Anterior cervical discectomy with fusion is an operation that involves relieving the pressure placed on nerve roots and/or the spinal cord by a herniated disc or bone spurs – a condition referred to as nerve root compression.

Through a small incision made near the front of the neck (i.e., the anterior cervical spine), the surgeon:

• Removes the intervertebral disc to access the compressed neural structures
• Relieves the pressure by removing the source of the compression
• Places a bone graft between the adjacent vertebrae, and
• In some cases, implants a small metal plate to stabilize the spine while it heals.

Discectomy involves removing all or part of an intervertebral disc. The termdiscectomy is derived from the Latin words discus (flat, circular object or plate) and -ectomy (removal). Spinal fusion involves placing bone graft between two or more opposing vertebrae to promote bone growth between the vertebral bodies.

Why is it done?

Pressure placed on neural structures, such as nerve roots or the spinal cord, by a herniated disc or bone spur may irritate these neural structures and cause: pain in the neck and/or arms; and lack of coordination, numbness or weakness in the arms, forearms or fingers. Pressure placed on the spinal cord as it passes through the neck (cervical spine) can be serious since most the nerves for rest of the body (e.g., arms, chest, abdomen, legs) have to pass through the neck from the brain.

Patients who suffer from these symptoms are potential candidates for this operation.

The Operation

An understanding of what an anterior cervical discectomy with fusion involves will help you to approach your operation and recovery with confidence.

Incision

You will lie on your back on the operative table and be given anesthesia. Once asleep, your neck area is cleansed and prepped. If a fusion is planned and your own bone will be used, the hip area is also prepped to obtain a bone graft. If a donor bone will be used, the hip incision is unnecessary.

Exposure

A 2-inch skin incision is made on the right or left side of your neck. The surgeon makes a tunnel to the spine by moving aside muscles in your neck and retracting the trachea, esophagus, and arteries. Finally, the muscles that support the front of the spine are lifted and held aside so the surgeon can clearly see the bony vertebrae and discs.

Removal

With the aid of a fluoroscope (a special X-ray), the surgeon passes a thin needle into the disc to locate the affected vertebra and disc.To remove the damaged disc, the vertebrae above and below the disc must be held apart. Your surgeon first inserts a spreader into the body of each vertebra above and below the disc to be removed. Gentle tension is placed on the spreader to separate the two vertebrae.

The outer wall of the disc (annulus) is cut (Fig. 3). The surgeon removes about 2/3 of your disc using small grasping tools, and then looks through a surgical microscope to remove the rest of the disc. The posterior longitudinal ligament, which runs behind the vertebrae, is removed to reach the spinal canal. Any disc material pressing on the spinal nerves is removed.

Material Placement

Bone grafts come from many sources. Each type has advantages and disadvantages.

• Autograft bone comes from you. The surgeon takes your own bone cells from the hip (iliac crest). This graft has a higher rate of fusion because it has bone-growing cells and proteins. The disadvantage is the pain in your hipbone after surgery. Harvesting a bone graft from your hip is done at the same time as the spine surgery. The harvested bone is about a half inch thick – the entire thickness of bone is not removed, just the top half layer.
• Allograft bone comes from a donor (cadaver). Bone-bank bone is collected from people who have agreed to donate their organs after they die. This graft does not have bone-growing cells or proteins, yet it is readily available and eliminates the need to harvest bone from your hip. Allograft is shaped like a doughnut and the center is packed with shavings of living bone tissue taken from your spine during surgery.
• Bone graft substitute comes from man-made plastic, ceramic, or bioresorbable compounds. Often called cages, this graft material is packed with shavings of living bone tissue taken from your spine during surgery.

Stabilization

A metal plate may be implanted on the front of the cervical spine to increase the stability of the spine immediately after the operation. Surgeons use these implants to decrease the amount of time that you have to wear a cervical collar after surgery and to increase your chances of developing a solid fusion. An x-ray is taken to verify the position of the bone graft and the metal plate and screws.

Closure

The spreader and retractors are removed. The muscle and skin incisions are sewn together with sutures. Steri-Strips or biologic glue is placed across the incision. The operation is completed when your surgeon closes and dresses the incision.

Recovery

Your surgeon will have a specific post-operative recovery/exercise plan to help you return to normal life as soon as possible. The amount of time that you have to stay in the hospital will depend on this treatment plan. You will normally be up and walking in the hospital by the end of the first day after the surgery.

It is important that you discuss the potential risks, complications, and benefits of spinal surgery with your doctor prior to receiving treatment, and that you rely on your physician’s judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.

What are the results?

Anterior cervical discectomy is successful in relieving arm pain in 92 to 100% of patients [3]. However, arm weakness and numbness may persist for weeks to months. Neck pain is relieved in 73 to 83% of patients [3]. In general, people with arm pain benefit more from ACDF than those with neck pain. Aim to keep a positive attitude and diligently perform your physical therapy exercises.

