Many people will have neck problem at some time in their lives. Problems can be caused by trauma or sometimes just as the natural aging process. Regardless, neck problems can be very painful and really interfere with our daily lives. Fortunately not all neck problems require surgical correction – but there are several problems which often do require surgery.
- Herniated disc: this happens when the disc herniates out of its normal position and can put pressure on a nerve.
- Cervical stenosis: this is narrowing of the spinal canal and can put pressure on a nerve.
- Spinal cord tumor: a benign or cancerous growth in the spinal cord, between the membranes covering the spinal cord, or in the spinal canal. A tumor in this location can compress the spinal cord or its nerve roots; therefore, even a noncancerous growth can be disabling unless properly treated.
When there is a “pinched” nerve, pain along with numbness and tingling into a shoulder and down an arm and sometimes into a hand(s) may occur. An MRI is needed to diagnose the severity of the problem and helps the surgeon determine if surgery is recommended. If there is severe pressure on the spinal cord, emergent surgery may be required.
Dr. Swaid will evaluate you and may recommend surgery to you only as a last resort. He will often recommend conservative treatments first such as physical therapy, epidural blocks, rest and medication – and only if these measures fail he may then recommend surgery.
The procedure most often performed is an anterior cervical discectomy and fusion. Dr. Swaid Swaid has performed over 7,000 of these operations during the 35 years he’s been in practice which makes him one of the most experienced neurosurgeons. Call our office today and have your neck pain evaluated by Dr. Swaid.
CERVICAL SPINE DEFECTS
You have been diagnosed with a defect in your cervical spine. Some of the most common defects are:
- Herniated disc. This is a condition where the disc material between two vertebrae has ballooned out of its normal position causing compression or pressure on the nerve. This condition may cause pain and/or numbness and/or tingling in your neck and/or arm(s), as well as weakness of the arm(s).
- Spondylosis/osteophyte (bony spur). This is a condition where calcium has built up on the bony structure of the cervical spine. This is a normal aging process. However, in some instances, the calcium build-up (spur) may impinge upon a nerve or nerve root causing pain and discomfort. This can result in weakness or numbness of the arms as well.
- Cervical stenosis. This is a condition in which calcium builds up around the canal which houses the spinal cord (main nerve). This is a normal aging process, or arthritis, of the cervical spine. However, if the pressure is on the nerves, weakness and numbness of the arms can occur.
WHAT IS THE PROCEDURE?
Surgery involves putting you to sleep under general anesthesia. A small incision will be made in a crease in your neck, just above the collar bone. The surgical team will remove the defect and fill the space with either a synthetic material as well as living (donor) bone or occasionally just an allograft (donor) bone plug. This implanted bone will fuse to the vertebrae above and below, causing stabilization without loss of movement in this area. A small plate may be screwed into the vertebrae to improve stability at the surgical site. Your incision will be closed and skin staples will be utilized. A dressing will be applied. Your surgery will be scheduled in the morning time and should last between 2 to 2½ hours. After surgery, you will be transferred to the recovery room until you are transferred to a room in the hospital. You will spend one night in the hospital and be discharged the following morning if you have no medical complications. Some patients may be discharged the day of surgery pending their recovery and progress.
Your admission will be registered with the hospital by our office. We will contact your insurance company for precertification requirements. You will be responsible for inquiring whether or not a second surgical opinion is required by your insurance.
The evening before your surgery – Do not eat or drink anything after midnight. This includes gum, mints, cigarettes, and your morning coffee. The anesthesiologist will not administer anesthesia if you have had anything by mouth after midnight, and your surgery will have to be postponed. If you are on any blood thinners, steroids or NSAIDS (aspirin, Coumadin, ibuprofen, Aleve, BC, Goody powders, etc), these must be discontinued one week prior to surgery. Please contact the physician who prescribed these medications for you for instructions on how to discontinue their use. Steroids must be discontinued in tapering doses. You also need to stop taking over the counter vitamins and supplements one week prior to surgery. If you are not sure about your medication, please contact our office. Please notify our office if your medical condition has changed since your last office visit, or if you develop a fever, rash, vomiting, diarrhea or productive cough.
