What is cervical microdiscectomy for arthroplasty?

Microdiscectomy for arthroplasty is a surgical technique that allows the damaged cervical disc to be removed when it causes pain, compresses a nerve root (herniated disc), or in some cases due to injuries that require stabilizing the spinal column. 

It is performed with the aid of a special microscope, which amplifies the image meaning that the operation can performed with a minimal incision. This decreases the damage of the surrounding tissues and allows for a faster recovery.

What cases is it used for?

For each patient, we must take into account how long they have been suffering the symptoms, the severity of the symptoms, and what their response has been to other treatments.

Your doctor might recommend this surgery for one of the following cases:

  • Intense pain that usually radiates from the neck area and shoulder towards the arm, and sometimes down to the hand, affecting the patient’s ability to carry out normal activities of daily life, and which does not respond to other medical treatment.    
  • Sensory alterations such as numbness, tingling, or loss of sense of touch. 
  • Decrease in strength or loss of mobility in the arms and hands.
  • Compression of the spinal cord affecting strength and feeling in the legs. 
  • Cervical injuries that provoke instability in a segment of the cervical spine.

What does cervical microdiscectomy for arthroplasty involve?

The patient is admitted to the hospital on the same day of the operation, and is usually discharged in 2 days. The surgery is performed under general anesthesia, with the patient lying in a face-down position. The surgeon will use optical magnification (microscope). To prevent risk of infection, the patient is given antibiotics. 

The surgeon makes a small incision in the front part of the neck. The lesion is located using a radioscopic device (x-rays). Next, the surgeon proceeds to gently separate the muscles in the area, and the other structures such as veins, the esophagus and the trachea. 

A surgical separating device is placed and the identification of the disc to be removed is confirmed. The injured disc is removed with special instruments, ensuring that the nerve roots are free.

Cervical microdiscectomy is the first step in several cervical spine procedures. In the case of arthroplasty, after removing the cervical disc and decompressing the medulla and nerve roots, we place a mobile disc implant. Finally, the incision is closed and local anesthesia is administered to reduce postoperative pain.

Frequently, we leave a small drain in place to prevent formation of a hematoma. We also place a soft cervical collar on the patient so that he can be more comfortable during the first days after surgery.

Recovery and rehabilitation

Within a few hours after the operation, in most cases, the patient can get up and use the toilet on their own. The patient can also walk slowly around the room and around the hallways.

After the operation, while the patient is still in the hospital a physical therapist will come to explain some appropriate exercises and what actions are to be avoided. The patient must abstain from lifting heavy objects and bending over during the first weeks following surgery.

We recommend that the patient take short and frequent walks in order to promote blood circulation in the legs and avoid contractures or stiffness. After 24 hours, we will remove the surgical drain.

With regard to food, it’s possible that hard foods will be uncomfortable to swallow. We recommend a soft diet and drinking lots of liquids. Very hot food should be avoided.

We will recommend what medications the patient should take to control pain and inflammation during recovery. At the time of discharge from the hospital, the patient will be given an appointment for a few days later to see how the surgical wound is healing, and an appointment to begin physiotherapy.
We will recommend an early rehabilitation program that the patient can begin as soon as possible a few days after surgery. A team of professionals will be in charge of applying specific physical therapy techniques and teaching you the appropriate exercises at every stage of your recovery.

At first, you may notice discomfort when staying in the same position for 30-40 minutes, but tolerance will progressively increase. It is also normal to note some stiffness and limitation to neck mobility. However, with the rehabilitation exercises, you will be able to move more easily as the days pass by.

The patient can begin gentle, non-impact, exercise at about 6 weeks after surgery, depending on their level of comfort. Stationary bike can be a good exercise for the first stages of recovery. Later on, other sports like running can be added. 

If the patient feels up to it, they can return to work such as office work about 3-4 weeks after surgery, as long as it is work that doesn’t require physical effort. For activities that require intense physical activity, the wait should be approximately 3 months.

Risks of cervical microdiscectomy for arthroplasty

As with any type of surgery, there are risks that you should be aware of.

  • Residual pain. Although microdiscectomy is an operation with a high rate of good results, sometimes it is not possible to eliminate the root pain entirely. This is more frequent when the nerve root has been compressed for a long time (more than 3-6 months).
  • Damage to the nerves or spinal cord. Fortunately, this is a rare complication because use of the microscope makes it easy to see the nerve structures clearly.
  • Injury to the dura mater and leakage of cerebrospinal fluid. If this occurs, the lesion is repaired and sealed during the operation. In the event of this complication, the patient will be asked to remain in bed for 24-48 hours in order for the scar to heal.
  • Hematoma or seroma. Sometimes a hematoma or seroma (build up of clear liquid) occurs in the operated area. Treatment usually consists of rest and compression. On some occasions it may be necessary to drain the hematoma or seroma.
  • Infection. Infection is rare, but when it occurs it requires treatment with antibiotics and sometimes, it requires having the operated area cleaned in a surgical operation (debriding).
  • Dysphonia (difficulty speaking). This is a rare complication that may occur after the operation due to manipulation of the nerves that control the larynx. Usually, it is transitory.
  • Dysphagia (difficulty swallowing). In some cases, the inflammation in the operated area makes it difficult to swallow. This usually gets better after a few days.

Who are the doctors who perform cervical microdiscectomyfor arthroplasty at Instituto Clavel?

All doctors on the Instituto Clavel team.

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