Anterior cervical discectomy and fusion for cervical disc disease

AORN Journal,  Dec, 2002  by Cecile Cherry

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ANTERIOR CERVICAL DISCECTOMY AND FUSION FOR CERVICAL DISC DISEASE

The article "Anterior cervical discectomy and fusion for cervical disc disease" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, education program professional, Center for Perioperative Education.

A minimum score of 70% on the multiple-choice examination is necessary to earn 2.5 contact hours for this independent study. Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is Dec 31, 2005.

Complete the multiple-choice examination and learner evaluation found on pages 1009-1012 and mail with appropriate fee to

AORN Customer Service
c/o Home Study Program
2170 S Parker Rd, Suite 300
Denver, CO 80231-5711
or fax the information with a credit card number to (303) 750-3212.
You also may access this Home Study via AORN Online at
http://www.aorn.org/journal/homestudy/default.htm.

BEHAVIORAL OBJECTIVES

After reading and studying the article on anterior cervical discectomy and fusion (ACDF), the nurse will be able to

(1) describe the pathophysiology that is responsible for cervical disc disease,

(2) discuss conservative treatment options available for the patient who has cervical disc disease,

(3) define the perioperative nurse's role throughout the ACDF procedure,

(4) explain the steps of the surgical procedure, and

(5) identify complications associated with the ACDF procedure.

This program meets criteria for CNOR and CRNFA recertification, as well as other continuing education requirements.

Anterior Cervical Discectomy and Fusion for Cervical Disc Disease

Anterior cervical discectomy and fusion (ACDF) is used to treat degenerative cervical disc disease that cannot be relieved by conservative therapy. This procedure has proven very successful in relieving pain and other symptoms and has a low incidence of associated side effects.

ANATOMY

The cervical spine consists of the seven cervical vertebrae and the intervertebral discs that lie between the vertebral bodies with the exception of C1 to C2. Intervertebral discs consist of the annulus fibrosis (ie, a fibrocartilaginous capsule) that surrounds the nucleus pulposus (ie, the semigelatinous center of the disc). (1) The purpose of the intervertebral disc is to serve as a shock absorber between the vertebral bodies. The structure of the annulus provides stability, and the elastic nature of the nucleus allows it to change shape to distribute forces equally along the cervical spine. (2) Intervertebral discs make up approximately 25% of the height of the cervical vertebral column. Cervical nerve roots exit the cervical spine through the intervertebral foramina between the vertebrae. (3)

PATHOPHYSIOLOGY

Cervical degenerative disc disease is associated with the aging process. (4) Disk degeneration and osteophyte formation are present on radiological studies in a majority of the population by age 56, yet many people never develop symptoms. (5) It is not yet understood why some people who have degenerative changes develop symptoms while others do not. (6)

In patients with cervical degenerative disc disease, the water content of the nucleus pulposus decreases, and the gelatinous interior of the disc gradually is replaced with fibrous cartilage, which reduces the shock absorbing capacity of the disc. (7) The decreased water content of the disc also may result in a narrowing of the disc space and loss of disc height, which increases motion at the affected disc space and further contributes to the degenerative process.

Many people develop osteophytes along the spine as a result of the degenerative process. These osteophytes may compress or irritate the cervical nerve root at the affected level or levels. (8) Fissures may develop in the annulus, which can allow portions of the nucleus to protrude through the annulus (ie, a herniated disc) (Figure 1). (9) Disc herniation may irritate or compress the spinal nerve roots exiting the spinal cord, causing pain or numbness along the distribution of the nerve. This degenerative process involving the cervical spine also is known as cervical spondylosis. Cervical disc degeneration occurs most commonly at the C5/C6 and the C6/C7 levels. (10) The degenerative process also can cause narrowing of the spinal canal (ie, spinal stenosis), compression of the spinal cord, or compression of the vessels supplying the spinal cord, resulting in cervical myelopathy. Cervical myelopathy results in numbness, weakness, and clumsiness of the upper extremities and weakness of the lower extremities that worsens progressively over time. (11)

Incidence. Research into the epidemiology of cervical disc disease indicates that men are affected more often than women by a small margin. Most people with symptomatic herniated cervical discs are in their forties and fifties because degenerative disc disease is a result of the aging process. Cigarette smoking also is associated with increased incidence of cervical disc disease. (12)