Cervical Discectomy
I underwent Anterior Cervical Discectomy about three years back for disc herniation at C5-C6 level. I have been having neck pain withuot radiation on and off over the past years, which would subside in a few days with some rest and using a soft cervical collar.

Since two weeks now,I had been experiencing moderate neck pain and a rubbing sound/click in my neck on certain movements. I have also been experiencing difficlty in swallowing(no pain), a feeling much like a lump in the throat flt more so when taking solids. This symptom transiently dissappears in certain positions of the neck, like lying in left lateral position with head resting on pillow or sometimes even in upright position with yet unfigured out movements of the neck.

My financial position at present doesn’t allow me to see a neurosurgeon or get an MRI. I wore a soft cervical collar for 10 days.The neck pain has reduced considerably but the swallowing difficulty persists, sometimes getting worse.During the day I am used to lifting my 22lbs. baby regularly as I have no other choice, all thru this.

I was wondering if the swallowing difficulty is in anyway related to any further disc herniation at any other level or instability of my cervical vertebrae?I have no radiating pain or any weakness/numbness.
Is a neurosurgical consult and X- ray/MRI mandated immediately?If it disc related , what are the treatment options (conservative & surgical) available, considering the fact that I have already undergone a cervical disc surgery?

Dr. Joshua’s Answer:

While symptoms such as local neck pain, slightly limited neck rotation, difficulty in swallowing, hoarseness and feeling of lump in the throat are all fairly common complications after an anterior cervical discectomy, they are usually present in the first weeks-months after the discectomy operation and gradually subside. It’s not generally acceptable to have such symptoms continue for years, or appear after several years.

I don’t know which technique was used in the discectomy operation, but I am assuming anterior discectomy with intervertebral fusion with a synthetic graft. Other possibilities are discectomy with bone craft, and / or anterior plate (laminofixation). In your case, if at all possible, get a C-spine x-ray done (lateral projection is the most important, AP projection is advisable. Oblique projection is probably unnecessary as there are no radicular symptoms). Additional, and potentially valuable information could be obtained by flexion-extension C-spine X-ray.

If you can afford to have the X-ray taken without the radiologist’s report, you could e-mail me a scan of the X-ray films and I’ll have a look.

Since you do not have radiating pain/numbness, motor weakness, or symptoms of spinal cord compression, MRI is not necessary and would probably be a waste of money at this point.

What we want to rule out is fusion material dislocation, lack of fusion (i.e. lack of bone growth), pseudoarthrosis, ie. pseudarthrosis, all of which could contribute to the symptoms you are experiencing. Your symptoms may be also due to further degeneration / arthritis in your cervical spine, including disc collapse, facet joint hypertrophy and osteophytes. However, these would not explain the difficulty in swallowing. Dislocation in the forward direction of the fusion graft could cause compression of the esophagus and consequently difficutly in swallowing and feeling of lump in throat.

In the case of fusion material displacement, lack of fusion, and/or pseudoarthrosis, treatment options include re-operation and re-fusion (with anterior plates if plates were not used in the first operation). However, this may not be absolutely necessary. Other possible treatments include anti-inflammatory drugs coupled with immobilisation (hard collar) and follow-up.

If the symptoms are not too bad, and not progressing, and you are really tight financially right now, you could follow the symptoms for a bit, use a soft collar and an anti-inflammatory drug such as ibuprofen 600 mg 3xdaily (check suitability for you) for the pain, and avoid heavy lifting, straining, and extensive neck movements if at all possible. See if the symptoms resolve over time.

To summarize, my recommendation is to have the X-rays taken and consult a neurosurgeon. If your situation does not permit this, you can look at the alternative options I’ve outlined here.

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