Overview

 

What is Cervical Spine Surgery ?

The goal of cervical spine surgery is to relieve pain, numbness, tingling and weakness, restore nerve function and stop or prevent abnormal motion in the spine. Your surgeon does this by removing a disc or a bone and fusing the vertebrae together with a bone graft either in front of or behind the spine. The bone graft may be one of two types: an autograft (bone taken from your body) or an allograft (bone from a bone bank). Sometimes metal plates, screws or wires are also used to further stabilize the spine. These techniques are called instrumentation. When the vertebrae have been surgically stabilized, abnormal motion is stopped and function is restored to the spinal nerves.

Normal anatomy

The cervical spinal column is made up of vertebral bodies which protect the spinal cord

Indications

Cervical spine disease is usually caused by herniated intervertebral discs, abnormal growth of bony processes on the vertebral bodies (osteophytes), which compress spinal nerves, trauma, and narrowing (stenosis) of the spinal column around the spinal cord.

Symptoms of cervical spine problems include:

Incision

The surgery is done while the patient is deep asleep and pain-free (general anesthesia). For the neck (cervical spine), an incision may be made either in the back of the neck (posterior cervical) or in the front side of the neck (anterior cervical), depending on the location of the problem.

Procedure

The bone that curves around and covers the spinal cord (lamina) is removed (laminectomy) and the tissue that is causing pressure on the nerve or spinal cord is removed. The hole through which the nerve passes can be enlarged to prevent further pressure on the nerve. If an intervertebral disc herniation is present, the intervertebral disc is removed. Sometimes, a piece of bone (bone graft) or metal rods (such as Harrington rods) may be used to strengthen the area of surgery.



What are the Potential Complications of Cervical Spine Surgery ?

As with any operation, there are risks involved with cervical spine surgery. Possible complications include injury to your spinal cord, nerves, esophagus, carotid artery or vocal cords; non-healing of the bony fusion; failure to improve; instrumentation breakage and/or failure; infection; bone graft site pain. Any of these complications may lead to more surgery.

Other complications may include phlebitis in your legs, blood clots in the lungs or urinary problems. Rare complications include paralysis and possibly death. Your doctor will discuss potential risks with you before asking you to sign a consent form.



How is Revision Surgery different ?

Revision surgery often requires correcting a deformity. The type of revision depends on the type of problem. The procedure may include operating on both the front and back of the neck.

The incidence of complications from cervical spine revision surgery is higher than in first-time procedures. It is also more difficult to relieve pain and restore nerve function in revision surgery. Patients should also be aware that the chance of having long-term neck pain is increased with revision surgery.

Cervical Spine Surgery: Preparation Steps

Preparing For Surgery

Before coming to the hospital, you can do some things to prepare your home to make your recovery easier, such as : -



Think about what changes you'll make if you need to stay on one floor.

Equipment Needs : -

You will be fitted for a neck collar/brace or halo brace before surgery. The brace is an important part of your recovery process. Your therapist and doctor may also prescribe several types of medical equipment to help you in your recovery. Insurance coverage for equipment varies from one company to another and may change over time. You should check with your insurance company to find out if you have coverage for durable medical equipment (DME), such as a walker or commode, so you can prepare for any co-pay or equipment that may not be covered.

The physical therapist and home-care coordinator will help order the equipment and verify your insurance coverage. Your medical equipment will be ordered a few days before your discharge and delivered to your home. Please arrange for someone to be home to accept the delivery.

Medical equipment may include : -



Hospital beds are necessary only for patients with specific medical needs and must be prescribed by your doctor. Most patients do not require a hospital bed after cervical spine surgery.

Transportation Home

You may travel home from the hospital by car, either reclining in the front passenger seat or lying down in the back seat. You must arrange for your own transportation home. Once you are home you may not drive until told otherwise by your doctor. In fact, it is illegal to drive while wearing a collar or brace. However, you may take short car rides as a passenger. If you have any questions about driving, please talk to your doctor.

Medication

Please stop taking aspirin and nonsteroidal anti-inflammatory medicines (NSAIDs), such as Ibuprofen and Indocin, two weeks before your surgery. If you aren't sure which of your medications are nonsteroidal anti- inflammatory medicines, check with your doctor or pharmacist. Once your NSAIDs are discontinued, you may take extra-strength Tylenol for pain relief. If this does not relieve your pain, call your doctor for other pain-relieving medicine. If you take aspirin or Coumadin for a heart condition, please contact your doctor for further instructions. On the day of surgery, please bring a list of your routine medications with you to the hospital.

Stop Smoking

If you smoke, it is important that you stop smoking for at least two weeks before your surgery and for six weeks after your surgery. Studies have shown that smoking interferes with healing of your bone graft.

Medical Doctor

Your orthopedic doctor may ask you to visit a medical doctor to be sure you have no health problems that could interfere with your surgery. The medical doctor will confer with your family physician or internist about any specific medical problems you may have. He or she will also follow your medical status during your hospital stay.



Preadmission Testing and Evaluation : -
Your doctor's office will schedule your appointment to have a preadmission evaluation. which may include some or all of the following : -

Hospital Care

Although each patient's procedure and recovery is different, the usual hospital stay for cervical spine surgery is one to two days. Most patients will be discharged home but some may go to a rehabilitation facility before returning to their home. Each patient will be evaluated during the hospital stay to determine if he or she needs rehabilitation. If you will be returning home, your doctor may ask the home care coordinator to arrange for a visiting nurse and/or therapist. If you will be going to a rehabilitation center, the social worker will coordinate your transfer.

The goal of your care after surgery is to help you become independent so you can return home.

By discharge, you should be able to : -



To help you reach these goals, the staff will help you as needed, but they will also encourage you to actively participate and do as much for yourself. When you wake up after surgery, you will be in bed on your back, wearing a neck collar/brace. You will be helped in getting out of bed and will begin your activity program the evening of your surgery. The activity program includes leg exercises, walking, stair climbing, activities of daily living such as bathing and dressing and home management.

Aftercare

Depending on the disease present and the surgery performed, mobility of the cervical spine may be limited after cervical spine surgery. Physical therapy is often indicated after surgery.

Preventing Breathing Problems

It is important to practice deep breathing exercises after your surgery.



You should always cough following the deep breathing exercises. This will help clear your lungs.




Your nurse will also teach you how to use an incentive spirometer, a device that helps you to breathe deeply. You should use this 10 times an hour while awake.

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