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Posterior Cervical Spine Surgery

Surgery :: Anterior lumbar interbody fusion :: Anterior Cervical Decompression Fusion
Lumbar Disc Replacement :: Spinal Deformity Surgery :: Lumbar Decompression and Fusion
Lumbar Discectomy :: Surgical Risks :: FAQ

Anatomy of the spine

The spine consists of 33 bony blocks called vertebrae stacked one above the other with a soft intervertebral disc between each pair of vertebrae. The intervertebral disc consists of a soft jelly-like substance called the nucleus pulposus in the centre, which is surrounded by multiple layers of collagen called the annulus fibrosis (like an onion). The disc connects and allows movement between the vertebrae and acts as a shock absorber for the spine. The vertebrae surround and protect the spinal cord and nerve roots.

The neck, also called the cervical spine, consists of seven vertebrae with an intervertebral disc in-between each pair of vertebrae.

Who needs a posterior cervical (neck) spine surgery?

  • When the problem causing symptoms is located in the posterior aspect of the spine;
  • when the compression on the spinal cord is from the posterior aspect;
  • when the cervical spine is excessively mobile and unstable; or
  • in association with an anterior procedure to provide additional stability or to achieve additional decompression.
The compression can be on the nerves going to the arms or on the spinal cord. Compression of the nerves in the neck can cause pain radiating down the arm and forearm with numbness, pins and needles, and muscular weakness in the affected limb. When the compression is on the spinal cord (myelopathy), it can cause difficulty in walking, clumsiness of the hands and problems with passing urine. The presence and severity of these symptoms vary from person to person. Pain in the neck could arise from numerous structures. Degeneration of the intervertebral disc and arthritis of the facet joints are the common causes of neck pain.

Who needs surgery?

Surgery is reserved for those with:

  • No relief of pain with the non-operative forms of treatment;
  • Increasing numbness and weakness in the arms and hands;
  • Or the presence of myelopathy indicates the need for early surgery.

After assessing your symptoms, examining your spine, and studying your x-rays and scans, the surgeon will decide whether you need a posterior spinal decompression, a spinal fusion or a combination of both.

About the surgery

Anaesthesia: The surgery is usually performed under general anaesthesia, with the patient lying on the tummy. Occasionally, a frame is attached to the skull after anaesthesia, to maintain the position of the head during surgery.

Procedure: The surgeon makes a 5-15cm incision in the skin on the back of the neck. The spine is exposed by retracting the muscles. Depending on the plan, a decompression, a fusion or a combination of both is performed. A decompression is performed by removing one or more bony laminae and any other structure overlying the spinal cord. A fusion is performed by inserting screws into the bones over the back of the spine and connecting the screws with rods. Occasionally, a combination of a decompression and a fusion is performed. At the end of the surgery a drain tube is inserted to remove the blood that collects at the surgical site.

Skin sutures: Dissolvable sutures are used to close the skin. These will dissolve as your wound heals, however, the ends of the suture on either end of the incision will need to be cut on your first visit to the surgeon's office (7-10 days after surgery).

After the surgery

In the recovery room: Following surgery, you will be transferred to the recovery room and may feel some pain at the operated site when you wake up. A patient controlled analgesia (PCA) pump will be provided, which releases a small dose of pain medication every time you press the button thereby putting you in control of your pain. You will be given intravenous fluids to keep you hydrated and a urinary catheter will empty your bladder. A neck collar will be provided to prevent excessive neck movements and to keep you comfortable. When the medical staff in the recovery room is confident that you are comfortable, you will be transferred to your room.

In the ward: You will be allowed to drink sips of fluids after surgery and gradually progress to a full diet. The day after surgery, the drain tube, urinary catheter and pain pump will be removed and you will be encouraged to walk wearing a brace to support your spine. You will stay in the hospital for 1-3 days and your surgeon will decide when you can go home safely.

Are there any risks involved in disc surgery?

All surgical procedures are associated with a risk of complications and all risks should be discussed with your surgeon. The risks may be associated with the anaesthesia given or the surgical procedure. Surgical complications can include bleeding, infection, spinal fluid leak, injury to the veins and arteries near the spine or injury to the nerve tissue of the spine 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 following 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 repeat surgery. 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% incidence 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 region (urinary bladder, chest and skin) immediately prior to surgery, you may be at a higher risk of post-operative infection in the spine, so let your surgeon know.

Venous thrombosis (DVT - clotting of blood in your calf muscles) and pulmonary embolism are uncommon after an elective spine surgery, particularly when you are out of bed and walking within 24 hours after surgery. We use calf compressors and TED stockings to prevent the clotting of blood in legs; we do not routinely use medications. However, if you have had an episode of DVT in the past, let your surgeon know.

There are certain warning signs you should look for after surgery that may indicate a problem, such as excessive bleeding, redness or discharge from the wound, fever, weakness or numbness of the legs or problems urinating. If you notice any worrisome symptoms, notify your surgeon at once.

Talk to your surgeon

This is a brief overview and does not contain all the known facts about your condition and the surgery. Feel free to seek any clarifications from your surgeon and his or her team. It is important for you to obtain a clear understanding of your condition, the surgery and the potential risks and benefits before you sign the consent form.

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