COVID-19 information

Visiting is once again welcomed at The Walton Centre. So that we can safely reintroduce visiting, visits should be pre-booked with an allocated appointment slot. Patients can have two visitors each.

General safety measures remain in place at The Walton Centre - and in our other clinic settings within the community – until further notice. These include temperature checks, the wearing of face coverings and social distancing.

Cervical Discectomy

Admissions to hospital can be a daunting experience for most people. The following information is designed to give you information about your stay in Hospital and what to expect. This information is intended as a guide and may vary depending upon your individual requirements.

The Walton Centre is a regional unit that admits patients 24 hours a day depending upon the urgency of their condition.

What is a cervical discectomy?

The surgical procedure that you are to be admitted for is called a cervical disectonomy. This is performed for someone who has a prolapsed (slipped) disc in the neck area.

The spine is composed of small bones called vertebrae which all sit on top of each other to form your spinal column. To stop these bones from rubbing on each other you have intervertebral discs. These are soft cushions of tissue which sit in between each of the bones in your spinal column and act as shock absorbers. 

The spinal cord and nerves run through your spinal column. This acts in a similar way to a telephone exchange passing information from your brain to your body and back again. At the level of each bone (vertebra) it sends out some nerves to transmit these messages to and from the body. A prolapsed disc occurs when one of these cushions (discs) slips out slightly and puts pressure on one of the nerves, or the spinal cord itself, causing your symptoms.

Image of spineSpinal cord diagram

What does a prolapsed disc cause?

Prolapsed discs can cause various symptoms depending on which nerves they press upon. Prolapsed discs in the neck area mostly cause symptoms in the arms. Usually, the pressure on the nerve causes pain to radiate down the arm. Occasionally, there may be numbness or weakness in the arm or hand, possibly with some tingling or unusual sensations.

Treatment

  • Most attacks of pain and altered sensation settle themselves after a few weeks and will not require any surgery.
  • The other options for treatment are:
  • Allow your body to heal naturally and the symptoms will resolve as the slipped part of the disc reduces by itself, and the pressure on the nerves is relieved.
  • Physiotherapy treatment, Pilates, Tai Chi and Yoga all of which will help with posture and muscle tone.
  • Managing the pain with medication. In some cases osteopathic treatment or injection therapies may help. If the pain does not settle spontaneously and persists with a degree of severity then surgery can be considered. Surgery allows considerable relief of pain in most cases.

It has less effect on any sensory changes you may have, such as pins and needles and numbness. If there is some muscles wasting (loss of muscle bulk), then this is usually irreversible but this may be improved by a little focused exercise after successful surgery. Surgery also allows the relief of symptoms earlier than of you wait for the natural healing process to complete.

What does surgery involve?

A discectomy allows the disc which is causing the pressure on the nerve to be removed with minimal disturbance of bone and tissue. This is achieved with microscopic surgical technique. Discectomy involves having a small horizontal incision just below the collar line of the neck, at the front which you are asleep under general anaesthetic. A microscope is used for the surgery to give a better picture of the tissues and to minimise the disturbance to the surrounding structures, improving the accuracy. The front of the spine is exposed, the disc is approached from the side and the disc that is pressing on the nerve is removed. 

Once the disc is removed, a Surgeon then inserts a small cage into the space left from where the disc was taken. A cage is made of metal or carbon fibre and is used as an aid to stabilising the structure. A cage is a small permanent implant in your spine, which usually goes between the vertebra where the disc has been removed, it supports the graft whilst it heals and is not removed.

Some patients may require a graft of bone. A graft is an addition of either byour bone or donor bone (bone from someone else), into the operation site to stabilise the bones of the spine. When bone is removed during surgery to allow access to the disc space or if your bones normally have too much movement in them, they can become unstable. They then, sometimes need to be packed in order to keep the structure stable and allow fusion of the spinal bones (the spine to become solid and stable) following surgery. The bone used to pack the space is either your own taken from part of the spinal column around the site of your surgery, or donor bone that is accessed from a source that has undergone rigorous testing. DBM (demineralised bone matrix) is a product made of bone fibres that have been shown to provide scaffolding for your own bone to build upon. Very occasionally bone may be taken for fusion from the front part of your pelvis, just behind your hip (during the operation) but this is only used rarely.

What are the advantages and disadvantages of surgery?

The advantage of surgery is that it gives significant chance of relief from pain. However there is no guarantee that there will be any improvement in any weakness or numbness that you have had prior to surgery

The Risks

All the risks will be discussed with you prior to your surgery and although they are not common you should be aware that there is the potential for them to occur.

