Posterior Cervical Spine Surgery
Posterior cervical spine surgery is performed when there is pressure or compression over the spinal nerves. The pressure can be at multiple level in multilevel cervical myelopathy or single level in cervical disc herniation.
Indications for Surgery:
- Severe pain.
- Pain more than 3 weeks, not relieved by medications.
- Progressive weakness in upper or lower limbs.
- Tingling, numbness in upper and lower limbs
- Imbalance while walking, difficulty in performing fine motor activities
- Difficulty in passing urine and stools or inability to control urine and stools.
Procedure
Posterior cervical spine surgery includes:
- Posterior cervical foraminotomy..
- Posterior cervical laminectomy.
- Posterior cervical laminectomy and fusion.
Posterior Cervical Foraminotomy
Anaesthesia: The surgery is performed under general anaesthesia with the patient lying face down on the operating table.
Surgery: After cleaning the area of surgery thoroughly, the level of surgery is confirmed under X ray machine. A small incision is made of about 1 – 2 cm at the level of surgery. Muscles are retracted to one side by dissection to expose the bone (lamina) underneath which lies over the spinal nerves. A small portion of bone is removed (laminotomy) along with the ligaments to enter into the spinal canal and expose the spinal nerves. The spinal nerve is gently retracted towards one side to locate the herniated disc material, which is then removed to complete the decompression of the nerve root.
After Surgery
In the recovery room: Immediately after surgery the patient is shifted to recovery room, where the patient is monitored for some time. Medications are provided for pain to control post operative pain relief. Once the patient is comfortable the patient is shifted to ward. A soft cervical collar is given for support and reduce muscular spasm.
In the ward: The patient is allowed to have liquids 6 hours after the surgery. Once the pain has reduced and the patient is comfortable, patient is allowed to sit and walk on the same of the surgery. The patient is discharged on the same day or next day after surgery.
After Discharge:
- It is necessary to stay active after surgery and patient can walk as per his comfort with in his home or nearby.
- The patient should follow healthy eating habits avoid weight gain and obese patient should try to reduce weight.
- The patient should refrain from smoking cigarettes, chewing tobacco and drinking alcohol as these can lead to recurrence of symptoms later.
- Patient should do exercise atleast for 45 mins to 1 hour daily to get good result after spine surgery and avoid future spine related problems.
- The soft cervical collar is worn for 3-4 weeks after which strengthening exercise is started for neck muscles.
Posterior Cervical Laminectomy
Anaesthesia: The surgery is performed under general anaesthesia with the patient lying face down on the operating table.
Surgery: After cleaning the area of surgery thoroughly, the level of surgery is confirmed under X ray machine. A small incision is made of about 4-5 cm at the level of surgery. Muscles are retracted to one side by dissection to expose the bone (lamina) underneath which lies over the spinal nerves. The portion of bone is removed (laminectomy) along with the ligaments to enter into the spinal canal and expose the spinal cord and achieve decompression of the spinal cord.
After Surgery
In the recovery room: Immediately after surgery the patient is shifted to recovery room, where the patient is monitored for some time. Medications are provided for pain to control post operative pain relief. Once the patient is comfortable the patient is shifted to ward. A soft cervical collar is given for support and reduce muscular spasm.
In the ward: The patient is allowed to have liquids 6 hours after the surgery. Once the pain has reduced and the patient is comfortable, patient is allowed to sit and walk on the same of the surgery. The patient is discharged on the next day after surgery.
After Discharge:
- It is necessary to stay active after surgery and patient can walk as per his comfort with in his home or nearby.
- The patient should follow healthy eating habits avoid weight gain and obese patient should try to reduce weight.
- The patient should refrain from smoking cigarettes, chewing tobacco and drinking alcohol as these can lead to recurrence of symptoms later.
- Patient should do exercise atleast for 45 mins to 1 hour daily to get good result after spine surgery and avoid future spine related problems.
- The soft cervical collar is worn for 3-4 weeks after which strengthening exercise is started for neck muscles.
Posterior Cervical Laminectomy and Fusion
Anaesthesia: The surgery is performed under general anaesthesia with the patient lying face down on the operating table.
Surgery: After cleaning the area of surgery thoroughly, the level of surgery is confirmed under X ray machine. A small incision is made of about 4-5 cm at the level of surgery. Muscles are retracted to one side by dissection to expose the bone (lamina) underneath which lies over the spinal nerves. The landmarks are marked for insertion of the screws (Lateral mass screws). The correct position of screws is checked under X ray machine. The portion of bone is removed (laminectomy) along with the ligaments to enter into the spinal canal and expose the spinal cord and achieve decompression of the spinal cord. The screws are connected with rods and pieces of bone are inserted along the rods to achieve fusion and gain stability of the spine.
After Surgery
In the recovery room: Immediately after surgery the patient is shifted to recovery room, where the patient is monitored for some time. Medications are provided for pain to control post operative pain relief. Once the patient is comfortable the patient is shifted to ward. A hard cervical collar is given for support and reduce muscular spasm.
In the ward: The patient is allowed to have liquids 6 hours after the surgery. Once the pain has reduced and the patient is comfortable, patient is allowed to sit and walk on the same day or next day of the surgery. The patient is discharged 3-4 days after surgery.
After Discharge:
- It is necessary to stay active after surgery and patient can walk as per his comfort with in his home or nearby.
- The patient should follow healthy eating habits avoid weight gain and obese patient should try to reduce weight.
- The patient should refrain from smoking cigarettes, chewing tobacco and drinking alcohol as these can lead to recurrence of symptoms later.
- Patient should do exercise atleast for 45 mins to 1 hour daily to get good result after spine surgery and avoid future spine related problems.
- The hard cervical collar is worn for 3-4 weeks after which strengthening exercise is started for neck muscles.