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General information: Posterior cervical decompression is a standard procedure for
treatment of cervical radiculopathy (brachialgia) or cervical myelopthy.
Depending on the underlying pathology, the results of the surgery is variable.
Target and results: The results of surgery are generally good. 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.
Risk of complications:
- Infection is less than 2 percent. It may affect the superficial
tissues and skin, or may affect
deep spinal structures, diskitis or vertebral osteomyelitis which is very
rare. - Bleeding which may lead to hematoma collection that may need
further surgery. - Cerebrospinal fluid (CSF) leak, inadvertent breach of the
thecal sac may lead to leaking of the fluid surrounding the brain and the
spinal cord. Instant repairs is possible, however, it may need an extended
admission in the hospital or further procedures. There is also very small
risk of meningitis. - Neural tissue injury: the most serious complication may cause
life changing consequences in form of weakness or paralysis of arms, legs,
sphincters, sensory or sexual changes. The risk is very small, <1%. - Worsening of neck pain which is about 20%, most of the patient
will improve after 4 weeks after the surgery. However, chronic neck pain
is not uncommon. - Failure to improve symptoms.
- Spinal instability which may need further spinal
fixation/spinal fusion. - General anesthetic complications (heart attack, stroke)
- Deep venous thrombosis/pulmonary embolism (clots in legs /
lungs).
Procedure
Posterior cervical decompression (laminectomy, foraminotomy inter-segmental decompression) is a standard procedure that is carried out on routine base. The procedure is usually done under general anesthesia and lasts approximately 60-90 minutes, depending on the number of levels. The patient is positioned on his face (prone), with the head fixed with pins and Meyfield clamp. It involves making a small midline incision in the back of the neck, followed by dissection of the muscles on both sides to expose the lamina. X-rays guided confirmation of the correct level. Small bony window will created using high speed drill to the nerves in case of foraminotomy or removal of the whole lamina to decompress the spinal cord in case of myelopathy. Partial removal of the lamina with the inter-laminar ligaments (ligmentum Flavusm) is called inter-segmental decompression.
The wound is closed in layers with dissolvable stitches; skin is closed with clips which need to be removed in 10 days. After the operation, some of the patient will have a drain in the wound for 24 hours (this is removed on the ward before discharge). Most patients will go home the next day and will be recovering at home for approximately 4 weeks. Following surgery the patient may notice some neck pain and stiffness but this should settle with simple pain killers. Specialist spinal physiotherapists will advice each patient on a postoperative exercise regime, to encourage neck movements. Further outpatient physiotherapy sessions will be offered, where indicated. Patient is usually followed up in the clinic in 8-12 weeks after surgery. If any complication happens, the patient may need to stay until everything gets sorted. All regular medication will continue except the blood thinning medication like Warfarin, Apixoban, Aspirin, cloidogrel etc, needs advised individually. Most of the cases can started after 48h from the surgery.