Achieving a spinal fusion varies depending on the technique used and your general health (smoker). In a study that compared three techniques: ACD, ACDF, and ACDF with plates and screws, the outcomes were [3]:

• 67% of people who underwent ACD (no bone graft) achieved fusion naturally. However, ACD alone results in an abnormal forward curving of the spine (kyphosis) compared with the other techniques.
• 93% of people who underwent ACDF with bone graft placement achieved fusion.
• 100% of people who underwent ACDF with bone graft placement and plates and screws achieved fusion.

Recurrences of neck pain are common. The key to avoiding recurrence is prevention:

• Proper lifting techniques
• Good postureduring sitting, standing, moving, and sleeping
• Appropriate exerciseprogram
• An ergonomic work area
• Healthy weight and lean body mass
• A positive attitude and relaxation techniques (e.g., stress management)
• No smoking

Mr. S.B. firstly contacted us on 7th February describing his low-back problem (prolapsed disc) affecting his right leg. Calcified disc herniation can clearly be seen on MRI images:

Image showing disc herniation at level L4-L5

Patient’s symptoms included minor low-back pain, but main problem was right buttock pain and a painful lower limb outside calf area. His symptoms were 100% concordant to the MRI and transforaminal endoscopic spine surgery (discectomy) is indicated.

On 7th March 2012, dr. Robert Saftic performed aware state selective endoscopic discectomy. Immediately after surgery, patient was pain free. Next day at the consultation, when asked “What percentage of pain relief do you feel?“, patient replied “100%“.

Nobody happier then us.

Day after the surgery: dr. Robert Saftic (neurosurgeon), patient, dr. Nikola Perisa (anesthesiologist)

Patient testimonial coming soon!

Images taken during surgery:

Until now, since Spine Surgery Croatia (also known as Vertebris International Spine Hospital) started in 2010, we have attracted numerous patients from all over the world, but understandingly most of them from Europe. In this article, we will write something about them and enable personal connection between You (possible patient interested in treatment in our clinic) and our old patients that were already treated here.

M.M. from Egypt
Vital 55 years old male patient with severe spinal stenosis at L3-L4 and herniated disc at L4-L5. Treated in Croatia in January 2011 with 100% success. As already mentioned, diagnosis was spinal stenosis and treatment was Coflex surgery and micro-decompression for spinal stenosis and PLDD (laser disc decompression) for herniated disc. Patient was walking without assistance immediately after surgery. Now, after 4 months patient is pain free and back to his life and daily activities.

M.B. from Romania
50 years old male from Romania first contacted us over a year ago. Together with us, he has contacted numerous of other clinics and facilitators to get appropriate diagnosis and treatment plan. For several reasons, he was unhappy with replies from others and decided to come for treatment in Croatia by the end of April 2011. Diagnosis was disc protrusion (contained) at L5-LS1 and treatment was endoscopic discectomy with interlaminar approach. Despite some discomfort and pains after surgery, patient is now almost pain free and will soon be back to his life and normal daily activities.

G.A. from Spain
Our first international patient, treated in mid 2010. Patient diagnosis was disc extrusion at L4-L5 and treatment was selective endoscopic discectomy. Immediately after surgery patient was feeling better. Regular follow-up’s were made and now after one year patient is back to his pain free life.

A.H. from United Kingdom
Unfortunate guy! He came to us with disc protrusion at L5-S1 which was successfully treated nine months ago. Patient was doing OK, back to work and daily activities. Unfortunately, he had accident while skiing and his disc has extruded. After follow-up MRI, we have concluded that patients needs endoscopic surgery as permanent treatment for his problems. Now, after few months patient has informed as that he is fresh as new, back to his life, job and daily activities.

D.G. from Germany
30 years old soccer player from Munich came to us 6 months ago. His diagnosis was annular tear at L4-L5 and primary back pain caused by disc degenereation. Treatment was selective endoscopic discectomy with thermal annulopasty. After 6 months patient is pain-free and back to second most important thing in the world – football.

There are more success stories, especially from local patients coming from Croatia, Bosnia, Serbia, Macedonia, Montenegro, Slovenia. Do not hesitate to contact us for more information or any questions.

All surgeries are performed by doctor Robert Saftic, neurosurgeon and pioneer in minimally-invasive spinal surgery in Croatia and south-eastern Europe. Special interests include minimally-invasive spinal surgery with philosophy of choosing most effective and least invasive methods of treating spinal disorders and diagnosis of pain in low back, neck, legs and arms. Internationally accepted and known expert in field of laser, METRx and endoscopic spine surgery which is proved by invitations to all leading spinal congresses and by publishing results in medical journals.

Contact information:
e-mail: info@spine-surgery-croatia.com
alternate e-mail: roberto.posavec@gmail.com
tel/fax: +385 32 338 650
mobile (24/7): +385 95 805 67 97

“Don’t be confused by clinics offering Minimally Invasive Spine Surgery (MISS) which by definition has an incision of less than 7.5mm, when they really mean Less Invasive Spinal Surgery (LISS) which uses an incision(s) which amount to 20 – 80mm.”

