What is the Difference Between a Cervical Disc Replacement and a Cervical Disc Fusion?
The aim of both of these operations is to relieve you of your arm, and occasionally leg symptoms. They are generally not designed to treat neck pain.
Both types of surgery require a discectomy. This is the removal of the damaged disc to allow the decompression of the nerves and spinal cord to give you relief from your symptoms. After the discectomy has been performed there is a choice between using either a disc replacement or a fusion device to reconstruct your cervical spine.
In a cervical disc replacement the disc is replaced with an artificial disc. The artificial disc is designed to allow preservation of neck movement at that level.
In a cervical fusion the disc is replaced with an artificial spacer called a ‘cage’. The cage is designed to stabilise the vertebrae on either side of it, allowing fusion between the 2 levels to occur. A cervical fusion is not intended to allow any movement at the operated level.
What Type of Operation is Best for me?
If you have significant wear and tear in your neck and the natural movement has already been lost, if there is structural instability in your neck, or if the spinal cord has been damaged by being severely compressed then you should have a fusion. If you have a cervical disc prolapse, then there is more of a choice. It is important to remember that when treating a cervical disc prolapse both operations are good operations.
The problem with fusing a disc is that the movement from that disc is transferred to the discs above and below. In theory, this can result in an increased rate of disc degeneration in these adjacent discs. Cervical disc replacements are now being increasingly used to treat cervical disc prolapses.
Unfortunately, a cervical disc replacement does not guarantee that you will have no further neck problems in the future, and it does certainly not prevent further wear and tear in the adjacent level discs. Currently, there is no convincing data that a cervical disc replacement is any better than a fusion in the long term. However, most spinal surgeons would aim to preserve motion and function where possible. If a disc replacement does not work, then it can always be converted into a fusion.
Before you come into Hospital
If you are on any medication that has the potential to thin your blood such as aspirin, clopidogrel, warfarin or any other blood thinning medication then we do need to know about this prior to the date of your injection as this will usually need to be stopped prior to your operation.
If you take anti-inflammatory tablets then you must stop taking them 7 days before your surgery.
How do we do an Anterior Cervical Discectomy?
A cervical discectomy is done under a general anaesthetic. The operation takes about 1 ½ – 2 hours. Once asleep the patient is placed on their back on the operating table. X-ray is used to identify the correct area of the neck.
A small incision is made in the front of the neck, just to the right of the Adam’s apple. The incision is normally about 3 cms long, usually within an existing skin crease. In order to expose the front of the spine the neck structures need to be carefully retracted out of the way. Once the correct level has been confirmed the disc is removed. This is done with the aid of an operating microscope. The microscope provides magnification as well as an excellent light source. The use of a microscope allows makes the operation safer. In addition to removing the disc, bony overgrowths secondary to wear and tear may also have to be removed to allow a satisfactory decompression of the nerves and the spinal cord.
Following the discectomy and decompression the cervical spine has to be reconstructed using either a fusion cage or a cervical disc replacement.
The wound will be closed with a fine, dissolvable suture, and covered with a dressing.
What are the Risks of Anterior Cervical Discectomy?
The risk of infection is less than 1%. All patients receive a dose of intravenous antibiotics when they are going off to sleep. If you develop an infection it is most likely to be a superficial wound infection that will resolve with a short course of oral antibiotics. Occasionally patients develop a deep infection. This is much more serious and may require a prolonged course of intravenous antibiotics or additional surgery.
You will lose minimal blood during the operation
Developing blood clots in the legs (deep vein thrombosis – DVT) is a risk of any surgery. We worry about DVTs as bits can break off a travel around your body. This is called an embolus. An embolus can affect your breathing, cause you to have a stroke, and could potentially be fatal. DVTs occur in approximately 1 in 200 patients having back surgery. An embolus is a much less common occurrence. We minimize the risk of DVT by asking patients to wear hospital stockings following their surgery (TEDS), and mechanical pumps during and immediately after surgery. These pumps squeeze your lower legs, helping the blood to circulate. They are put on when you go to sleep and stay on until you start to mobilize. We encourage early mobilization as this also helps to prevent DVTs. If a patient is considered to be high risk for a DVT then we will prescribe blood thinning medication for a couple of weeks after your surgery.
