When will I be back to my normal activities, i.e. driving?
A. Most people return to normal activities including driving by 6 – 9 weeks, depending on the surgery.
A. This depends upon the number of levels fused; however, most patients can get back to some reasonable level of activity within a few weeks.
Will I have to wear a collar after surgery?
A. We use a soft collar in some cases to help control the neck and take stress off the neck muscles after surgery. Some patients feel better wearing a collar. After 4 – 8 weeks, the collar is no longer required.
A. This is surgeon dependent. For patients who have anterior fusion surgery at a single level with instrumentation, I do not believe a collar is necessary; however, patients who have over a two-level fusion with anterior surgery, I do place patients in a collar for usually six to twelve weeks.
What are my risks?
A. Failure to improve is the most common. Less common complications include failure of fusion, infection, nerve root or spinal cord injury, difficulty swallowing, need for further surgery to extend the fusion, and injury to the adjacent structures in the neck.
A. Anytime we operate on the cervical spine, there is a slight risk for paralysis, continued nerve root injury, non-union of the fusion, failure of the instrumentation, and hardware loosening. Also, in anterior cervical surgery, there is a chance of significant bleeding and injury to a nerve that goes to your voice box.
What are my chances for success?
A. Excellent pain relief with disk surgery occurs in >90% of patients. In our experience, for patients who require more extensive decompression and fusion, the success rates are usually above 80% for most procedures.
A. The chances for complete pain relief for actual neck pain are not great. In most papers reported results decrease the neck pain from 70% to 80% or 85%. If one is talking about relief of arm pain from a herniated disc, that success rate is greater than 90% to 95%.
Will I have pain after my surgery?
A. Pain relief is related to the severity of the problem, the occurrence of complications, and a host of other factors. Rest assured that with current techniques, by far the majority of patients are much better after surgery than they were before and would do it all again.
A. Everyone will have some level of discomfort after surgery. This is usually very short lived. Physical therapy usually helps to decrease this even further to the point where most patients do not have significant discomfort after neck surgery.
Will the surgery lessen my mobility?
A. Each segment in the neck fused results in a 7% loss of motion. For most people, this is not even noticeable. Many patients already do not have much motion of the segments being fused so they would not notice much difference in their ability to move or bend the neck.
A. In some cases with longer fusions of the cervical spine, decreased head/neck range of motion is noted; however, in most single- level fusions the patient will not notice any decrease in mobility or any significant stiffness.
Should I have allograft or autograft bone?
A. The fusion rates for autograft and allograft for single level fusions is the same. There is pain associated with the autograft harvest site, so we use allograft whenever possible.
A. For a single-level fusion from the front or anterior aspect of the neck, it makes no difference whether you have allograft or autograft. For multi-level fusions, i.e. more than a single level through an anterior approach, it has been shown that autograft is a better choice.
What affect does the fusion have on the rest of the cervical spine?
A. Fusing the spine does increase the stress seen by the adjacent disks and joints. Whether this added stress translates into a new source of pain or instability is harder to predict.
A. Fusion in any area of the spine will cause increased stress on the levels right next to it. To that end, those levels will wear out slightly more quickly than if you did not have a fusion.
Why is surgery often done through the front of the neck?
A. Many of the problems in the cervical spine can be better addressed through the front of the neck, leaving the neck muscles in the back undisturbed. This allows for a quicker rehabilitation of the neck muscles after the fusion heals.
A. Surgery is done through the front of the neck because the disc is often the cause of the pain and/or neurologic dysfunction. Reaching it from the back is dangerous secondary to the spinal cord's being in the path of getting to the disc.
When do I need a fusion?
A. Fusing painful joints helps get rid of neck pain. Fusion is appropriate after cervical discectomy or spinal cord decompression in order to stabilize the neck, prevent neck pain, and protect the nerves from getting pinched again.
A. Patients need a fusion for instability of the spine and at times for some neurologic problems.
Will I have irreversible damage if I delay surgery?
A. Only in cases of significant spinal cord or nerve compression with functional deficits is surgery emergent or urgent. If significant weakness is present, waiting longer than 3 months for surgery is associated with a poorer return of muscle strength. In general, nerves that have been chronically and severely pinched do not respond as well as nerves that have been pinched a short time.
A. In some cases with nerve root injury or spinal cord injury, delay of surgery can cause permanent damage; however, surgeons cannot tell you exactly when that time of irreversible damage will occur.
When do I need surgery?
A. Surgery is appropriate when conservative care has not helped and you decide that you are tired of living with your pain.
A. Surgery is needed in the true sense of the word mainly in three instances, one with paralysis or other neurologic dysfunction, two with infection of the bone, and number three, with instability of the cervical spine.
Are there alternative therapies available to help me deal with my pain?
A. Physical therapy, daily exercises, gentle traction, a cervical collar, medications, and epidural steroid injections can help patients improve without surgery. Passive forceful manipulation of the neck (chiropractic) should be avoided since it can cause worsening and even catastrophic complications.
A. Many patients can undergo pain management, which can include injections. Medications can also be tried. Physical therapy can also be tried to help avoid surgical intervention in patients who have pain that has not been alleviated with rest or time.
What can I do to avoid surgery?
A. Physical therapy, daily exercises, gentle traction, a cervical collar, medications, and epidural steroid injections can help patients improve without surgery. Depending on the severity of the problem, surgery may be the only realistic option for achieving relief from pain.
A. Most spinal problems including neck problems do not need surgical intervention. Surgery is only necessary for patients who have neurologic disorders, some infections of the bone, and tumors.
Should I have an MRI if I have pain?
A. An MRI provides valuable information about the status of the spinal cord, nerves, disks, and joints in the cervical spine. When abnormalities in these structures are suspected due to the presence of arm pain, numbness or tingling, or severe neck pain, an MRI helps clarify the diagnosis.
A. Pain in the neck proper does not warrant an MRI unless the patient also has neurologic symptoms such as weakness in the arms and legs, inability to control bowels or bladder or pain in a single nerve distribution of one arm. Reasons to obtain an MRI include pain that has lasted for greater than six months and is not relieved by conservative care.