Anesthesia
- Surgery is performed in general anesthesia, the patient will be fully asleep.
Patient position
- Patients are positioned in the prone (lying on the stomach) position, generally using a special operating table with special padding and supports.
Procedure
- A 5-centimeter longitudinal posterior midline incision is made. The level is confirmed with intraoperative fluoroscopy. Retractors are used and muscles are dissected subperiosteally to expose the targeted spinal level. In decompression alone surgery, the whole lamina (complete laminectomy) is removed along with the surrounding hypertrophied ligaments and osteophytes with or without discectomy to decompress the nerve root and dural sac adequately. For decompression and fusion surgery, pedicle screws are inserted into the targeted vertebra and join them using rods. The bone graft will be placed on the sides of the rods and between the affected vertebrae to join them. The wound area is usually washed out with sterile water containing antibiotics. The deep fascial layer is closed with strong non-absorbable sutures, while is closed with subcuticular self-absorbable sutures leaving a minimal scar.
The total surgery time is approximately 2 hours
Post-Operative Care
- After 1-2 hours of monitoring in the recovery room, patients are shifted to ward. Oral fluid intake started after 4 hours and gradually switched to a full diet. Most of the patients can stand and walk by the evening or the next morning with good pain tolerance and can be sent home accordingly in 1-2 days.
Home Care
- To follow proper techniques of getting in and out of bed and walking independently. The patient should walk and stay active as much as possible and can climb stairs if required. The patient should avoid excessive rotation and extension of neck activities and avoid lifting (more than 2-3 kg).
Brace
- Usually not required to wear a back brace after surgery, however, one can wear it if found comfortable and getting some support while standing and walking.
Wound Care and follow up
- Before leaving the hospital, a waterproof dressing is applied to the surgical wound, and the patient can take shower and will be called on the 5th post-op day for a dressing checkup and change of medication if needed.
Return to work
- The patient can resume light work or driving once the pain is tolerable, usually in a week to 10 days. While heavy work and sports activity should be avoided for at least 3 months after the surgery.
Complications
Posterior cervical surgery is generally considered a very safe procedure, however, like any other surgery, there are several risks and complications associated with are:
- Operative wound infection
- Hoarseness of voice and difficulty in swallowing
- Dural tear and CSF leakage
- Bleeding
- Implant related complication- loose screw, broken implant
- Adjacent segment disease
- Pseudoarthrosis or non-union
- Nerve root damage
- Bowel/bladder incontinence
- Deep vein thrombosis, which occurs when blood clots form in the leg
Result of surgery
- Posterior cervical surgery is a very safe surgery and successful in relieving arm pain and myelopathy symptoms in approximately 90-95% of patients.