Spinal Cord Injury
Any surgery on your neck carries the risk of paralysing you. Fortunately, this is incredibly rare. However, if you were to become paralysed during a cervical spine operation you could loose all arm, leg, bowel, bladder and sexual function.
During this operation there is a 1% risk of physical nerve damage. This can lead to loss of nerve function with persisting pain, weakness, and numbness in the territory of that nerve. This may be permanent.
Following anterior neck surgery it is usual to have some discomfort on swallowing for a few days. This will normally settle over a couple of weeks. About 1-2% of patients will have some long term discomfort on swallowing.
Following anterior neck surgery, most patients feel a bit hoarse for a few days. Occasionally the nerve to the vocal cords – the recurrent laryngeal nerve – is damaged during the operation. This may result in a permanent change to your voice. This occurs in 1-2% of patients having this type of surgery.
Posterior Neck Pain
It is not uncommon for patients to experience some discomfort in the back of their neck for a few days following surgery.
It is always possible for symptoms to persist, despite a technically successful operation. This usually reflects the degree of pre-operative nerve damage. These operations are very successful in relieving pain, but it is not uncommon for some persisting weakness or numbness, especially when the symptoms have been there for a long time before the operation.
Unfortunately there is no guarantee that you will not experience a return of your symptoms. This can be due to the formation of scar tissue, or further degenerative processes in your neck.
What Can I Expect Following my Operation?
Following your operation you should start trying to move your neck as soon as you feel able. To begin with this may be a little bit uncomfortable. The aim is to do small amounts of neck movement on a regular basis. You will be seen by the physiotherapists whilst in hospital, and they will give you some simple exercises to do. For the first 2 weeks you should not do any exercise that hurts.
You will be in hospital for 2 or 3 nights. By the time you are discharged home you will have been safely mobilising around the ward and able to manage the stairs. Once you get home you should not plan to anything more than gentle pottering around for the first 2-weeks. If you need to use a computer, then you should only do so for short periods of time.
Following the operation you will have a waterproof dressing over your wound. Ideally this should be kept dry. If you get it wet, then it should be dabbed dry. If the dressing starts to come off, then it should be changed. You should keep your wound covered and dry for 10 days. The nursing staff will explain to you how to look after your wound before you go home.
When you are sitting, you should aim to sit up straight and not have your neck too supported by pillows and this will lead to you bending your neck forwards. When in bed do not use too many pillows.
You will be seen back in the clinic a few weeks after your operation. You will normally be referred on for further physiotherapy at this stage. After 2-weeks you can slightly increase your activity levels, and start doing a bit more walking. However, you should avoid prolonged activity, lengthy trips, housework and looking after others for the first 6-weeks following your operation. You should also avoid bending and heavy lifting.
For the first few weeks following your operation you should not drive. As you feel more comfortable you can start to undertake short journeys yourself. Initially you should do this with someone else in the car with you. There is no restriction with the DVLA, though there will be with your insurance company. You will need to be able to undertake an emergency stop, and be in complete control of your car at all times without being distracted by pain. If this is not the case then your insurance will NOT be valid. Unless you can look over your shoulder, you are not considered safe to drive.
You should not fly for 2-weeks following your surgery. You should not undertake any long haul flights for 6-weeks.
You should not plan to return to any sports for 3-months following your operation.
Returning to Work
When you can return to work depends on what it is that you do, and may be anything between 2 and 12 weeks. This will be discussed with you before your operation. Where possible days spent working from home can be helpful as part of your return to work. Your return to work should be gradual, and you should increase what you do over a period of time.
You will be seen back in the clinic a few weeks after your operation. An appointment will be made for you before you are discharged.