  1. Risk from anaesthesia.
  2. Small risk of persistent or increased pain.
  3. Risk of injury to the nerves or spinal cord causing weakness or numbness. In the extreme this can result in total paralysis (unable to move from the neck down) but this is an exceptionally care complication.
  4. Sore throat/swallowing problems due to manipulation of the throat structures during surgery to allow access to the front of the spine (this should settle down in a few days)
  5. Vocal cord problems, horse voice (although this should settle down within a few days)
  6. In theory there could be injury to the nerve for sweating, eye lid and the pupil (Horners Syndrome) although this is also exceptionally rare.
  7. Leak of spinal fluid.
  8. Infection, which includes infection from the MRSA bacteria (infection with MRSA is very rare)
  9. Bleeding or haematoma (collection of blood) 10)In patients having a graft or cage there is potential for the graft or cage to slip forward and move out of the correct position.

It is possible for a prolapsed (slipped) disc to occur at another level in the spinal column at some time in the future.

As already mentioned complications are rare, if you are worried about any of the aspects surgery you will have the opportunity to discuss any concerns prior to surgery and following your hospital admission. 

Pre-operative assessment

You will be brought into the Hospital for your pre-operative assessment. This is usually a few weeks before your admission date. Please see pre-operative assessment booklet.

Admissions to Hospital

When you arrive you will be seen in an admission area and then informed which ward you will go to after your surgery.

The Day of Surgery

You will be kept fasted (nothing to eat or drink) and need to wear a theatre gown following your morning bath or shower. Your details will be checked with you on the ward before you go to theatre. You will be collected for theatre and taken to the theatre reception area. You will be taken to the anaesthetic room. Here the Anaesthetist will give you your anaesthetic medication, and once you are asleep you will be taken into theatre and surgery performed. The surgery will be performed by the Consultant or one of his team. It is common for x-rays to be used in theatre to assist the Surgeon with checking the correct position of the neck bones. After surgery you will be taken into the recovery room where you will be monitored whilst you wake up from your anaesthetic, and you will be made comfortable for your transfer back to the ward. 

You may require a wound drain, this is a small plastic tube located just beneath the skin that comes out of the wound and is attached to a plastic collection device. It drains any excess fluid/blood away from the wound but is not always needed. 

The Day after Surgery

The day following surgery your drip will be removed, your wound will be checked and if you have a wound drain, it will be removed. Taking the wound drain out requires the nurse to remove the stitch holding it in place and gradually sliding the drain tube out. It is not normally painful and they are usually easily removed. In very rare circumstances the drain may need to be removed in theatre however this exceptionally rare. You will be expected to get out of bed and move around, the Physiotherapist will see you to explain correct posture and the exercises that you will need to do. A copy of these exercises is enclosed in this booklet. You will need to bring this booklet into Hospital with you so that you will know what your exercises are and so that the Physiotherapist can complete the individual details for your exercise programme whilst explaining it to you. You should be careful not to do excessive movements of your neck for the first week in order to protect the position of the cage/graft until it settles into place. You will have an x-ray of your neck the day after surgery, some patients may need to wear a neck collar, this depends on the type of surgery performed. The medical staff will make this decision of each individual patient. One of the medical team will check how you are managing. Following this you will normally be able to go home in the afternoon. It is quite normal practice to go home the day after your operation. Occasionally some patients who have had extensive surgery may need some extra time in Hospital to recover. This is often just an extra day and is not usually more than a few extra days. 

Discharge Home

Your stitches will be due to be removed approximately 7 days after your surgery. Most patients make an appointment to get this done by their GP or Practice Nurse. If you do not have access to this then a District Nurse can be organised to check your wound and remove your stitches (dissolvable stitches will only need to be trimmed at the ends) If needed then the date of your District Nurse visit will be given to you before you leave the ward. Please make sure that if you are not going home to your usual address and you are going to stay with someone else you inform the staff to ensure that the District Nurse comes to the correct address

Should you have any problems with your wound after your surgery, even if your GP or District Nurse are managing this, it is very important that we are also informed as we may need to monitor your more closely. Please phone either: Spinal Nurses on 0151529 8853 Tissue Viability Team on 0151 529 5599

It is not unusual for you to get increased pain or altered sensation for a few days to a few weeks after surgery as your spinal cord and/or nerves recover from your surgery. Research has shown that patients who return to normal routine as quickly as possible make the best recovery. You should progressively return to your normal daily routine as you continue to recover. You can return to work as soon as you feel you can cope even if you feel uncomfortable. Heavy lifting should only be performed in the correct way and should be avoided for the first three months. You will be sent an outpatient appointment approximately 3 months by post to come and see us so we can check you are recovering well. Here you will be seen by a either a Doctor or a Nurse Specialist.

