Introduction

Neck pain is very common and most of us will experience it at some point. With the right approach, basic neck pain can be avoided. This advice booklet will describe some of the basic ways you can prevent neck pain.
The spine is made up of 33 small bones, called vertebra, stacked on top of each other in an ‘S’ shape. Not all spines are the same ‘S’ shape but they are usually curved at the neck and lowest part of the back.

This shape should be kept in mind when you move to maintain the natural curves in your neck and back whatever you are doing. Each of the vertebrae has a disc in between them which acts like a shock absorber. Spinal nerves pass between each vertebra next to the disc and travel to the arms and legs. These nerves allow us to move our muscles and feel things at different parts of our body.

What is a disc?

What has happened to my disc?

What is stenosis?

Discs are tough yet flexible and allow the spine to bend and twist. Discs have a central part filled with a rubbery substance called the nucleus. The outside wall is called the annulus which is made from tough and flexible fibres. The annulus is a very strong substance which is usually able to heal and ‘reseal’ itself after surgery.

What happens during surgery?

Posterior cervical decompression/fixation

Disc replacement

Expectations of surgery

Your surgery will take place in an operating theatre, where you will be put to sleep by an anaesthetist. The operation is performed under general anaesthetic. Different types of surgery include:

Anterior cervical decompression and fusion (ACDF)

A small incision is made in the front of the neck. The throat structures are moved to the side and the operation is performed between these and the blood vessels that are supplying the brain. The disc that is pressing on the spinal nerve or spinal cord is removed. A bone graft and a cage are used to stabilise the bones and maintain disc height to promote fusion.
Once the surgical procedure is completed the incision is closed with either stitches or clips and a sterile bandage applied.

A small incision is made in the back of the neck. A small section of bone and ligament from the spine are removed so the nerves have more space. This is called a laminectomy and will not make your spine weaker. The surgeon may also remove the osteophytes, this is called a foraminotomy.
After completing the spinal decompression, the bone removed may be repositioned into a similar position as before surgery. Sometimes, to add stability to the spine following decompression, a cervical plate or rod can be placed on the side of the spine and attached using screws.
Once the surgical procedure is completed the incision is closed with either stitches or clips and a sterile bandage applied.

Artificial spinal disc replacement involves removing the damaged disc and inserting an artificial disc in its place. The patient is given a general anaesthetic and the procedure is carried out through a cut in the front of the patient’s neck. Bone or parts of the disc are removed from around the nerve roots (decompression) and the damaged disc or part of the disc is removed. An artificial disc is inserted that aims to allow painless movement between the bones and prevent damage to the adjacent discs over time. Depending on how many discs are affected, a person may have one or more discs in the neck replaced during the same operation.

The primary reason for surgery is to prevent further deterioration in your symptoms, NOT to improve any symptoms you may already have. If your surgery is for arm pain then you may have good pain relief following surgery. If you have other symptoms such as weakness, muscle wasting and stiffness in the limbs, these are less likely to change and the surgery is primarily to prevent any deterioration in your symptoms.

Possible complications following spinal surgery

What to expect after the surgery

• Disc-space infection - this is an infection in the disc that was operated on. It is uncommon and is treated with antibiotics.
• Nerve damage - this is damage to the nerves in your neck which can lead to weakness, pins and needles, temperature changes or no feelings in your arms, legs or both.
• Bleeding or haematoma (collection of blood).
• Swallowing problems.
• Hoarseness of voice.

• Bone grafts used during surgery may not fuse properly with your bone, this may require further surgery.
• Bladder and or bowel problems - this may lead to incontinence (loss of control), which may be temporary or permanent.
• Dural tears or leaks – this is when the membrane covering the spinal cord (the dura) is damaged. This may lead to nausea, vomiting and headaches. It is usually treated with bed rest.

You must remember the main aim of your surgery is to prevent deterioration in your symptoms as opposed to fully resolving your symptoms. Some patients do notice some recovery, though this may take several months.
Everyone is different. You may experience discomfort around your wound and from spending time in one position. You may also find it difficult to pass urine and so may need a catheter for a short time after surgery. It is normal to be in some discomfort, but let the nurse know if your pain stops you from doing normal things like eating, sleeping, walking and going to the toilet.
Soon after your surgery a nurse will come and see you to work on safely getting out of bed and walking. You will be seen by a Physiotherapist who will provide post-operative advice, information on starting to exercise and advise when you are ready for home.

If you have had clips to close your wound, the nurses on the ward will arrange a referral for them to be removed usually between 5-10 days after your surgery. An outpatient appointment will be made for you to see the surgeon’s team about 6 weeks after surgery. It is usually sent to your home address if not given to you in hospital.

If you experience any of the following symptoms you should see a doctor immediately:
• Numbness around your back passage and genital region
• New onset of bladder or bowel incontinence
• New numbness, pins and needles or weakness in both arms and legs