Anterior cervical discectomy and fusion for cervical disc disease

AORN Journal,  Dec, 2002  by Cecile Cherry

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Symptoms. The most common symptoms seen in patients presenting for treatment of degenerative disc disease are

* neck pain,

* occipital headaches, and

* pain and numbness radiating to one or both shoulders, the scapular area, or arms and hands.

Many patients have radicular pain, which is pain following the dermatome pattern of the affected nerve root. Radicular pain can be aggravated or relieved by the patient's neck and head position. Neck flexion can relieve symptoms in some patients, and tilting or rotating the head toward the affected arm may increase pain and numbness. Some patients also have decreased reflexes and motor weakness in the affected arm and hand, though these are less common symptoms than pain and numbness. (13)

DIAGNOSIS AND CONSERVATIVE TREATMENT

A combination of plain radiographs and magnetic resonance imaging (MRI) with or without computed tomography (CT) myelograms often are used in the diagnosis of patients presenting with symptoms of degenerative cervical disc disease. Plain x-ray films can be used to determine whether cervical osteophytes are present and whether a loss of disc height is present in the cervical spine. The disc space and cervical nerve roots can be examined by MRI scan to identify disc herniation. Compression of the spinal cord or nerve roots can be identified with CT myelograms. (14)

Conservative treatment for patients with symptomatic degenerative disc disease includes rest, pain medication, nonsteroidal anti-inflammatory medications, intermittent cervical traction, and physical therapy to instruct the patient in isometric neck exercises. Many patients benefit from conservative treatment and experience improved symptoms. Patients who continue to have pain, numbness, or weakness, despite conservative therapy, are candidates for surgical treatment. (15)

When the patient and surgeon agree on surgical treatment, a staff member from the surgeon's office calls the OR to schedule surgery. At HealthSouth Medical Center, Birmingham, Ala, patients scheduled for ACDF are admitted the morning of surgery through the same day surgery unit. The patient is instructed when to report to the hospital for admission on the day of surgery and to remain NPO after midnight the night before surgery.

PROCEDURE PREPARATION

On the day of surgery, the circulating nurse and scrub person gather all equipment, supplies, and medications for the procedure (Table 1). They cooperatively open the appropriate items onto the sterile field. The circulating nurse balances the operating microscope, and the scrub person performs a surgical hand scrub and dons a sterile gown and gloves. The scrub person then sets up the back table, Mayo stand, cervical vertebral body distraction system, and cortical ring allograft with graft sizers and impactors (Figures 2 and 3). Meanwhile, the circulating nurse goes to the preoperative holding area to interview and assess the patient.

Patient assessment. The circulating nurse greets the patient in the preoperative holding area and verifies the patient's identification verbally and by using the patient's identification bracelet. The nurse verifies the procedure and surgical site with the patient and the surgical consent form. The perioperative nurse also questions the patient regarding allergies and NPO status and verifies that any dentures and jewelry, including body jewelry, have been removed. The nurse questions the patient to determine whether he or she is experiencing pain or numbness in one or both arms and assesses the patient for any bilateral or unilateral sensory loss or motor weakness. Depending on the patient's signs and symptoms, the nurse determines any special positioning or other perioperative needs that the patient might require.