Exposure and Removal of the Cervical Disc
After a retractor is used to pull aside fat and muscle, the disc is exposed between the vertebrae. Part of it is removed with a forceps (Fig. 3).

Then a surgical drill is used to enlarge the disc space (Fig. 4), making it easier for the surgeon to empty the intervertebral space fully and remove any bone spurs. Afterwards, only a single ligament separates the surgical instruments from the spinal cord and nerve roots.

Placement of the Bone Graft
The bone graft is placed in the disc space, where it will begin to fuse the vertebrae it lies between (Fig. 5).

Adding Stability: Fusion
In fusion, your doctor joins (fuses) the vertebrae above and below the removed disk. Fusion is done with a bone graft, but occasionally metal plates are added. Metal plates add stability to the cervical spine and aid in the healing process (Fig. 6).

Incision Closure
The operation is completed when the neck incision is closed in several layers (Fig. 7). Unless dissolving suture material is used, the skin sutures (stitches) or staples will have to be removed after the incision has healed.

Risk
Certain risks must be considered with any surgery. Although every precaution will be taken to avoid complications, among the most common risks possible with surgery are: infection, excessive bleeding (hemorrhage), and an adverse reaction to anesthesia.

Other risks possible when anterior cervical fusion include: stroke, injury to the recurrent laryngeal nerve, which causes hoarseness and may or may not be permanent; and injury to the involved nerve root(s) or the spinal cord, both of which can cause varying types and degrees of paralysis.

Clinical experience and scientific calculation indicate that, in general, surgical risks are limited; however, surgery is a human effort. Unforeseen circumstances can complicate any surgical procedure and lead to serious or even life-threatening situations. Although such complications are rare, you should feel free to discuss the question of risk with your doctor.

Pain
It is normal to have pain after the operation, especially in the incision area. This does not mean that the procedure was unsuccessful or that your recovery will be slow. Pain in the neck or arms is also not unusual, caused by inflammation of the previously compressed nerve. It will slowly lessen as the nerve heals. Medication will be given to control pain. Moist heat and frequent repositioning may also help.

Numbness
Numbness or tingling sensations are often the last symptoms to leave. Numbness which lingers in parts of the arm or fingers usually is no cause for worry and should gradually go away.

Physical Activity
You may move about in bed and rest in any comfortable position when you have recovered from anesthesia. Walking may begin within several hours. The easiest way for you to get out of bed is to raise the head of the bed as far as it will go, and then swing your legs to the floor. Avoid pulling up from a flat position with the trapeze.

The doctor may order a cervical collar to be worn whenever you are up and about. Your nurse will explain its proper use and help with any activity.

Gradually increase the amount of walking you do each day. Since it may at first be painful, try making short trips. Begin with a trip to the bathroom, then to the door, and later out into the corridor.

Sitting and standing also require a gradual pace. If discomfort occurs, change positions frequently.

Hygiene
Usually you may take a shower the day after surgery. This will make you feel better and should be done with the dressing left in place to protect the incision. Your nurse will change the dressing afterwards.

Nutrition
Intravenous (I.V.) fluids will be ordered during the early recovery period and continued until you can tolerate regular liquids without nausea or vomiting. Your diet will then be adjusted back to normal as your appetite returns. Constipation will be treated with laxatives and a diet of whole grain cereals, fruits, and fruit juices.

Emotional Changes
It is normal to feel discouraged and tired for several days after surgery. These feelings may be your body's natural reaction to the cutback of extra hormones it put out to handle the stress of surgery. Although emotional let-down is not uncommon, it must not be allowed to get in the way of the positive attitude essential to your recovery and return to normal activity.

Discharge from the Hospital
The hospital stay for anterior cervical fusion patients usually lasts 1 or 2 days. This will be determined by your progress and by the amount of comfort and help available to you at home.

Home Recovery
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Physical Activity
Daily walking is the best exercise. Try to increase your distance a little each day, setting a pace that avoids fatigue or severe pain. You may climb stairs when you feel able.

Sexual relations may be resumed during the recovery period, but positions that strain the neck or cause pain should be avoided.

"Listen" to your body. Discomfort is normal while you gradually return to normal activity, but pain is a signal to stop what you are doing and proceed more slowly.

Working
Your doctor will help determine when you can return to work and with what limitations. If a work release is required, it will be given to you during the first post-operative visit.

Driving
Drive a car only when you have recovered full coordination and are experiencing minimal pain. Do not drive after taking pain medication.

Medication
You should gradually use less pain medication while recovering at home. This can be accomplished by increasing the amount of time between taking pills, then by reducing the number taken each time. A certain amount of discomfort and pain in the neck and arm(s) can be expected until the inflammation and nerve sensitivity have subsided. Heat, exercise, massage, and short rest periods will also help relieve pain.

Hygiene
If the skin sutures were removed before your discharge from the hospital, it is not necessary to keep the incision covered. Unless instructed otherwise, you may take a daily shower or tub bath, which will help you feel better. Let the water run over the incision, but do not scrub or rub over it. Pat it dry. After bathing, massage lotion over the tightened neck muscles.

Inflammation
If you notice increased redness, swelling, or any drainage around the incision after leaving the hospital, notify your doctor.

Nutrition
A well balanced diet is necessary for proper healing. Include foods from each basic food group: dairy products, meats, vegetables, and fruits. Since you will be less active during recuperation, avoid rich, heavy foods and those high in calories but low in nutrients.

Healing and Recovery
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Healing
Healing is the body's natural process of restoring its damaged tissues to a normal or nearly normal state. Although healing may be improved by general good health, proper nutrition, rest, and physical fitness, it will occur without your having to work at it.

Recovery
Recovery is the process during which you work to become well. It requires a gradual but persistent effort to increase physical strengths and minimize weaknesses. You must concentrate on what is improving, rather than on what symptoms remain. This focus on progress that has been made, combined with the constant effort to improve, make up the positive attitude that will speed your return to normal daily activity.

Making Sure You Understand
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Test your knowledge of anterior cervical fusion by answering the following questions.

1. What is a herniated disc? How can it cause neck and arm pain?

2. What is the bone plug used for? Why isn't it rejected by your body?

3. Why, after surgery, is there still pain in the neck or arms - sometimes even temporarily worse than before surgery?

4. After the operation, how soon may you return to normal physical activity?

5. When should you wear the cervical collar? Why?

6. What will help relieve pain besides medication?

7. What is the difference between healing and recovery? How does a positive attitude affect each?

8. Are you comfortable with your understanding of the risks of this procedure? Do you realize the part human effort plays in its expected outcome?

The human body is an intricate network of interrelated systems. Each system functions on its own but is also influenced by and dependent upon the others. When illness or injury occurs, it disrupts the function of one or more of these systems.

Surgery is a human effort made to correct one system's malfunction, but it will affect all others. Because of this complex interrelationship, surgical outcomes cannot be predicted.

When recovery is possible, it occurs as a combination of the surgeon's effort, the patient's faith, and a positive acceptance of the outcome.