SPINAL SURGERY

in Hull and East Yorkshire

GEORGE SPINK FRCS (Neurosurg.) BSc Hons

 

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POSTERIOR CERVICAL DECOMPRESSION

Patients with a disc prolapse or degenerative ‘wear and tear’ changes in the neck will usually have either arm pain (brachalgia) due to nerve root compression or worsening fine hand function (myelopathy) due spinal cord compression.

Depending on the appearance of the scans it may be necessary to consider posterior cervical surgery to decompress the spinal cord or nerve roots.

For patients with brachalgia the arm pain will usually improve after surgery. Patients with a myelopathy may see some improvement, but in many cases the aim of surgery is to prevent further deterioration and preserve the remaining function.

The operation is carried out through a cut in the back of the neck under a general anaesthetic. It takes approximately 1 hour. Depending on the scan findings patients will either need spinal cord decompression (laminectomy) or nerve root decompression (foramenotomy).  Both are similar procedures but a laminectomy involves removing more bone. The wound is closed using skin clips that need to be removed 1 week after surgery – this can be done by the ward staff or by the practice nurse at the GPs surgery. Most patients have a wound drain, which is removed 24 hours after surgery. Patients are usually well enough to go home the day after surgery and will be recovering at home for another 4-6 weeks.


The risks of the operation include:

            Wound infection (2%)

            Spinal fluid leak (1%)

            Blood clot at operation site requiring re-operation (1%)

Nerve root injury resulting in worsening arm pain, numbness, weakness or paralysis (1%)

            Spinal cord injury resulting in arm / leg weakness or paralysis (1 in 2000)

No improvement in symptoms (10% of patients with arm pain; variable in Myelopathic patients)

Risk of spinal instability requiring further surgery (1%)

            General anaesthetic risks, including a small risk to life

 

Following surgery the patient may notice some neck pain and stiffness but this should settle with simple anti-inflammatory medication, such as Neurofen. Some patients will develop tingling in the arm after surgery. This is due to swelling in the nerve following manipulation at surgery. It is temporary and will settle down after a few days.

Patients do not usually need to wear a neck collar or support. A specialist physiotherapist will advice each patient on a postoperative exercise regime, to encourage neck movements, rather than restrict them with a collar.