What dr. Martin Knight is trying to say? True minimally-invasive spinal surgical techniques are exactly – endoscopic (which by definition has an incision of less than 7.5mm). With minimally-invasive endoscopic surgical techniques, surgeons are able to treat variety of spinal diseases like:

• herniated disc
• protruded disc
• extruded disc
• bulging disc
• pinched nerve
• back pain
• FBSS – failed back surgery syndrome
• annular tear
• spinal instability
• sciatica

Less-invasive spinal surgeries (which by definition have an incision from 15-80mm) are for example this surgical procedures:

• tubular retractor assisted surgeries, known as METRx procedures, or micro-endoscopic procedures (acceptable solutions if surgeon is following principles of minimally-invasive spinal surgery)
• cervical surgical procedures like posterior foraminotomy
• interspinous implant surgery

Usually, this are good surgical procedures when performed by minimally-invasive spinal surgery, in comparison to traditional surgical procedurs.

This surgeries are not minimally-invasive and will never be minimally-invasive. However, they can be performed with some principles of minimally-invasive concept with result of shorter hospitalization, less blood loss, etc. They are not minimally-invasive because they are somehow drastic and aggressive. For example:

• minimally-invasive spinal fusion – during this surgery, complete disc is removed and bones are damaged. Irreversible!
• artificial disc surgeries – complete disc is removed. Irreversible! We recommend experienced surgeon for this type of surgery.
• ACDF (anterior cervical discectomy and fusion) for which many surgeons claim that it is minimally-invasive surgery. Of course it is not. Whole disc is removed and metal plates, rods and screws are used.
• Micro-surgery, micro-spine surgery, micro-discectomy (traditional spine surgeries).

Do not hesitate to contact us with any questions.

Please prepare your :

• CAT/MRI films or CD,
• Filled patient history form,
• Written description of your current pains, problems and symptoms.

There are few methods of MRI transfer:

• Uploading MRI to the server (2 methods):
• If you have MRI on CD, please compress all the files from the CD and upload on some free web server like dropbox.com, skydrive.com, uploading.com, etc.
• If you have MRI films, you can put them on a light source and take a pictures with a digital camera (example image). After that, you can upload that files on some free web server like dropbox.com, skydrive.com, uploading.com, etc.
• For booth of this processes, we offer free consulting service (phone, skype). We are able to connect to your PC and do the job (transfer of the files to our servers).

• Sending by e-mail (2 methods):
• If you are able to extract images from MRI viewer software, you can send images via -email – info@spine-surgery-croatia.com.
• If you have MRI films, and you pictured them with a digital camera, you can send that images via e-mail - info@spine-surgery-croatia.com.
• For booth of this processes, we offer free consulting service (phone, skype). We are able to connect to your PC and do the job (transfer of the files to our servers).

• Sending by normal post:
• If you preffer sending by normal post, please use only this address:

VERTEBRIS INTERNATIONAL SPINE HOSPITAL
attn. dr. Robert Saftic
Petrovaradinska 1/8
10000 Zagreb
Croatia
Contact phone: +385 95 805 67 97

When you are done with above, please make sure to fill the form bellow and inform us that you have send us your MRI so we can expect it and track it is possible:

This congress (course) as awlays has attracted most of the leading name of world spinal surgery like dr. John C. Chiu (USA), dr. P. Choi (Brasil), dr. Destandau (France), dr. Dezawa (Japan), dr. Hellinger (Germany), dr. Sang-Ho Lee (South Korea), dr. Schubert (Germany), dr. Tolgay Satana (Turkey), and others.

Dr. Saftic’s invitation to this congress (course) is big award for up his up to date work at Vertebris International Spine Hospital and for his efforts in developing minimally-invasive spine surgery in Croatia.

Please remember that this type of surgery, in comparison to traditional spine surgery, ensures bigger patient satisfaction, quicker recovery, less blood loss, less need for post-operative medications, quicker return to daily activities and normal life.

Do not hesitate to contact us for free advice or second opinion.

With extensive consultation with spinal neurosurgeon Robert Saftic MD and patient coordinator, Mr. J.G.R. has decided to come to Croatia for minimally-invasive treatment called dorsal endoscopic rhizotomy, pioneered and invented  by Anthony Yeung from USA.

Patient has arrived to Croatia on 1st January 2012 with his wife. Our patient coordinator has spent time with the patient and his wife, guided them trough Zagreb and helped them in preparation for the surgery. Surgery was scheduled for 3rd January 2012 in our well known Vertebris International Spine Hospital. Bellow you can see images directly from the operating room:

Fingers crossed for good recovery and successful final outcome after recovery period!

10 days follow-up letter from Mr. J.G.R.

“In England we have a saying

LIFE BEGINS AT 40.   This has now been amended to

LIFE BEGINS WITH DR. SAFTIC.

Many thanks to all the team”