The morning of your surgery – Do not eat or drink anything! Do not wear make-up, contact lenses, hair pins, etc. Leave all jewelry and valuables at home. Please remove any body piercings and dark fingernail polish. You will be contacted prior to your surgery date by our office to let you know what time to arrive the morning of your surgery. Arrive promptly at your scheduled time. If you are late, your surgery may have to be cancelled or delayed. Bring your daily medications with you or bring a list that includes the names of the medication, dosage and when you take them. If you have a living will, please bring a copy to go with your chart. You will be given a hospital gown to change into, however, after surgery you may change into your own pajamas or clothes.
Each patient undergoing a surgical procedure is required to have preoperative blood work, including an HIV screen and a hepatitis panel drawn before surgery. This must be done at least one week before surgery, but no greater than two weeks. Our staff will give you information about the conveniently located lab in the building. You will need to bring your driver’s license and insurance cards to your appointment.
After your surgery is finished, you will be moved to the recovery room inside the surgical area. Your stay in recovery will be approximately one hour. During this time, you will be closely monitored by nurses and anesthesia staff. Friends and family are not allowed to visit in the recovery room. For a faster recovery, it is important for you to: not smoke or allow anyone around you to smoke, cough and breathe deeply to prevent postoperative respiratory complications, and walk around as soon as possible after surgery with assistance from the nursing staff.
You will have an incision that is closed with skin staples and you will have a dressing covering it. You should not get the dressing wet, therefore, sponge bathe until you come back to the office one week after your surgery. Your incision should remain covered. If the original dressing should come off, or if your skin becomes irritated from the tape, apply a new dressing. The dressing and staples will be removed at your one week office visit. After your staples are removed, you may get your incision wet. Your incision will no longer have a dressing on it after this visit. It is normal for your incision to be sensitive for a few days. If you notice any excessive redness, discharge or have a fever greater than 102°, please contact the office.
LEAVING THE HOSPITAL
Upon discharge from the Alabama Surgical Center, you will be given instructions on activities and restrictions for the following week. You must call the office at (205) 949-1800 to set up your appointment to have your staples removed seven to ten days from surgery if you have not been given an appointment time and date already. Prescription(s) will also be given to you upon discharge. You need to make arrangements for transportation home, as you will not be allowed to drive yourself.
Although the nerve compression has been corrected with surgery, it will take time for the nerve to heal, and the muscles and tissues around the area will go through a healing process. Therefore, you may experience symptoms very similar to your preoperative condition. If you experience pain or muscle spasms that are not relieved with medication, you may use a heating pad or ice pack for ten minutes four times a day. Do not sleep on a heating pad. Numbness is usually the last symptom to resolve. Generally, most of your pain should resolve over a period of four weeks. If you continue to have problems at the time of your one-month postoperative visit, you may be prescribed a form of conservative treatment such as steroids or physical therapy.
RETURN TO DAILY ACTIVITIES
For about the first week following surgery, you will need to rest and do as little activity as possible. You will probably feel sore and stiff. By week two, however, you should begin to feel less pain and stiffness. During the second postoperative week, you should be able to take short walks, go out to eat or go shopping. Do not do any strenuous activities including lifting, stretching, bending, pushing or pulling. Gradually over the next few weeks, you will be able to progressively increase your activities. Use the following as a guideline:
- Driving. You should not drive for two to three weeks after surgery. After the first week, you may ride in the car. If you must ride over 30 miles, get out and walk every 30 minutes. Make an effort to avoid long distance traveling for one month after surgery.
- Working. If your job involves manual labor, you should not plan to return to work for four to six weeks following surgery. At your one-month return office visit, the doctor will assess you and determine at what point you may return to work. If you have a predominantly sedentary job, you can plan to return to work, most likely part time, after two to three weeks. Caution and common sense should be used to determine whether or not you should engage in any activity.
- Sexual activity. You should abstain from sexual activity for at least three weeks following surgery. After this time you may resume your normal sexual activities as you feel able.
- Exercise. Resuming exercise should be done carefully. Do not exercise during the first week after surgery. You may resume walking after one week following surgery if it is comfortable for you to do so. Do not participate in any aerobic type activity (including tennis, golf, etc) or contact sports for three months following surgery.
PRE AND POSTOPERATIVE QUESTIONS
If you have further questions regarding your scheduled procedure, please contact our office Monday through Thursday between 8:00am and 4:00pm.
If you experience any signs or symptoms which cause you concern, please contact our office at (205) 949-1800 during office hours. After-hours calls will be directed to the answering service. This document should be used as a general information guide only and should not be used in lieu of medical treatment. As individual conditions vary, always contact your doctor regarding your health care.