Question:My wife is going to have discs removed from her neck for a problem called myelopathy. I know the surgeon is going to fuse the neck in three places. They make it sound all so simple. Is it really that straightforward? I can't tell my wife but I'm feeling a little nervous about it all.
Answer:Any surgical procedure has its challenges and potential problems. The surgeon will go over with you and your wife what to expect during and after the operation.
The operation itself is carefully planned and orchestrated right down to how the patient is positioned and where to make the first incision. Imaging technology such as fluoroscopy help guide the surgeon throughout the procedure.
Fluoroscopy is a special type of X-ray that gives the surgeon instant images during any stage of the operation. For example the fluoroscope makes it possible for the surgeon to know for sure that the correct spinal level is being operated on.
As each disc is removed, the surgeon smoothes away any bone spurs and flattens the bone back to its original shape. Traction can be applied to restore the spine to its natural length. Various methods of bone grafting can be used. The patient makes this decision with the surgeon during a preop visit.
Problems can occur with any surgical procedure. In the case of discectomy and fusion, the type of problems may depend on the approach used for the operation. Many surgeons choose to operate from the front of the neck (anterior approach). With the anterior approach, there is a chance that the vocal cords or nerve to the vocal cords can get damaged.
Difficulty swallowing and hoarseness can occur. Newer techniques developed in the last few years have decreased the incidence of these problems dramatically. Most nerve damage is temporary and only last a few weeks or months. Permanent vocal cord paralysis occurs in about three per cent of the patients.
The benefits of this surgery are reduced pain and a stable neck. Restoring the natural disc height will also prevent further damage from occurring at the level above and below the problem area. Most patients do very well and don't even need a collar or brace after the operation.Virany H. Hillard, MD, and Ronald I. Apfelbaum, MD. Surgical Management of Cervical Myelopathy: Indications and Techniques for Multilevel Cervical Discectomy. In The Spine Journal. November/December 2006. Vol. 6. No. 6S. Pp. 242S-251S.
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