraxia & Nerve Injury nerves under pressure can react with pain or increased weakness after being decompressed. These issues are expected and usually resolve with treatment or time. The goal of fusion is to realign and improve the position of the spine which can cause some nerves to be stretched and also induce typically temporary changes. Rarely, these changes are permanent As a precaution, Dr. Paul utilizes a state of the art nerve and spinal cord monitoring system to avoid neurologic problems.

Non-Union not all fusions heal. Some heal as early as three months but many take longer. Some fusions require a year to heal. Dr. Paul’s team gets x-rays regularly during the first year and meets with you to make sure the fusion is successful. Some fusions will require revision surgery to fix the problem.

Medical Complications related to the heart, lung and kidneys  and other organs are also a possibility. Although shorter less invasive procedures are associated with lower complication rates, they can still occur. We work closely with your primary care doctor and other specialists to make sure your medical conditions are optimized prior to surgery.

How Do People Function After ACDR Surgery?

The average person should have reasonable functions from day to day. The exception would be people involved with significant overhead activities, such as tradespeople. People with pre-existing stiffness may still have some. Disc replacements do not replicate the natural motion of the spine. If you had neck pain prior to surgery, you may still retain some after surgery. The focus of neck surgery is on neurologic arm symptoms and spinal cord issues.

Most of the surgeries performed by Dr. Paul are for degenerative conditions like a herniated disc, spinal stenosis. If you have had surgery at one level in your spine, it would be reasonable to assume you could have problems at the same or other levels. Since the spine has 36 levels, this is not unusual. Most people handle degenerative difficulties with self-care and non-operative care. That being said, Dr. Paul and his team go to great lengths to minimize the chances of needing additional care for your spine. That includes careful surgical planning, intraoperative decision making, and post-operative care.

In the early weeks you should gradually increase activities. Remain on your feet for more extended periods and improve your walking distances. You may return to a sedentary job in as little as 1-3 weeks. Minimize lifting more than 10 pounds. Elevate laptops and computer screens.  Avoid overhead activity. You may start a regular aerobic activity such as vigorous walking, Stairmaster, or low impact aerobic exercise classes if allowed after the first follow up appointment. This is typically in 2-3 weeks.

Click here to learn more about the first 12 weeks after surgery.

It is not uncommon to feel mildly depressed or anxious for the first 4-6 weeks of surgery, but those feelings should go away as your daily activities and exercise resume. This is more common with larger or multilevel surgeries. If the depression continues, please consult with your primary care doctor.

You may return to light duty or physical labor if pain-free and allowed by your surgeon. You may drive up to one hour. You may swim if allowed by your surgeon. Continue your physical therapy exercise program. You may be shown specific therapeutic exercises at your six-week visit.

Preparing For Surgery

Things to do Leading up to Surgery

Optimization For Spinal Surgery

Before undergoing surgery, Dr. Paul and his team will work with your primary care provider and other specialists to optimize your health to minimize the risk of complications.

Cardiovascular Health

People who have had cardiac interventions such as stents, ablations and surgery or a history of significant cardiac diagnoses will need to see their cardiologist prior to surgery. Your cardiologist may require additional testing or interventions prior to surgery.

Smoking

We require all patients undergoing spine surgery to quit smoking two weeks prior to surgery. Nicotine is a significant risk factor for many complications, including infections, recurrent nerve problems, fusions failure, and others. Click here for more information and support.

Obesity

A BMI over 35 is associated with major complications from spine surgery. Your pain and recovery are also adversely impacted by excess weight. If your BMI is over 35 we postpone surgery because the weight must be improved. We are happy to offer additional help from our weight loss clinic. For more information, see our DMG weight loss clinic by clicking here.

Supplements to Begin Before Surgery

We recommend all our patients start the following regimen of supplements two weeks prior to surgery. There is some evidence that they improve wound healing and bone healing (if fusion is required).

Calcium

Calcium is essential for normal bodily functioning. If not received in great enough quantities, the body will look to mobilize other sources, namely the bones. Naturally, this leads to weakening of the skeletal system, and increases the risk of injury. Adults should aim to consume approximately 1000 mg of calcium per day.

Vitamin C

Necessary for the formation of collagen, vitamin C is another essential supplement if normal daily intake is inadequate. Collagen is used in bone building and supports the skeletal system in connective tissues. A recommended daily dosage is at least 1000 mg.

