Name of the Procedure:

Arthrodesis, Anterior Interbody Technique with Minimal Discectomy; Cervical Below C2

Summary

Arthrodesis is a surgical procedure where two or more bones in the spine are fused to prevent any motion between them. The anterior interbody technique involves accessing the spine from the front (anterior) and removing a portion of the intervertebral disc to prepare the space for fusion. This specific procedure is performed on the cervical spine below the C2 vertebra.

Purpose

Arthrodesis aims to alleviate pain and stabilize the spine in patients with severe cervical spine issues. It is often performed to address conditions like degenerative disc disease, cervical spondylosis, and spinal instability. The goal is to eliminate motion at a problematic vertebral segment, thereby reducing pain and preventing further degeneration.

Indications

• Chronic neck pain unresponsive to conservative treatments
• Cervical degenerative disc disease
• Cervical spondylosis
• Spinal instability or deformity
• Cervical radiculopathy or myelopathy due to disc herniation or spinal stenosis

Preparation

• Patients may be required to fast for 8 hours prior to the surgery.
• Medication adjustments may be necessary, particularly for blood thinners.
• Preoperative imaging studies, such as MRI or CT scans, are performed to assess the spine.
• A thorough medical evaluation, including blood tests and a physical exam, is conducted.

Procedure Description

1. Anesthesia: General anesthesia is administered to the patient.
2. Incision: A small incision is made in the front of the neck.
3. Discectomy: The surgeon removes a portion of the intervertebral disc to prepare the space.
4. Fusion: Bone graft material or an interbody cage is placed between the vertebrae to promote fusion.
5. Stabilization: Metal plates, screws, or rods may be used to hold the vertebrae together while the bone fusion occurs.
6. Closure: The incision is closed with sutures or surgical staples.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity and number of levels being fused.

Setting

This surgery is usually performed in a hospital's operating room.

Personnel

• Orthopedic spine surgeon or neurosurgeon
• Anesthesiologist
• Operating room nurses
• Surgical technologists

Risks and Complications

• Infection
• Bleeding
• Nerve injury or spinal cord damage
• Difficulty swallowing or hoarseness
• Non-union (failure of the bones to fuse)
• Hardware failure
• Adjacent segment disease

Benefits

• Significant reduction in neck pain
• Improved stability and function of the cervical spine
• Potential improvement in neurological symptoms like numbness or weakness
• Increased quality of life

Benefits are typically realized within a few months as the bone graft heals and fusion occurs.

Recovery

• Initial recovery involves a few days in the hospital.
• Use of a cervical collar may be recommended.
• Physical therapy often begins a few weeks post-surgery.
• Full recovery and fusion can take 6 months to a year.
• Activity restrictions may include avoiding heavy lifting and strenuous exercise.

Alternatives

• Conservative treatments: Physical therapy, medications, and injections.
• Cervical disc replacement: Replacing the damaged disc with an artificial one.
• Posterior or other surgical approaches: Alternate surgical techniques for spinal fusion.

Each alternative comes with its own set of pros and cons related to effectiveness, recovery time, and potential risks.

Patient Experience

During the procedure, the patient is under general anesthesia and feels no pain. Post-surgery, the patient may experience discomfort and pain, managed with medications. Physical therapy and gradual return to activities are key parts of the recovery process. Follow-up appointments are crucial to monitor the fusion progress and overall recovery.