What Patients Say
Very professional, willing to explain my questions and concerns. August 2020
Mr James Langdon was extremely helpful and informative. Fantastic bedside manner. July 2020
Mr Langdon has been fantastic. Not only, importantly, inspiring confidence, but practical and down to earth. He always ensured I had the opportunity to ask questions. Feb 2020
Extremely lucky to have Mr Langdon and his team, in every way so professional and so easy to talk with. September 2020
I had every faith in my consultant, that he was advising me and working in my best interest. September 2020
Mr Langdon is a caring person, listened to me and fully explained and discussed everything with me. I had complete confidence in him. September 2020
Once again a massive thank you to Mr Langdon and his team for their outstanding work and making the whole experience bearable. September 2020
I would like to express my sincere thanks and gratitude for curing my pain. For months I have suffered in agony day and night. I was in despair and you were my last hope. Now I am not in pain! I am continually smiling and enjoying life again! March 2020
Mr Langdon was great from start to finish. I know that he saw me at the end of an already full clinic and on top of that arranged an immediate MRI…making him much later than he needed to be in getting home! I was in a great deal of pain and I very much appreciated his help in getting me sorted as fast as possible. He made sure I was early on in the running order of procedures on the day of my treatment and everything was explained well to me both before and afterwards. Cannot fault in any way. Thank you very much.
Very patient took his time explaining the surgery and aftercare. Very knowledge about my condition. Made me feel relaxed and in safe hands as I was very scared of the surgery itself and the possible risks.
Very caring, explained fully what was wrong and what he was going to do. December 2019
He was very professional and helpful before, during and after my minor treatment. December 2019
Mr Langdon was extremely helpful and reassuring. December 2019
Mr Langdon was clear and confident with his communication. This is reassuring for a patient. December 2019
Professional and treated to a high standard. Mr Langdon was excellent, he knew everything on my condition explaining all the options available. December 2019
Mr Langdon’s manner was very polite, professional and efficient, he answered all her questions and came to see her quickly after her epidural. June 2017
I have just completed a 102 mile walk over 7 days. Thank you so much for patching me up and making this experience possible. June 2017
Thank you for your specialist surgical and operational skills as well as your patient friendly approach. The two don’t always go together. We need people like you to maintain such high standards of surgery and care. October 2017
I wanted to take the opportunity to thank you and your team following my surgery. It has been so long since I felt so well and without pain. The surgery and my recuperation has far surpassed my expectations and has made a huge difference to my lifestyle. December 2017
Three months on from my back operation and I am feeling so much better. Thank you for all the kindness and support you showed when I was in such desperate pain. February 2018
Thank you so much for the work that you have done. What an incredible job you have and do. Life changing. March 2018
Thank you for all you have done for me during the last few weeks. I am most grateful not only for the main work but also the extras like telephoning to keep me informed. April 2018
I cannot thank you enough for the success of my back operation. Everyone was so pessimistic and you were so positive. May 2018
I was at all times given all necessary information, listened to, and I had confidence that Mr Langdon would complete the operation successfully. August 2018
Highly skilled and intuitive. October 2018
He was brilliant, I felt so comfortable that he would look after me even though I felt so anxious, and he made sure to give me all the information I needed. Also, every nurse and employee of Spire had nothing but brilliant things to say about Mr Langdon – I didn’t even need to ask. They would look on my notes and see I had Mr Langdon and say I was in excellent hands, and so I felt extremely happy. My partner also has disc problems so I will very much be pointing him to Mr Langdon October 2018
Very understanding and caring chap from start to finish, and a great bedside manner, unusual for some consultants. He is trying hard to understand my problems and working with me on a treatment plan for the present, and the future. November 2018
My consultant is obviously a very competent person and comes across as such. My procedure was fully explained both before and after my surgery. He also has a professional sense of humour, which helped as I was very nervous November 2018
Mr Langdon was always prepared to fully explain what was wrong and what he could do about it, he gave me a lot of confidence to make the decision to operate, and so far so good. Albeit early days. November 2018
Mr Langdon was very professional and helpful, he came in on his day off because my treatment had to be moved. November 2018
Excellent, extremely knowledgeable on his speciality. I managed to get an appointment to see him at very short notice for which I was very grateful. December 2018
Excellent surgeon, great manner, explained procedure well. December 2018
