Generally, this surgery is done to alleviate compression on the nerves and the spinal cord. It can also be performed to treat severe arthritis. In this procedure, the operation is done from the back of the neck; the nerves on the back of the neck are compressed. In some cases, a posterior cervical spine surgery is done together with the anterior cervical spine surgery.
Causes of nerve root and spinal cord compression
- Disc prolapse – Disc prolapses are also known as slipped disc or disc herniation. Disc prolapses happen when the soft disc centers (nucleus pulposus) are torn and displaced into the spinal canal. This squeezes the nerves extending from the spinal cord, causing immense pain.
- Bony Outgrowths – Bony outgrowths or osteophytes can also compress the spinal cord and nerve root. These outgrowths are usually formed because of spinal arthritis.
- Thickening of the ligaments supporting the spinal column
- Fractures and tumors can also cause compression in rare cases.
The compression and subsequent inflammation of the affected nerve root by a prolapsed disc causes pain in the arms and forearms. Myelopathy, or direct compression of the spine, can make it hard to walk. Other symptoms include clumsiness and issues with urinating. Remember, the intensity and presence of these symptoms may vary from person to person.
Indications for surgery
Surgery is done on patients when:
- Symptoms do not decrease following a reasonable period of non-operative treatment
- Significant or increasing muscular weakness due to the nerve compression
- Spinal cord compression or Myelopathy. This demonstrates the need for an early and quick surgery
About the surgery
Anesthesia: The surgery is done under general anesthesia. During the procedure, the patient will be lying face down on the operating table.
Procedure: The surgeon makes a 5-15 cm incision (cut) in the skin on the back of the neck. After gently pulling away the muscles, a decompression, a fusion, or a combination of both is performed. A decompression (removal of compression) is performed by removing one (or more bony) laminae, ligaments and any other structure compressing the spinal cord and nerves. A fusion is performed by inserting screws into the bones (vertebrae). These screws are then connected with rods. In some cases, bone grafts (from the pelvic bone) are needed to make a solid fusion. The surgery is finished by inserting a drain tube. This tube removes any excess blood, preventing it from collecting at the operation site. Finally, dissolvable sutures (stitches) are used to safely close up the skin.
After the surgery
In the recovery room: After the surgery, you may feel some pain on the operated area when you wake up. Pain medications, antibiotics, and IV fluids will help you stay hydrated and stable. You may also receive a temporary urinary catheter to use the bathroom. Additionally, a neck collar will help keep you comfortable and secure.
In the ward: After your surgery, you’ll be on a liquid diet before slowly going back to a full, regular diet. The drain tube and catheter will be removed. You’ll be able to walk around. Typically, you’ll stay in the hospital for 1-3 days, depending on your surgeon’s suggestions.
At home: Remember to stay active to speed up your recovery! Take short walks every day and slowly increase the distance. Please avoid heavy lifting, strenuous activity, and excessive movement of your neck. If you can, try to have someone to help you with your chores and errands for the first few weeks. The last thing you want to do is over-exert yourself!
Risks and potential complications
Keep in mind all surgical procedures come with a risk of complications. You should thoroughly talk about these risks with your surgeon before the procedure. Remember to list out any allergic reactions to anesthesia or other medicines. Other chronic illnesses related to your heart or lungs – such as hypertension, diabetes and asthma – should also be disclosed. Provide a list of all your current and past medications. Remember, unexpected complications such as stroke, heart attack, and pneumonia are not caused by surgical treatment and are generally rare. However, these rare complications may have serious consequences.
Surgical complications may consist of infection, bleeding, spinal fluid leak, injury to the veins and arteries near the spine or injury to the spine’s nerve tissue or its surrounding protective layer. Injury to the spinal cord or the nerves may occur during surgery and can result in complete paralysis of all four limbs or paralysis of certain muscles in the arms or legs, with loss of normal sensation. Loss of bowel and bladder control can also occur in consequence of injury to the nerves. An injury to the covering layers of the nerves (dura) can result in a leak of spinal fluid and this may occasionally require a surgery again.Great care is taken to ensure the accurate placement of the screws including the use of intra-operative fluoroscopy (x-rays).
Although antibiotics are given before and after surgery, there is a 1-5% chance of wound infection. Superficial mild infections can be treated with antibiotics, while deep infections may require a wound wash-out under anaesthesia. If you have had an infection in any other area (urinary bladder, chest and skin) immediately before surgery, you may be at a higher risk of post-operative infection in the spine, so make sure to let your surgeon know.
Deep vein thrombosis (DVT – clotting of blood in your calf muscles) and pulmonary embolism (clot migrating to your lungs) are uncommon after an elective spine surgery, especially when you are out of bed and walking within 24 hours after surgery. We do not routinely use medications to prevent DVT; however, if you have had an episode of DVT in the past, let your surgeon know.
In rare cases, solid fusion may not occur. When this happens, further surgery to re-fuse the spine may be necessary. Non-fusion (non-union) rates are higher for patients who have had spinal surgery in the past, as well as smokers, patients who undergo multiple level fusion surgery, and patients who have undergone radiation for cancer. Not all patients who have a non-union will need to have another fusion procedure. As long as the joint is stable and the symptoms are better, further surgery is not necessary. Conversely, there is a risk of having a successful fusion but without relieving the nerve pain.
Notify your surgeon immediately if you notice the following after surgery:
- Excessive bleeding
- Redness or discharge from the wound
- Weakness or numbness in the arms and legs
- Persistent headache
- Difficulty urinating
Talk to your surgeon
This is a concise overview and does not include all the known facts about your condition and the surgery. If you have any questions, make sure to seek any clarifications from your surgeon and his team. It is important for you to attain a clear understanding of your condition and the risks, benefits, and limitations of the surgical procedure before taking action.