Key Points

• Pressure on a nerve in the neck may variously cause pain the in the region of the shoulder blade, shoulder, upper chest and the associated arm or upper forearm.
• The pain often gets better within days or weeks without treatment but sometimes persists for months and sometimes never gets better without surgical treatment.
• In the lower spine the surgical incision is usually on the back but in the neck the surgical approach is usually through an incision on the front of the neck. In the neck the spine is closer to the front of the neck than the back of the neck. The approach through the front of the neck is easier, quicker and safer and the recovery shorter.
• Surgery is performed using optical magnification. It involves removal of the disc (the soft part between the vertebrae) and, working through the disc space, removal of any separated disc fragment or bone spurs to relieve pressure on the nerve.
• It is necessary to place a spacer (cage) into the gap and this is usually secured with a metal plate on the front of the spine.
• Nearly every patient has discomfort swallowing for a few days or a week or two. Occasionally this persists for longer.
• Surgery is very safe. The risk of an injury to a spinal nerve or the spinal cord is much less than 1% and should be almost 0%.

Frequently Asked Questions

I am still experiencing some pain in my shoulder or arm or numbness after my operation. Should I worry about this?
No, providing the pain is less than it was prior to the surgery. Surgery relieves the pressure on the nerve but in some patients the nerve has a “memory” for the pain and remains slightly irritable. This usually resolves within a matter of weeks. The numbness usually resolves over weeks or months as the nerve recovers.

Will fusion of the vertebrae make my neck permanently stiff?
In the vast majority of patients, following a one or two level fusion there is no detectable stiffness in the neck once recovery is complete.

What do I do with the dressing?
The stitches are under the skin and will dissolve. The dressing is waterproof and you can shower in it. One week after leaving hospital simply peel it off as if it were a big “band aid”. Under the dressing you will find steri strips (tapes) holding the skin edges together. These may come off with the dressing but otherwise remove them one week later if they have not fallen off.

General Information

Pressure on a nerve in the neck may variously cause pain the in the region of the shoulder blade, shoulder, upper chest and the associated arm or upper forearm.

Some patients experience numbness or tingling in one or more of the fingers and/or weakness in the arm or hand.

Most commonly this occurs because as the discs and joints in the neck age bone spurs develop around the margin of the discs and narrow the space for the exiting nerve.

Less commonly a piece of disc separates (disc protrusion or disc herniation) causing pressure on the nerve.

The pain of a nerve compression in the neck can be very severe and unresponsive to painkillers and anti-inflammatory medication, even strong painkillers such as Morphine.

The pain often gets better within days or weeks without treatment but sometimes persists for months and sometimes never gets better without surgical treatment.

In the lower spine the surgical incision is usually on the back but in the neck the surgical approach is usually through an incision on the front of the neck. In the neck the spine is closer to the front of the neck than the back of the neck. The approach through the front of the neck is easier, quicker and safer and the recovery shorter.

Surgical Procedure

Surgery is performed under general anaesthetic and usually takes about two hours. The incision is on the front of the neck and usually heals to a fine line which is difficult to see.

Surgery is performed using optical magnification. It involves removal of the disc (the soft part between the vertebrae) and working through the disc space removal of any separated disc fragment or bone spurs to relieve pressure on the nerve.

It is necessary to place a spacer (cage) into the gap and this is usually secured with a metal plate on the front of the spine. The cage is filled either with a small amount of bone taken from the hip or alternatively a bone graft substitute such as a Tricalcium Phosphate product to fuse the vertebrae together.
 

Post Operative Course

The day after surgery the drainage tube is removed from the neck, the urinary catheter is removed and patients commence walking.

Nearly all patients go home on the second day after surgery.

Most patients notice that the pain in the shoulder and arm goes immediately. In some patients the pain gradually resolves over days or weeks.

Nearly every patient has discomfort swallowing for a few days or a week or two. Occasionally this persists for longer.

Most patients have remarkably little pain in the neck but some residual discomfort and stiffness for several weeks up to three or four months.

The surgery removes the pressure upon the nerve and quickly relieves the pain but numbness or weakness may take weeks or months to resolve and do not always resolve completely.

Because the vertebrae are held with a plate it is not necessary to wear a cervical collar after the surgery but a minority of patients feel more comfortable in a collar.

You will leave hospital with a waterproof dressing which should be removed one week later. Simply peel off this dressing as if it were a big “band aid” – the stitches under the skin resolve. No suture removal is necessary. Under the dressing you will find steri strips (tapes) holding the skin edges together. These may come off with the dressing but otherwise remove them one week later if they have not fallen off.

Return to work is variable and may occur in as little as one to two weeks for sedentary works but make take up to two to three months for heavy manual workers.

Driving is normally resumed as soon as it feels safe and comfortable.

Complications

Most patients have discomfort swallowing for a few days or a week or two. In the occasional patient this persists longer.

A small proportion of patients notice an alteration in the quality of the voice which nearly always resolves completely within several weeks.

Surgery is very safe. The risk of an injury to a spinal nerve or the spinal cord is much less than 1% and should be almost 0%.

Infection almost never occurs with surgery on the front of the spine.

The risk of the bones not fusing together (pseudarthrosis) requiring further surgery is approximately 1% to 2%.

The risk of further surgery being required over the next ten years because of development of similar problems at an adjacent disc is approximately 5%.

A few patients have persisting discomfort and stiffness in the neck but this usually gets better with time and physiotherapy treatment.

Bone grafts are avoided if possible. Some patients find the bone graft donor site quite painful and very occasionally taking a bone graft causes numbness on the outer aspect of the thigh due to bruising of a nerve to the skin.