Vitamin D

Another crucial vitamin for healthy bones, vitamin D aids in calcium absorption. Inadequate levels can lead to thin or brittle bones prone to damage. Optimal daily intake for adults is approximately 1000 IU.

Pre-Operative Timeline

2-4 Weeks Before Surgery

  • Attend PCP appointment
  • Choose Your Coach (see below for suggestions):
  • If recommended by your surgeon, see your current specialists for medical clearance
  • If you are a smoker, you should stop using tobacco products. Please read information about
  • Stop all herbals and supplements, vitamins, and appetite suppressants 14 days before surgery
  • Stop non-steroidal anti-inflammatory medications (NSAIDs) such as Motrin, ibuprofen, Advil, Aleve, Naproxen, and others 10 days before surgery
  • Stop taking herbals, Vitamin E, Fish Oil, 14 days before surgery
  • Stop taking appetite suppressants 14 days before surgery

1 Week Before Surgery

  • Prepare your home
  • Start using the Hibiclens 4% solution 5-days prior to surgery.
  • Fill post operative pain prescriptions from Dr. Paul’ office.*
  • Confirm your ride home from the Westmont Surgery Center or Edward Hospital.

Day Before Surgery

  • Use your Hibiclens 4% solution (4oz or 8oz) as instructed the night before surgery
  • Stop eating solid foods at 10pm.
  • Pack your bag along with walker/cane, Any brace IF ORDERED, loose fitting clothing for the ride home and insurance information.
  • Set your alarm and wake up 3½ hours prior to your scheduled arrival time.

Morning of Surgery

Approximately 12 hours prior to scheduled surgery:

  • Drink 12 oz of regular Gatorade (not red) – finish in less than 30 minutes. If you oversleep or miss the alarm, do not drink Gatorade.

Approximately 4 hours prior:

  • Drink another 12 ounce bottle of Gatorade and take the two Tylenol (500mg each) with a small sip of water.
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Stopping Medications Before Surgery

Because of the risk of bleeding we require you come off the following medications for at least ten days prior to surgery. You may need to get clearance from the prescribing physician to allow a pause in these medications.

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Why Do I Need a Coach?

Suggestions for choosing your coach..

The Days After Surgery

Post-Operative Information

The First Few Days After Surgery

Incisional Care:

Be sure to keep the wound dry by changing the dressings at least once a day, more if needed. Your incision may drain for the first week or so after surgery. This is common and expected and should lessen as you get further out from surgery.

Regular dressing changes will prevent problems. A wet dressing will breakdown the healing skin and may lead to delayed healing and possibly infection. You may shower 72 hours after surgery, but you must keep the wound dry. If you cannot keep the wound dry, please take a sponge bath until your first postoperative visit to discuss. Concerning signs include foul smelling drainage and a “tomato red” wound.

How to handle post-operative pain:

Naturally, once anesthetics have worn off, pain will become increasingly evident in the areas involved in a surgical procedure. You may not have much incisional pain after surgery because there is local anesthesia injected at the time of surgery. This will wear off in the evening. We recommend you use the pain medicine prescribed or muscle relaxant to avoid the potential for getting behind your pain.

Dr. Paul will prescribe pain-killers, also known as analgesics, to reduce the discomfort of this post-surgical recovery period. Medications prescribed can range from over-the-counter NSAIDs (after the first five days) to potent prescription opioids depending on the projected severity of pain.If you are or have undergone a fusion procedure, you should avoid NSAIDs for the first 6 weeks.
Patients should take care to manage their dosing relative to the pain experienced. Opioids can usually be tapered off within the first two weeks of surgery. NSAIDs may be taken with protective measures for the gastrointestinal system such as proton-pump inhibitors (PPIs) such as omeprazole, antacids such as TUMS, and bismuth salts such as Pepto Bismol to reduce the risk of ulcer formation.

Night Time and Transitions:

It is very common to have increased pain at night and when you first get up out of bed. Any time you remain in one position for an extended period of time the muscles may tighten and swell and you can experience pain. As a result, transitioning can bring on pain.
Transitioning includes lying to sitting, sitting to standing. Anticipate this and use medication appropriately and or take time to do these activities. Do not try to move quickly. You won’t do anything to harm your surgery but you may have an increase in pain. This will improve with time.

Stairs and Toilets:

You may have some mild to moderate discomfort going up and down stairs immediately after surgery. However, you are allowed to do so since you will not hurt yo