- Why did I herniate a disc in my neck?
In most cases, the cause of herniated discs is arthritis. As the discs degenerate, they lose their structural strength, and eventually a hole develops in the outer part of the disc. The jelly-like material that is in the center of the disc protrudes out of this hole and starts pressing on a nerve. In some cases, patients remember an event that led to the herniation. For example, a car accident may lead to a disc herniation when a disc that was previously degenerated (or at risk of herniation) develops a hole and the disc material suddenly herniates. The vast majority of patients cannot recall an event that led to the herniation. They typically state that they started developing pain one day without any inciting event.
- Why didn’t my doctor order an MRI right away?
In most cases, the symptoms of a disc herniation improve over a period of weeks with conservative treatment (rest and physical therapy). If you do not have any weakness in your arms or legs, you do not necessarily need an MRI right away. If your symptoms do not improve over a period of 3-4 weeks, an MRI of your neck is ordered.
- When do I need neck surgery?
Surgery is recommended when there is significant weakness in the arms or legs, or if you have tried conservative treatment and still have significant pain that is affecting your quality of life.
- If I delay surgery, will I have irreversible damage?
In general, if there is severe spinal cord compression or if a nerve is severely compressed over a period of time, there may be irreversible damage. Much of this depends on the severity of your condition and your surgeon can counsel you about the risk of irreversible damage, which can be difficult to predict at times. If you experience worsening weakness in the arms, or weakness in the legs or loss of balance and/or hand dexterity problems, these symptoms may be irreversible and you should immediately be evaluated by a spine surgeon.
- What effect does a fusion have on the rest of the cervical spine ?
A fusion takes away the motion at one or more levels in the neck. This does increase the stress on the levels above and below the fusion. Whether this fusion leads to arthritis at these other levels, or whether arthritis would have happened anyway at these levels due to the natural history of disc degeneration, is somewhat debatable. However, there is little doubt that the stress at levels above and below a fusion is increased. The likelihood that these levels become symptomatic is 25% over a 10 year period. This means that one out of every 4 patients who has a neck fusion will develop some symptoms as a result of arthritis at the adjacent levels in an average of 10 years. Disc replacement has been developed to decrease the likelihood of what is called “adjacent segment disease”, but because it is a new technique, we still do not have the long-term data to tell us whether this issue is prevented.
- What kind of bone graft is used for my fusion?
In most cases, “allograft” is used, which is cadaver bone. An alternative is to take the patient’s own bone (called autograft) from the patient’s hip, but this can lead to pain and soreness in the hip area. Because allograft that is supplemented with instrumentation ( a plate) has such a high fusion rate, it is the graft of choice in the majority of patients.
- How much motion will I lose in my neck after fusion surgery?
There is a lot of variation in how much motion is lost depending on the patient and their specific pathology, but as a general guideline, with each level that is fused, roughly 10% of motion is lost. So if a patient has 3 levels fused, they lose roughly 30% of their neck motion. In most cases, this is not significant enough to cause any functional problems and many patients do not notice a real difference in their neck motion once they have recovered from surgery.
- When can I drive after surgery?
You can drive when you have stopped taking pain medications, and you are comfortable enough to turn your head slightly in both directions to make driving safe. This can take anywhere from 2-4 weeks.
- When can I shower after anterior cervical spine surgery?
You can shower on postoperative day 2. Keep your incision covered with gauze and Tegarderm dressing while you shower. After your shower, change the dressing. You do not want to leave a wet dressing on the incision. Do not apply any ointments to the incision, simply pat it dry and apply a new gauze and Tegaderm after your shower.
- How long will I be off work after surgery?
You should discuss this with your surgeon. Much of it depends on your job description, and your employer’s willingness to accommodate activity restrictions.