Posterior Cervical Spine Surgery
This surgery is usually performed to relieve compression on the nerves and the spinal cord and to treat painful arthritis. The spine is operated on from the back of the neck and is considered when the compression on the nerves is from the back. A posterior cervical spine surgery is occasionally considered as a supplemental procedure in combination with the anterior surgery.
Pressure on the nerve roots and spinal cord is caused by
- Disc prolapse - A disc prolapse (also referred to as slipped disc or disc herniation) is said to have occurred when the jelly-like central portion of the disc (nucleus pulposus) tears through the surrounding layers (annulus pulposus) and is displaced into the spinal canal, compressing the nerves extending from the spinal cord
- Bony out-growths - (osteophytes) - as a result of arthritis in the spine can compress the nerve root and spinal cord
- Thickening of the ligaments supporting the spinal column
- Fractures and tumours, though rare, can also produce compression on the nerves.
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. Direct compression of the spinal cord (myelopathy) 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 degeneration of the intervertebral disc and arthritis of the joints in the neck
Indications for surgery
Surgery is reserved for those with
- Symptoms fail to subside following a reasonable period of non-operative treatment
- Significant or progressive muscular weakness resulting from the nerve compression
- Spinal cord compression - Myelopathy - indicates the need for early surgery
About the surgery
Anaesthesia: The surgery is performed under general anaesthesia, with the patient lying face-down on the operating table.
Procedure: The surgeon makes a 5-15cm incision in the skin on the back of the neck. After retracting the muscles, a decompression, a fusion or a combination of the two 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) which are then connected with rods. Bone graft obtained from the pelvic bone may be used to produce a solid fusion. At the end of the surgery a drain tube is inserted to remove the blood that collects at the surgical site. Dissolvable sutures are used to close the skin.
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. You will be given pain medications, antibiotics, 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 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 and urinary catheter will be removed and you will be encouraged to walk with the neck collar. You will stay in the hospital for 1-3 days and your surgeon will decide when you can go home safely.
At home: Once you are at home, it is important to stay active and take short walks at regular intervals to help reduce pain and hasten your recovery. Gradually increase the distance you walk each day but avoid strenuous activities, heavy lifting and excessive rotation or extension of your neck. You may require some help with chores and errands for the first few weeks and it is advisable to have someone to help with these activities.
Risks and potential complications
All surgical procedures are associated with a risk of complications and all risks should be discussed with your surgeon. Allergic reaction to the anaesthetic or other medications and unforeseen complications such as pneumonia, stroke or heart attack are not caused by the surgical treatment and although rare it may have serious consequences. Please let your surgeon and anaesthetist know if you are allergic to medications and if you have any medical problems (relating to your heart, lungs, diabetes or increased blood pressure) and provide a list of your current and past medications.
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 do not routinely use medications to prevent venous thrombosis. However, if you have had an episode of DVT in the past, let your surgeon know.
Occasionally a solid fusion is not obtained (nonunion) and further surgery to re-fuse the spine may be necessary. Nonunion rates are higher for patients who have had prior spinal surgery, smokers, patients who undergo multiple level fusion surgery, and patients who have undergone radiation for cancer. Not all patients who have a nonunion will need to have another fusion procedure. As long as the joint is stable, and the patient's symptoms are better, more surgery is not necessary. In addition, there is a risk of achieving a successful fusion, without relieving the pain.
Notify your surgeon at once if you notice the following after surgery
- Excessive bleeding
- Redness or discharge from the wound
- Persistent headache
- Weakness or numbness in the arms and legs
- Difficulty in passing urine
This is a brief overview and does not include all the known facts about your condition and the surgery. Feel free to seek any clarifications from your surgeon and his team. It is important for you to obtain a clear understanding of your condition and the risks, benefits and limitations of the surgical procedure before proceeding.