Physiotherapy Following Discectomy Surgery

This information has been designed for post-operative neck care. It is intended to answer the most commonly asked questions. Any further enquiries should be directed to your Physiotherapist.

The Physiotherapist may visit you during the day after your operation. The movement and strength of your limbs will be assessed so that an exercise programme can be devised for you. You will be shown the most appropriate exercises to be started immediately and progressed as directed. You will be expected on your first day post-op to be up and walking around.

General Advice on Posture

Good posture is important as it reduces the strain on the joints and ligaments in the spine and therefore will reduce the recurrence of neck and back pain.

When you have poor posture, the body’s proper cervical position is out of alignment and the back’s natural curves become distorted. Try to avoid:

  • Head forward or slouched
  • Slumped sitting posture

Lying Posture

  • Use a firm mattress (not hard) which allows absorption of your gip and shoulder.
  • Lie horizontally in any position you find comfortable. Support your head with a pillow to make your head level with your spine.

Sitting Posture

  • A firm upright chair should be chosen that allows your bottom right to the back whilst feet are flat on the floor.
  • To correct your posture tuck in your chin as if making a double chin. 

You must avoid heavy lifting immediately following your surgery. You may resume lifting when you feel able to do so. When you do resume lifting ensure you use the correct technique. Ask your Physiotherapist to demonstrate if you are unsure of this. Use this method even if picking up light objects.

Lifting

  • Stand close to the object you are lifting.
  • Face in the direction you will be moving the object - never lift and twist
  • Bend knees, keep the back straight, standing up by straightening the hips and knees. Initially your legs may be weak but will strengthen with practice
  • Never twist or rotate when you are lifting.
  • When shopping/travelling use two lighter bags rather than one heavy one – better still use a trolley. 

Illustration of how to properly lift

Occupational Advice

You can return to work as soon as you feel you can cope, even if your neck is still uncomfortable. Hurt does not mean harm. Returning to work and normal activities will help your recovery. Simple changes can make your job easier, talk to your foreman, boss or occupational health adviser.

Exercise

The surgery may leave you with a painful and stiff neck. The exercises shown below are important tro increase the mobility of the neck and strengthen the muscles which support it. They will also promote proper healing and ensure the joints of the neck are receiving the nutrition they require. Aim to keep your neck moving as normally as possible. Start the exercises from day one in hospital; try to do 10 repetitions, 1 to 2 times each day. Regular exercise has many benefits and the body must stay active to stay healthy. Regular exercise gives you stronger bones, develops fit and active muscles, keeps you supple and fit, makes you feel good and it releases natural chemicals that reduce pain. Staying active will help you get better faster and prevent more neck problems. The following exercises are taken from PhysioTools General Exercises, used with permission from PhysioTools LTD.

Exercise Programme

Sitting: Bend your head forward until you feel a stretch behind your neck. Hold approx 10 secs.

Sitting: Bend your head backwards as far as is comfortable. Hold approx 10 secs. Repeat 10 Times.

Sitting: Turn your head to one side until you feel a stretch. Hold approx. 10 secs. Repeat to other side. Repeat 10 times.

Sitting: Sitting straight-backed, push your head back against a firm surface. Pull your chin in, keeping your neck and back straight (not tipping your head forwards). Hold at the end position and feel the stretch in your neck.

Sit or Stand. Roll your shoulders in both directions. Repeat 10 Times.

Sit or Stand. Lift both arms above head up letting the thumb lead the way. Repeat 10 Times.

 

If you have any queries, before or after your surgery please do not hesitate to contact us or speak to your GP.

Spinal Nurses 0151 529 8853

Physiotherapist 0151 529 5451

Secretary to your Consultant 0151 525 3611 and ask for your Consultant’s Secretary

  • Last Updated:
    01 September 2018
  • Review Date:
    01 September 2022
  • Author:
    Keren Smallwood
  • Summary:

    The surgical procedure that you are to be admitted for is called a cervical disectonomy. This is performed for someone who has a prolapsed (slipped) disc in the neck area.

     

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