A good sense of humour, understanding and non-judgmental. They explained everything very clearly. January 2019
Mr Langdon, very professional and calm, did not push the treatment on me which I really liked, but advised and let me make up my own mind. January 2019
James Langdon is a really good person to have on your side. He’s smart, attentive and very dedicated. January 2019
I felt very safe with Mr Langdon, he fully explained the procedure, the risks and the recovery. January 2019
A very professional consultant. Showed great care and understood me as a person and patient. Saw me pre procedure and after in recovery room and own room. Visited again before going home in late evening and yet again first thing the next morning. It felt like I was Mr Langdon’s only patient which I know is far from the truth. Unfortunately, I am a nervous patient but could not have been in better hands. Many thanks January 2019
Explained everything in detail, understood my concerns, excellent bedside manner, very professional. January 2019
James Langdon is very patient – he answers questions and really listens to you and explains again if you haven’t quite got something. March 2019
Mr James Langdon was in every way, courteous, clearly good at his particular area of expertise, took time out every day to see me and check that all was ok. Was happy to answer any questions I had. April 2019
Mr Langdon was very understanding about my condition and talked me through every procedure that could help me get more mobile again. I was always at ease with him with his caring attitude. A true professional thanks. April 2019
Mr Langdon gave a full explanation of the procedure and what would happen and what to do afterwards. Perfect. May 2019
Fully informed by Consultant Surgeon and Consultant Anaethetist who put me at ease with procedure. May 2019
I saw Mr Langdon before I had the operation and he explained everything that would happen on the day of the operation. June 2019
Very attentive, understood exactly what I was saying and made me feel confident that what I was doing was the right thing. June 2019
Mr. Langdon gave you complete confidence that all would be well and that he was available if needed at any time. He showed kindness and consideration. June 2019
Calm, professional, helpful. July 2019
Everything went off so smoothly. So pleased that the operation was so successful & the next day I was able to walk around without pain. July 2019
In overall terms he was absolutely brilliant. Clearly he is a brilliant surgeon but also a wonderful and understanding human being who, whilst pointing out the risks involved in the operation, filled me with absolute confidence that if success was possible, it would definitely be achieved – and I am delighted to say that it was. He is certainly a hero to me! It was also abundantly clear that all the staff at the hospital have absolute confidence in him and hold him in the highest regard. August 2019
Excellent, he fitted me in with an early appointment and treated me extremely well. September 2019
Extremely helpful explained everything very clearly. September 2019
Mr Langdon has been very clear and concise about the treatment he would be providing and the possible outcome. He has a very professional manner and I felt very at ease with him. He provided me with lots of information and visited me numerous times after my operation to see how I was and to explain what was done and what I should expect. I would be very happy to see Mr Langdon again in the future should I have a need to. September 2019
Caring conscientious and totally professional in all respects. September 2019
Mr Langdon gave me the confidence to go ahead with surgery that I was very worried about. He is very professional and thoroughly explained all the pros, cons and side effects that could possibly happen. All of the above helped me to make a more informed decision. October 2019
James Langdon was the consummate professional. He explained his diagnosis in plain language that was easy to understand and interpret from a layman’s point of view. He was careful to manage expectations and clear about potential risks keeping them in perspective and proportionate to the circumstances. His manner was direct whilst always retaining a caring attitude listening to the patient and answering questions clearly; even taking time out to follow up with my wife whilst I was still in post Op recovery. Very thorough and I would highly recommend James. October 2019
Fully explained the treatment I required and the reasons why. I felt very confident I was in good hands. October 2019
Professional, inspires confidence. October 2019
He was very understanding explaining everything very carefully and advising me on altering medication for the procedure and when to restart normal regime. November 2019
He was courteous, listened, understood the issue very quickly. Explained everything well and was sure to confirm I understood and asked if I had questions. I didn’t feel hurried. He provided an effective and efficient service. I’d definitely recommend him. November 2019
Professional and approachable. November 2019
Extremely happy. Care was first class throughout the stay and looked after all my needs November 2019
Very approachable, caring, friendly, put me at ease. December 2019
Very approachable and knowledgeable. Felt I was in very safe hands. December 2019
Very professional throughout. December 2019
Spire Harpenden Hospital
(01582) 714 304